Re: A 'Family Health Assessment Tool'

[Guest guest]

Yes Woody, I saw that and I am sure will have some comments after our

recent experience of looking at how health needs assessment tools were used

inpractice. We are busy writing papers that we hope will soon be in print about

the results. Actually, I was pleased that Kate had been funded to develop her

project; I had heard about it a couple of

years ago when she first started on it. There are two good things about her

work. One is that she is trying to find a way to take account of coping skills

as well as the problems faced by families, which does make it more positive than

some of the more stigmatising versions. The other is that she is genuinely

trying to go through a rigorous research

procedure to try and validate it, so it is not just based (as so many are) on a

brainstorm of issues that health visitors think are important.

I do have grave doubts, even so, about whether it is really ever going to be

possible (I am not sure that I would like it even if it was!) to get this kind

of 'holy grail' of a general health needs assessment tool. As Jane

pointed out in her systematic review, these kinds of 'risk screening' activities

have been around in social services for

about 30-40 years and none have managed to get anywhere near achieving their

intentions, because the theory base is fundamentally flawed. People all have

all sorts of worries, problems and coping skills most of the time, but

identifying a screening tool to identify when that turns into a need for

professional help is a very tall order! I worry about

giving lists of questions to health visitors to use with clients, too, just

because they are liable to be used as survey tools that distract from focusing

on what the client is trying to say. Is this a 'qualitative/quantitative'

issue, perhaps? I would be interested in hearing views from people with a more

structured approach to research than mine.

I wish, instead, that more attention could be paid to the kind of research that

Hilton Davies has done about 'listening' instead of questioning. I hear

(perhaps knows a reference, now she is working with him) that his

recent research has shown that practitioners who are able to really tune in to

what their clients are telling them are very

successful at identifying needs. Oh dear, did we need a research study to show

us that? Best wishes

woody@... wrote:

> The latest issue of the Newsletter of the Foundation of Nursing Studies

(Summer 2001) contains a report by Kate in Winchester on a health

visiting Family Health Assessment Tool (FHAT). This seems only to have been

used on a small scale- Senate members may have views on the wider applicability

of such tools and their usefulness in practice....

>

> Woody

> UCL.

>

>

[Guest guest]

Dear and Woody,

As a simple practitioner I now find I am so busy filling in child surveillance

check lists, safety check lists, Edinburgh Post Natal Depression check lists

etc. that I don't have time to eyeball the patient and really listen. We may be

able to be evaluated by these tools but I feel severely handicapped as a

practitioner by using them.

Regards,

Ruth Grant

Cowley wrote:

> Yes Woody, I saw that and I am sure will have some comments after our

recent experience of looking at how health needs assessment tools were used

inpractice. We are busy writing papers that we hope will soon be in print about

the results. Actually, I was pleased that Kate had been funded to develop her

project; I had heard about it a couple of

> years ago when she first started on it. There are two good things about her

work. One is that she is trying to find a way to take account of coping skills

as well as the problems faced by families, which does make it more positive than

some of the more stigmatising versions. The other is that she is genuinely

trying to go through a rigorous research

> procedure to try and validate it, so it is not just based (as so many are) on

a brainstorm of issues that health visitors think are important.

>

> I do have grave doubts, even so, about whether it is really ever going to be

possible (I am not sure that I would like it even if it was!) to get this kind

of 'holy grail' of a general health needs assessment tool. As Jane

pointed out in her systematic review, these kinds of 'risk screening' activities

have been around in social services for

> about 30-40 years and none have managed to get anywhere near achieving their

intentions, because the theory base is fundamentally flawed. People all have

all sorts of worries, problems and coping skills most of the time, but

identifying a screening tool to identify when that turns into a need for

professional help is a very tall order! I worry about

> giving lists of questions to health visitors to use with clients, too, just

because they are liable to be used as survey tools that distract from focusing

on what the client is trying to say. Is this a 'qualitative/quantitative'

issue, perhaps? I would be interested in hearing views from people with a more

structured approach to research than mine.

