Assess co-existing needs

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Learner guideCHCCCS004Assess co-existing needsRelease 2CHCCCS004Assess co-existingneedsRelease 2Learner guideAspire version 1.4Copyright WarningThis product is copyrighted toAspire Training & Consulting(ABN 51 054 306 428).Aspire Training & Consulting ownsall copyright to its products. Exceptas permitted by the Copyright Act1968 (Cth) or unless you haveobtained the specific writtenpermission of Aspire Training &Consulting, you must not:• reproduce or photocopy thisproduct in whole or in part• publish this product in whole orin part• cause this product in whole or inpart to be transmitted• store this product in whole orin part in a retrieval systemincluding a computer• record this product in whole orin part either electronically ormechanically• resell this product in whole orin part.Aspire Training & Consulting:• invests significant time andresources in creating its originalproducts• protects its copyright material• will enforce its rights in copyrightmaterial• reserves its legal rights toclaim its loss and damage oran account of profits maderesulting from infringements ofits copyright.Version control and modification history
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Release 2, version 1.1
April 2017
First release
Release 2, version 1.2
November 2017
Minor corrections as part of ourcontinuous improvement program
Release 2, version 1.3
December 2018
Minor corrections as part of ourcontinuous improvement program
Release 2, version 1.4
July 2019
Updated to reflect the new AgedCare Quality Standards
Aspire is committed to developing quality resources that meet the needs of ourcustomers. However, occasionally Aspire finds, or is notified of, errors. Pleaserefer to our website at www.aspirelr.com.au to see if there are any updates thatmay be relevant to you.Every effort has been made to ensure the information in this book is accurate;however, the author and publisher accept no responsibility for any loss, damageor injury arising from such information.Except where an information source is acknowledged, the names and detailsof individuals and organisations used in examples are fictitious and havebeen devised for learning purposes only. Any similarity to actual people ororganisations is unintentional.All websites referred to in this unit were accessed and deemed appropriate attime of publication.Aspire Training & Consulting apologises unreservedly for any copyrightinfringement that may have occurred and invites copyright owners to contactAspire so any violation may be rectified.CHCCCS004 Assess co-existing needs, Release 2© 2017 Aspire Training & ConsultingLevel 1, 464 St Kilda RoadMELBOURNE VIC 3004 AUSTRALIAPhone (03) 9820 1300First published April 2017Reprinted (with amendments) November 2017Reprinted (with amendments) December 2018Reprinted (with amendments) July 2019Cover design Rewind CreativePrinter Doculink Australia Pty Ltd, 1d/28 Rogers Street,Port Melbourne VIC 3207e-ISBN 978-1-76059-772-6 (PDF version)ISBN 978-1-76059-770-2Contact detailsParticipantName:Start date:Phone number:Email:Work locationName:Address:Postal address:Workplace supervisor name:Phone number:Fax:Email:Registered Training Organisation (RTO)Name:Address:Postal address (if different):Phone number:Fax:RTO contact name:Mobile:Email:
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING vContentsBefore you begin viiTopic 1 Prepare for assessment 11A Identify and prepare assessment tools and processes 21B Gather existing information about the person 161C Seek additional information from specialists and other sources 221D Organise practical aspects of assessment in consultation 291E Provide information about the assessment process and obtain consent 36Summary 40Learning checkpoint 1: Prepare for assessment 41Topic 2 Analyse the person’s needs 472A Work within scope of own role 482B Empower the person to identify and prioritise their own needs 532C Evaluate needs 612D Identify and analyse complex, multiple and interrelated issues 662E Evaluate issues of urgency and eligibility 822F Assess potential risk factors for service delivery 89Summary 95Learning checkpoint 2: Analyse the person’s needs 96Topic 3 Determine appropriate services 1033A Consider service delivery and referral options 1043B Evaluate internal capability and other service networks 1113C Provide the person with service information 1183D Encourage the person to advocate on their own behalf 125Summary 129Learning checkpoint 3: Determine appropriate services 130Topic 4 Complete reporting 1354A Document outcomes of the assessment 1364B Maintain and store the person’s information 1484C Provide the person’s information to other services 153Summary 159Learning checkpoint 4: Complete reporting 160Topic 5 Evaluate assessment and referral processes 1655A Seek feedback about assessment processes 1665B Monitor processes and their outcomes 1715C Routinely seek feedback 1755D Use feedback to improve processes 178Summary 183Learning checkpoint 5: Evaluate assessment and referral processes 184
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING viiBefore you BeginBefore you beginThis learner guide is based on the unit of competency CHCCCS004 Assess co-existingneeds, Release 2. Your trainer or training organisation must give you information aboutthis unit of competency as part of your training program. You can access the unit ofcompetency and assessment requirements at: www.training.gov.au.How to work through this learner guideThis learner guide contains a number of features that will assist you in your learning.Your trainer will advise which parts of the learner guide you need to read, and whichpractice tasks and learning checkpoints you need to complete. The features of thislearner guide are detailed in the following table.
feature of thelearner guide
How you can use each feature
Learning content
XX Read each topic in this learner guide. If you come acrosscontent that is confusing, make a note and discuss it with yourtrainer. Your trainer is in the best position to offer assistance. Itis very important that you take on some of the responsibility forthe learning you will undertake.