>

> I wish, instead, that more attention could be paid to the kind of research

that Hilton Davies has done about 'listening' instead of questioning. I hear

(perhaps knows a reference, now she is working with him) that his

recent research has shown that practitioners who are able to really tune in to

what their clients are telling them are very

> successful at identifying needs. Oh dear, did we need a research study to

show us that? Best wishes

>

>

>

> woody@... wrote:

>

> > The latest issue of the Newsletter of the Foundation of Nursing Studies

(Summer 2001) contains a report by Kate in Winchester on a health

visiting Family Health Assessment Tool (FHAT). This seems only to have been

used on a small scale- Senate members may have views on the wider applicability

of such tools and their usefulness in practice....

> >

> > Woody

> > UCL.

> >

> >

[Guest guest]

Ruth I have given this a bit of thought here is the result:-

To all colleagues on the topic of needs assessment:

It seems to be a buzz word left over from the previous Conservative

government and grasped with both hands in 1997 when Labour came in a long

with the other great word –‘targeting’

I have been interested in needs assessment since reading ’s work in

1991. At that time there was a drive, when I was in practice, to target and

assess needs in a structured way and define what health visiting was about.

Believe me, in practice, we tried lots of different types of ‘checklists’ To

cut a long story short being ‘difficult’ about the implementation I was

given permission to develop a process that management and health visitors

could both be happy with. Something like if you don’t like the needs

assessment tool then you develop something better - so I did! (it is now

written up and under review) but there were a number of elements in the

process that were important not least of these was the presence of a

supportive, flexible management.

That is a little of the background to the story of the recent one year study

completed in March, addressing the process of assessing needs in health

visiting practice using a tool that had already been developed by health

visitors and managers.

I interviewed managers’ health visitors and clients. I also observed visits

where the tool was used and where it wasn’t used. I talked to clients who

liked the tool and clients who didn’t I talked to health visitors who liked

the tool and health visitors who didn’t and I talked to clients and health

visitors who were what we called neutral.

We are ( and I) in the process of writing up the papers for publication

from the study. This was a fascinating and sometimes painful piece of

research. In my mind I likened it to practitioners pulling their own

separate wagons, worse than that the wagons were all tangled up and they

were all pulling really hard in different directions, with management on the

periphery saying ‘come on pull’. This was so different from my own

experience of developing an awareness of the process of needs assessment.

Here is a flavour of some of the issues that have come out of the study

addressing expressly one particular closed style of needs assessment:

HEALTH VISITORS

· Found, the particular, checklist for needs assessment difficult to use or

integrate into the visit. Whatever they did the piece of paper inevitably

became some sort of barrier to the process of health visiting. Listening in

the frame of an open questions system was lost.

· some health visitors liked the checklist framework because it helped them

to ask and explore areas that they had never developed before in their

practice.

· some health visitors felt uncomfortable raising issues that they had no

power to do anything about like questions of finance or housing.

· All health visitors agreed that the process of assessing need was

positive.

MANAGERS

· became frustrated with health visitors inability to just get on with it.

In fact some health visitors did (after a fashion) and some refused. Not

good for team building!

CLIENTS

· often felt bewildered by the process, were they being judged, what was the

health visitor going to do with the information, why did she not show what

she was writing?

· the process raised anxieties and clients said they felt upset, angry or

annoyed by the use of the tool.

· Some clients did not mind, commonly those clients had no problems

· Some clients did mind, those clients had problems and the tool made their

problems more difficult to address because they became angry with the health

visitor for asking ‘judgemental questions’

· The relationship with the health visitor was an important part of the

assessment process.

· Clients became most annoyed over being asked about things that resulted in

no action e.g the health visitor asking about housing issues and then

stating that she could do nothing about it. The clients said repeatedly -

why ask and raise false hopes!

Overall the use of the tool upset the clients, affected the dynamics of the

visit in a negative way, and robbed the health visitor of an element of

autonomy and professional judgement of when the practitoner thought it was

an appropriate time to raise issues and to decide how many visits would be

required. The saddest thing is that it seemed to stop the health visitors

from listening.

Hope this is of some help to colleagues in the throes of this difficult

issue – writing as fast as I can with to get the issues here and many

others out to the wider profession.

Houston

>From: ruthngrant <ruthngrant@...>

>Reply-

>

>Subject: Re: A 'Family Health Assessment Tool'

>Date: Fri, 25 May 2001 21:55:27 +0100

>

>Dear and Woody,

>

>As a simple practitioner I now find I am so busy filling in child

>surveillance check lists, safety check lists, Edinburgh Post Natal

>Depression check lists etc. that I don't have time to eyeball the patient

>and really listen. We may be able to be evaluated by these tools but I

>feel severely handicapped as a practitioner by using them.

>

>Regards,

>

>Ruth Grant

>

> Cowley wrote:

>

> > Yes Woody, I saw that and I am sure will have some comments after

>our recent experience of looking at how health needs assessment tools were

>used inpractice. We are busy writing papers that we hope will soon be in

>print about the results. Actually, I was pleased that Kate had been funded

>to develop her project; I had heard about it a couple of

> > years ago when she first started on it. There are two good things about

>her work. One is that she is trying to find a way to take account of

>coping skills as well as the problems faced by families, which does make it

>more positive than some of the more stigmatising versions. The other is

>that she is genuinely trying to go through a rigorous research

> > procedure to try and validate it, so it is not just based (as so many

>are) on a brainstorm of issues that health visitors think are important.

> >

> > I do have grave doubts, even so, about whether it is really ever going

>to be possible (I am not sure that I would like it even if it was!) to get

>this kind of 'holy grail' of a general health needs assessment tool. As

>Jane pointed out in her systematic review, these kinds of 'risk

>screening' activities have been around in social services for

> > about 30-40 years and none have managed to get anywhere near achieving

>their intentions, because the theory base is fundamentally flawed. People

>all have all sorts of worries, problems and coping skills most of the time,

>but identifying a screening tool to identify when that turns into a need

>for professional help is a very tall order! I worry about

> > giving lists of questions to health visitors to use with clients, too,

>just because they are liable to be used as survey tools that distract from

>focusing on what the client is trying to say. Is this a

>'qualitative/quantitative' issue, perhaps? I would be interested in

>hearing views from people with a more structured approach to research than

>mine.

> >

> > I wish, instead, that more attention could be paid to the kind of

>research that Hilton Davies has done about 'listening' instead of

>questioning. I hear (perhaps knows a reference, now she is

>working with him) that his recent research has shown that practitioners who

>are able to really tune in to what their clients are telling them are very

> > successful at identifying needs. Oh dear, did we need a research study

>to show us that? Best wishes

> >

> >

> >

> > woody@... wrote:

> >

> > > The latest issue of the Newsletter of the Foundation of Nursing

>Studies (Summer 2001) contains a report by Kate in Winchester on a

>health visiting Family Health Assessment Tool (FHAT). This seems only to

>have been used on a small scale- Senate members may have views on the wider

>applicability of such tools and their usefulness in practice....

> > >

> > > Woody

> > > UCL.

> > >

> > >

[Guest guest]

Dear ,

Yippee! A plus for our long suffering clients. In my opinion with close

attention and

empathy clients reveal their pain at their own pace and when they feel safe. A

tool

to prise senstive information out of them all in one go is so clumsy and crude.

Do

you think you will be able to get a piece of 'negative result' research

published -

especially a qualitative study?

Thank you for your patience and thoroughness in answering my question.

Regards,

Ruth Grant

Houston wrote:

> Ruth I have given this a bit of thought here is the result:-

> To all colleagues on the topic of needs assessment:

> It seems to be a buzz word left over from the previous Conservative

> government and grasped with both hands in 1997 when Labour came in a long

> with the other great word –‘targeting’

> I have been interested in needs assessment since reading ’s work in

> 1991. At that time there was a drive, when I was in practice, to target and

> assess needs in a structured way and define what health visiting was about.