Examples and casestudies
XX Examples of completed documents that may be used in aworkplace are included in this learner guide. You can use theseexamples as models to help you complete practice tasks andlearning checkpoints.XX Case studies highlight learning points and provide realisticexamples of workplace situations.
Practice tasks
XX Practice tasks give you the opportunity to put your skills andknowledge into action. Your trainer will tell you which practicetasks to complete.
Video clips
XX Where QR codes appear, learners can usesmartphones and other devices to accessvideo clips relating to the content. Forinformation about how to download a QRreader app or accessing video on your device,please visit our website: www.aspirelr.com.au/help
Summary
XX Key learning points are provided at the end of each topic.
Learning checkpoints
XX There is a learning checkpoint at the end of each topic. Yourtrainer will tell you which learning checkpoints to complete.These checkpoints give you an opportunity to check yourprogress and apply the skills and knowledge you have learnt.
viii UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSFoundation skillsAs you complete learning using this guide, you will be developing the foundation skillsrelevant for this unit. Foundation skills are the language, literacy and numeracy (LLN)skills and the employability skills required for participation in modern workplaces andcontemporary life.The following table outlines specific foundation skills noted for your learning in thislearner guide.
foundationskill area
foundation skill description
Learning
XX Understanding your job role, organisational procedures and legalresponsibilitiesXX Managing your work and seeing how well you are going andmaking goals for yourself at workXX Seeking professional development opportunities for continuousimprovement
Reading
XX Understanding how documents are presented and being able tonavigate through documentsXX Understanding industry- and job-specific terminologyXX Interpreting key information in relevant documentsXX Understanding routine workplace checklists and documentation
Writing
XX Planning, drafting and writing reports and documentsXX Communicating through written letters, email and onlineXX Recording progress; reporting incidents
Oralcommunication
XX Clarifying instructionsXX Providing informationXX Supporting others through encouragement, negotiation andconflict resolutionXX Using body language to model desired behaviour and respondingto others’ body language
Numeracy
XX Calculating costs, weights, measurements of height and distanceXX Interpreting measurements
Teamwork
XX Working well with other people by cooperating, collaborating,encouraging and building rapport
Planning andorganising
XX Planning your workload and commitmentsXX Implementing tasksXX Completing work on timeXX Knowing how to deal with hazards and risks
Making decisions
XX Understanding and applying decision-making processesXX Reviewing the impact of your decisions
Problem-solving
XX Identifying problemsXX Working out how to fix a problem using problem-solving processesand reviewing the outcome
Innovation andcreation
XX Recognising opportunities to develop and apply new ideasXX Generating ideas by thinking of new ways to do somethingXX Making suggestions to improve work
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING ixBefore you Begin
foundationskill area
foundation skill description
Technology anddigital literacy
XX Efficiently using digitally based technologies and systems correctlyand safelyXX Accessing, organising and presenting informationXX Using equipment correctly and safely
What do you already know?Use the following table to identify what you may already know. This may assist you towork out what to focus on in your learning.
Topic
Key outcomes
Rate your confidencein each section
Topic 1 Prepare forassessment
1A Identify and prepareassessment tools andprocesses
ConfidentBasic understandingNot confident
1B Gather existinginformation about theperson
ConfidentBasic understandingNot confident
1C Seek additionalinformation fromspecialists and othersources
ConfidentBasic understandingNot confident
1D Organise practicalaspects of assessmentin consultation
ConfidentBasic understandingNot confident
1E Provide informationabout the assessmentprocess and obtainconsent
ConfidentBasic understandingNot confident
Topic 2 Analyse the person’sneeds
2A Work within scope ofown role
ConfidentBasic understandingNot confident
2B Empower the person toidentify and prioritisetheir own needs
ConfidentBasic understandingNot confident
2C Evaluate needs
ConfidentBasic understandingNot confident
2D Identify and analysecomplex, multiple andinterrelated issues
ConfidentBasic understandingNot confident
x UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS
Topic
Key outcomes
Rate your confidencein each section
2E Evaluate issues ofurgency and eligibility
ConfidentBasic understandingNot confident
2F Assess potential riskfactors for servicedelivery
ConfidentBasic understandingNot confident
Topic 3 Determineappropriate services
3A Consider service deliveryand referral options
ConfidentBasic understandingNot confident
3B Evaluate internalcapability and otherservice networks
ConfidentBasic understandingNot confident
3C Provide the person withservice information
ConfidentBasic understandingNot confident
3D Encourage the person toadvocate on their ownbehalf
ConfidentBasic understandingNot confident
Topic 4 Complete reporting
4A Document outcomes ofthe assessment
ConfidentBasic understandingNot confident
4B Maintain and store theperson’s information
ConfidentBasic understandingNot confident
4C Provide the person’sinformation to otherservices
ConfidentBasic understandingNot confident
Topic 5 Evaluate assessmentand referral processes
5A Seek feedback aboutassessment processes
ConfidentBasic understandingNot confident
5B Monitor processes andtheir outcomes
ConfidentBasic understandingNot confident
5C Routinely seek feedback
ConfidentBasic understandingNot confident
5D Use feedback to improveprocesses
ConfidentBasic understandingNot confident