> Believe me, in practice, we tried lots of different types of ‘checklists’ To

> cut a long story short being ‘difficult’ about the implementation I was

> given permission to develop a process that management and health visitors

> could both be happy with. Something like if you don’t like the needs

> assessment tool then you develop something better - so I did! (it is now

> written up and under review) but there were a number of elements in the

> process that were important not least of these was the presence of a

> supportive, flexible management.

> That is a little of the background to the story of the recent one year study

> completed in March, addressing the process of assessing needs in health

> visiting practice using a tool that had already been developed by health

> visitors and managers.

> I interviewed managers’ health visitors and clients. I also observed visits

> where the tool was used and where it wasn’t used. I talked to clients who

> liked the tool and clients who didn’t I talked to health visitors who liked

> the tool and health visitors who didn’t and I talked to clients and health

> visitors who were what we called neutral.

> We are ( and I) in the process of writing up the papers for publication

> from the study. This was a fascinating and sometimes painful piece of

> research. In my mind I likened it to practitioners pulling their own

> separate wagons, worse than that the wagons were all tangled up and they

> were all pulling really hard in different directions, with management on the

> periphery saying ‘come on pull’. This was so different from my own

> experience of developing an awareness of the process of needs assessment.

> Here is a flavour of some of the issues that have come out of the study

> addressing expressly one particular closed style of needs assessment:

> HEALTH VISITORS

> · Found, the particular, checklist for needs assessment difficult to use

or

> integrate into the visit. Whatever they did the piece of paper inevitably

> became some sort of barrier to the process of health visiting. Listening in

> the frame of an open questions system was lost.

> · some health visitors liked the checklist framework because it helped

them

> to ask and explore areas that they had never developed before in their

> practice.

> · some health visitors felt uncomfortable raising issues that they had

no

> power to do anything about like questions of finance or housing.

> · All health visitors agreed that the process of assessing need was

> positive.

> MANAGERS

> · became frustrated with health visitors inability to just get on with

it.

> In fact some health visitors did (after a fashion) and some refused. Not

> good for team building!

> CLIENTS

> · often felt bewildered by the process, were they being judged, what was

the

> health visitor going to do with the information, why did she not show what

> she was writing?

> · the process raised anxieties and clients said they felt upset, angry

or

> annoyed by the use of the tool.

> · Some clients did not mind, commonly those clients had no problems

> · Some clients did mind, those clients had problems and the tool made

their

> problems more difficult to address because they became angry with the health

> visitor for asking ‘judgemental questions’

> · The relationship with the health visitor was an important part of the

> assessment process.

> · Clients became most annoyed over being asked about things that

resulted in

> no action e.g the health visitor asking about housing issues and then

> stating that she could do nothing about it. The clients said repeatedly -

> why ask and raise false hopes!

> Overall the use of the tool upset the clients, affected the dynamics of the

> visit in a negative way, and robbed the health visitor of an element of

> autonomy and professional judgement of when the practitoner thought it was

> an appropriate time to raise issues and to decide how many visits would be

> required. The saddest thing is that it seemed to stop the health visitors

> from listening.

>

> Hope this is of some help to colleagues in the throes of this difficult

> issue – writing as fast as I can with to get the issues here and many

> others out to the wider profession.

>

> Houston

>

> >From: ruthngrant <ruthngrant@...>

> >Reply-

> >

> >Subject: Re: A 'Family Health Assessment Tool'

> >Date: Fri, 25 May 2001 21:55:27 +0100

> >

> >Dear and Woody,

> >

> >As a simple practitioner I now find I am so busy filling in child

> >surveillance check lists, safety check lists, Edinburgh Post Natal

> >Depression check lists etc. that I don't have time to eyeball the patient

> >and really listen. We may be able to be evaluated by these tools but I

> >feel severely handicapped as a practitioner by using them.

> >

> >Regards,

> >

> >Ruth Grant

> >

> > Cowley wrote:

> >

> > > Yes Woody, I saw that and I am sure will have some comments after

> >our recent experience of looking at how health needs assessment tools were

> >used inpractice. We are busy writing papers that we hope will soon be in

> >print about the results. Actually, I was pleased that Kate had been funded

> >to develop her project; I had heard about it a couple of

> > > years ago when she first started on it. There are two good things about

> >her work. One is that she is trying to find a way to take account of

> >coping skills as well as the problems faced by families, which does make it

> >more positive than some of the more stigmatising versions. The other is

> >that she is genuinely trying to go through a rigorous research

> > > procedure to try and validate it, so it is not just based (as so many

> >are) on a brainstorm of issues that health visitors think are important.

> > >

> > > I do have grave doubts, even so, about whether it is really ever going

> >to be possible (I am not sure that I would like it even if it was!) to get

> >this kind of 'holy grail' of a general health needs assessment tool. As

> >Jane pointed out in her systematic review, these kinds of 'risk

> >screening' activities have been around in social services for

> > > about 30-40 years and none have managed to get anywhere near achieving

> >their intentions, because the theory base is fundamentally flawed. People

> >all have all sorts of worries, problems and coping skills most of the time,

> >but identifying a screening tool to identify when that turns into a need

> >for professional help is a very tall order! I worry about

> > > giving lists of questions to health visitors to use with clients, too,

> >just because they are liable to be used as survey tools that distract from

> >focusing on what the client is trying to say. Is this a

> >'qualitative/quantitative' issue, perhaps? I would be interested in

> >hearing views from people with a more structured approach to research than

> >mine.

> > >

> > > I wish, instead, that more attention could be paid to the kind of

> >research that Hilton Davies has done about 'listening' instead of

> >questioning. I hear (perhaps knows a reference, now she is

> >working with him) that his recent research has shown that practitioners who

> >are able to really tune in to what their clients are telling them are very

> > > successful at identifying needs. Oh dear, did we need a research study

> >to show us that? Best wishes

> > >

> > >

> > >

> > > woody@... wrote:

> > >

> > > > The latest issue of the Newsletter of the Foundation of Nursing

> >Studies (Summer 2001) contains a report by Kate in Winchester on a

> >health visiting Family Health Assessment Tool (FHAT). This seems only to

> >have been used on a small scale- Senate members may have views on the wider

> >applicability of such tools and their usefulness in practice....

> > > >

> > > > Woody

> > > > UCL.

> > > >

> > > >

[Guest guest]

Dear ,

No reference for this work yet as it is part of the findings of the European

Early Intervention Project which has been running for two years in ham.

might know about it.

The Project in London comes to an end in October when the research findings

will be published. Meanwhile look out for an article in the Community

Practitioner Journal by Rosemary (et al, the health visitors who

took part in the project) the project co-coordinator in London. It has

recently been submitted for publication. In a RCT initial findings show

that trained health visitors were better at identifying families at risk of

psychosocial problems.

A checklist was used to act as an aide memoir, both the health visitors that

had been trained to use it and those who had not used this checklist.

However those who had been trained in using the tool were more able to

identify families in need than those who had not. Needless to say the

health visitors that have been trained to establish a trusting relationship

with the client and are using the skills of listening and asking open

questions, exploring and clarifying, summarising,and helping clients

identify their own goals. They also received fortnightly clinical

supervision from a clinical psychologist following their training in order

to build on their skills. I suspect that I shouldn't say any more about it

just now as I don't want to steal their thunder.

It is interesting to note though that in Finland all the health visitors

will be systematically trained in this way of working.

Re: A 'Family Health Assessment Tool'

> Yes Woody, I saw that and I am sure will have some comments after our

recent experience of looking at how health needs assessment tools were used

inpractice. We are busy writing papers that we hope will soon be in print

about the results. Actually, I was pleased that Kate had been funded to

develop her project; I had heard about it a couple of

> years ago when she first started on it. There are two good things about

her work. One is that she is trying to find a way to take account of coping

skills as well as the problems faced by families, which does make it more

positive than some of the more stigmatising versions. The other is that she

is genuinely trying to go through a rigorous research

> procedure to try and validate it, so it is not just based (as so many are)

on a brainstorm of issues that health visitors think are important.

>

> I do have grave doubts, even so, about whether it is really ever going to

be possible (I am not sure that I would like it even if it was!) to get this

kind of 'holy grail' of a general health needs assessment tool. As Jane

pointed out in her systematic review, these kinds of 'risk

screening' activities have been around in social services for

> about 30-40 years and none have managed to get anywhere near achieving

their intentions, because the theory base is fundamentally flawed. People

all have all sorts of worries, problems and coping skills most of the time,

but identifying a screening tool to identify when that turns into a need for

professional help is a very tall order! I worry about

> giving lists of questions to health visitors to use with clients, too,

just because they are liable to be used as survey tools that distract from

focusing on what the client is trying to say. Is this a

'qualitative/quantitative' issue, perhaps? I would be interested in hearing

views from people with a more structured approach to research than mine.

>

> I wish, instead, that more attention could be paid to the kind of research

that Hilton Davies has done about 'listening' instead of questioning. I

hear (perhaps knows a reference, now she is working with him) that

his recent research has shown that practitioners who are able to really tune

in to what their clients are telling them are very

> successful at identifying needs. Oh dear, did we need a research study to

show us that? Best wishes

>

>

>

>

> woody@... wrote:

>

> > The latest issue of the Newsletter of the Foundation of Nursing Studies

(Summer 2001) contains a report by Kate in Winchester on a health

visiting Family Health Assessment Tool (FHAT). This seems only to have been

used on a small scale- Senate members may have views on the wider

applicability of such tools and their usefulness in practice....

> >

> > Woody

> > UCL.

> >

> >

[Guest guest]

From :Nina Heaps

I would like to empathise with Ruths plight as a practitioner ,I have recently started in post as a h.v. lead practitoner in Norfolk and I do have concerns that the clients needs are not being listened to as I look at the check lists that are now in place .Whos needs are we addressing ?What do the clients think of this approach ? I would be interested to hear from other health visitors.

>From: ruthngrant

>Reply- > >Subject: Re: A 'Family Health Assessment Tool' >Date: Fri, 25 May 2001 21:55:27 +0100 > >Dear and Woody, > >As a simple practitioner I now find I am so busy filling in child surveillance check lists, safety check lists, Edinburgh Post Natal Depression check lists etc. that I don't have time to eyeball the patient and really listen. We may be able to be evaluated by these tools but I feel severely handicapped as a practitioner by using them. > >Regards, > >Ruth Grant > > Cowley wrote: > > > Yes Woody, I saw that and I am sure will have some comments after our recent experience of looking at how health needs assessment tools were used inpractice. We are busy writing papers that we hope will soon be in print about the results. Actually, I was pleased that Kate had been funded to develop her project; I had heard about it a couple of > > years ago when she first started on it. There are two good things about her work. One is that she is trying to find a way to take account of coping skills as well as the problems faced by families, which does make it more positive than some of the more stigmatising versions. The other is that she is genuinely trying to go through a rigorous research > > procedure to try and validate it, so it is not just based (as so many are) on a brainstorm of issues that health visitors think are important. > > > > I do have grave doubts, even so, about whether it is really ever going to be possible (I am not sure that I would like it even if it was!) to get this kind of 'holy grail' of a general health needs assessment tool. As Jane pointed out in her systematic review, these kinds of 'risk screening' activities have been around in social services for > > about 30-40 years and none have managed to get anywhere near achieving their intentions, because the theory base is fundamentally flawed. People all have all sorts of worries, problems and coping skills most of the time, but identifying a screening tool to identify when that turns into a need for professional help is a very tall order! I worry about > > giving lists of questions to health visitors to use with clients, too, just because they are liable to be used as survey tools that distract from focusing on what the client is trying to say. Is this a 'qualitative/quantitative' issue, perhaps? I would be interested in hearing views from people with a more structured approach to research than mine. > > > > I wish, instead, that more attention could be paid to the kind of research that Hilton Davies has done about 'listening' instead of questioning. I hear (perhaps knows a reference, now she is working with him) that his recent research has shown that practitioners who are able to really tune in to what their clients are telling them are very > > successful at identifying needs. Oh dear, did we need a research study to show us that? Best wishes > > > > > > > > woody@... wrote: > > > > > The latest issue of the Newsletter of the Foundation of Nursing Studies (Summer 2001) contains a report by Kate in Winchester on a health visiting Family Health Assessment Tool (FHAT). This seems only to have been used on a small scale- Senate members may have views on the wider applicability of such tools and their usefulness in practice.... > > > > > > Woody > > > UCL. > > > > > >

[Guest guest]

Having had some involvement with the SOlihull Approach, one of the 3 elements of

it is 'containment', ie active listening. Certainly listening to the feedback

from the the HV's who have been using it for several months they find that there

are

frequent occasions that this is almost all that is needed.

Yet another intervention/model - how many are there being used??????

Toity

On Fri, 25 May 2001

21:55:27 +0100 ruthngrant <ruthngrant@...> wrote:

> Dear and Woody,

>

> As a simple practitioner I now find I am so busy filling in child surveillance

> check lists, safety check lists, Edinburgh Post Natal Depression check lists

etc.

> that I don't have time to eyeball the patient and really listen. We may be

able to

> be evaluated by these tools but I feel severely handicapped as a practitioner

by

> using them.

>

> Regards,

>

> Ruth Grant

>

> Cowley wrote:

>

> > Yes Woody, I saw that and I am sure will have some comments after our

recent

> experience of looking at how health needs assessment tools were used

inpractice.

> We are busy writing papers that we hope will soon be in print about the

results.

> Actually, I was pleased that Kate had been funded to develop her project; I

had

> heard about it a couple of

> > years ago when she first started on it. There are two good things about her

> work. One is that she is trying to find a way to take account of coping

skills as

> well as the problems faced by families, which does make it more positive than

some

> of the more stigmatising versions. The other is that she is genuinely trying

to go

> through a rigorous research

> > procedure to try and validate it, so it is not just based (as so many are)

on a

> brainstorm of issues that health visitors think are important.

> >

> > I do have grave doubts, even so, about whether it is really ever going to be

> possible (I am not sure that I would like it even if it was!) to get this kind

of

> 'holy grail' of a general health needs assessment tool. As Jane

pointed

> out in her systematic review, these kinds of 'risk screening' activities have

been

> around in social services for

> > about 30-40 years and none have managed to get anywhere near achieving their

> intentions, because the theory base is fundamentally flawed. People all have

all

> sorts of worries, problems and coping skills most of the time, but identifying

a

> screening tool to identify when that turns into a need for professional help

is a

> very tall order! I worry about

> > giving lists of questions to health visitors to use with clients, too, just

> because they are liable to be used as survey tools that distract from focusing

on

> what the client is trying to say. Is this a 'qualitative/quantitative' issue,

> perhaps? I would be interested in hearing views from people with a more

structured

> approach to research than mine.

> >

> > I wish, instead, that more attention could be paid to the kind of research

that

> Hilton Davies has done about 'listening' instead of questioning. I hear

(perhaps

> knows a reference, now she is working with him) that his recent

research

> has shown that practitioners who are able to really tune in to what their

clients

> are telling them are very

> > successful at identifying needs. Oh dear, did we need a research study to

show

> us that? Best wishes

> >

> >

> >

> > woody@... wrote:

> >

> > > The latest issue of the Newsletter of the Foundation of Nursing Studies

(Summer

> 2001) contains a report by Kate in Winchester on a health visiting

Family

> Health Assessment Tool (FHAT). This seems only to have been used on a small

scale-

> Senate members may have views on the wider applicability of such tools and

their

> usefulness in practice....

> > >

> > > Woody

> > > UCL.

> > >

> > >

[Guest guest]

Dear Toity,

I agree with both yourself and Solihull - which is currently used in part of our

area and

may well be extended shortly. I counsell distressed teenagers for the practice

and find

that most often all that is needed is really good listening and reassurance plus

an ever

open door policy.

Regards,

Ruth Grant

Toity Deave wrote:

> Having had some involvement with the SOlihull Approach, one of the 3 elements

of

> it is 'containment', ie active listening. Certainly listening to the feedback

> from the the HV's who have been using it for several months they find that

there are

> frequent occasions that this is almost all that is needed.

>

> Yet another intervention/model - how many are there being used??????

>

> Toity

>

> On Fri, 25 May 2001

> 21:55:27 +0100 ruthngrant <ruthngrant@...> wrote:

>

> > Dear and Woody,

> >

> > As a simple practitioner I now find I am so busy filling in child

surveillance

> > check lists, safety check lists, Edinburgh Post Natal Depression check lists

etc.

> > that I don't have time to eyeball the patient and really listen. We may be

able to

> > be evaluated by these tools but I feel severely handicapped as a

practitioner by

> > using them.

> >

> > Regards,

> >

> > Ruth Grant

> >

> > Cowley wrote:

> >

> > > Yes Woody, I saw that and I am sure will have some comments after our

recent

> > experience of looking at how health needs assessment tools were used

inpractice.

> > We are busy writing papers that we hope will soon be in print about the

results.

> > Actually, I was pleased that Kate had been funded to develop her project; I

had

> > heard about it a couple of

> > > years ago when she first started on it. There are two good things about

her

> > work. One is that she is trying to find a way to take account of coping

skills as

> > well as the problems faced by families, which does make it more positive

than some

> > of the more stigmatising versions. The other is that she is genuinely

trying to go

> > through a rigorous research

> > > procedure to try and validate it, so it is not just based (as so many are)

on a

> > brainstorm of issues that health visitors think are important.

> > >

> > > I do have grave doubts, even so, about whether it is really ever going to

be

> > possible (I am not sure that I would like it even if it was!) to get this

kind of

> > 'holy grail' of a general health needs assessment tool. As Jane

pointed

> > out in her systematic review, these kinds of 'risk screening' activities

have been

> > around in social services for

> > > about 30-40 years and none have managed to get anywhere near achieving

their

> > intentions, because the theory base is fundamentally flawed. People all

have all

> > sorts of worries, problems and coping skills most of the time, but

identifying a

> > screening tool to identify when that turns into a need for professional help

is a

> > very tall order! I worry about

> > > giving lists of questions to health visitors to use with clients, too,

just

> > because they are liable to be used as survey tools that distract from

focusing on

> > what the client is trying to say. Is this a 'qualitative/quantitative'

issue,

> > perhaps? I would be interested in hearing views from people with a more

structured

> > approach to research than mine.

> > >

> > > I wish, instead, that more attention could be paid to the kind of research

that

> > Hilton Davies has done about 'listening' instead of questioning. I hear

(perhaps

> > knows a reference, now she is working with him) that his recent

research

> > has shown that practitioners who are able to really tune in to what their

clients

> > are telling them are very

> > > successful at identifying needs. Oh dear, did we need a research study to

show

> > us that? Best wishes

> > >

> > >

> > >

> > > woody@... wrote:

> > >

> > > > The latest issue of the Newsletter of the Foundation of Nursing Studies

(Summer

> > 2001) contains a report by Kate in Winchester on a health visiting

Family

> > Health Assessment Tool (FHAT). This seems only to have been used on a small

scale-

> > Senate members may have views on the wider applicability of such tools and

their

> > usefulness in practice....

> > > >

> > > > Woody

> > > > UCL.

> > > >

> > > >