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 1Topic 1In this topic, you will learnhow to:1A Identify and prepareassessment tools andprocesses1B Gather existinginformation about theperson1C Seek additionalinformation fromspecialists and othersources1D Organise practicalaspects of assessmentin consultation1e Provide informationabout the assessmentprocess and obtainconsentPrepare for assessmentIt is essential to prepare for assessments to ensure theassessment process takes into account the differentphysical, emotional, social, cognitive and culturalneeds of individuals. Establish rapport during initialconsultations to identify the need for assessments.When you identify a need, negotiate an appropriatetime and place for assessment, and inform the personabout relevant policies, such as their right to privacy. Theindividual also needs to provide their written consent forthe assessment. To ensure the individual understandsthe process, you may need to arrange for an interpretingservice.2 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS1A Identify and prepare assessment tools and processesA diverse range of assessment tools and processes are available for use in thecommunity services sector. Identification of the most appropriate assessment toolrequires a thorough understanding of the types of tools available, their use in differentcontexts, and the processes, policies, procedures and guidelines of your organisation.Community Service Organisations have standardised assessment tools and processes.It is important to familiarise yourself with these prior to conducting assessments. Taketime to review the approved assessment tools and processes of your organisation.Clarify questions that you have about these tools and processes with your supervisorprior to conducting assessments.When preparing for assessment, the following questions should be considered:XX Is an assessment required?XX What is the reason for the assessment?XX What issues/needs are we assessing?XX Which type of assessment will best address these needs/issues?XX Will the assessment tool be relevant to the person’s individual characteristics andcircumstances?XX What is my role in the assessment process?XX Does the person require referral to a more qualified or specialised agency forassessment?XX How will the assessment be conducted?XX Where should you conduct the assessment?XX What resources will you need to conduct the assessment?Reasons for assessmentReasons for assessment and the type ofassessment required vary depending on thecontext and the person’s specific needs.Determining these are key components of theassessment planning process.You should clearly understand your role in thisprocess, including the type of assessmentsyou are expected to carry out and who, withinor outside of your organisation, conductsother types of assessments. For example, aservice coordinator may carry out an initialcomprehensive assessment when a person firstaccesses the service, but other workers may be responsible for ongoing assessmentsor assessing specific needs. It is also important to understand when you should refera person to another organisation for assessment that is outside the scope of yourorganisation’s practice, such as a medical or a clinical mental health assessment.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 3TopiC 1 PREPARE FOR ASSESSMENTTypes of assessmentPeoples’ individual situations and specific needs vary greatly, therefore the types ofassessments needing to be conducted vary too. Who carries out the assessment willdepend greatly on what services the organisation provides. For example, an agedcare assessment service may assess individual who requires respite. A carer supportservice may also assess them to determine eligibility for the service.The types of assessment organisations might provide include:XX comprehensive assessments when a person first joins a service to determine theirneeds and the services requiredXX crisis assessments when a person is experiencing an emergencyXX periodic assessments to identify a person’s changing needsXX assessments in response to a change in a person’s personal circumstances orconditionXX specialised assessments that focus on specific areas of a person’s life, such asbehaviour and physical or psychological needs.Purposes of assessmentYour organisation’s assessment policies and procedures will indicate when you need toconduct assessments to meet people’s needs or identify changing needs.Here are some examples of some different assessment types and reasons you mayneed to conduct them.
Assessments
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Intellectual disabilitiesAssessment will identify the person’s IQ and determine eligibility for funding.People with intellectual disabilities are supported to access generic servicesand disability-specific services, which will make further assessments todetermine the person’s skill level and support needs.
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Physical disabilities or impairmentsMedical practitioners and physiotherapists carry out assessments todetermine accessibility needs, skill level and needs regarding requiredsupport. People with physical disabilities are assessed to determine the levelof funding required to support them.
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Drug and alcohol usePeople with alcohol and other drug issues will have medical assessments,behavioural assessments and needs assessment. These assessments candetermine the level of support required.
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People with mental health issuesPsychiatrist and general health practitioners can be involved in needsassessments to determine level of care required. An individual may needsupport with their medication needs, short-term intervention and/or longerskills developments.
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Sensory impairmentsAssessment through medical practitioners, depending on age, may involveaged care assessment services/team; support services providers andphysiotherapists in relation to aids; and appliances that may support theperson’s independence.
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Centre Against Sexual Abuse (CASA)An adult or child who has been referred to CASA will undertake assessmentto determine the best type of support required; for example, individualcounselling coupled with small group work.
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HomelessnessDepending on the support service, you can do some assessments throughinformal conversation to determine the level of support the person needs. Theinformation from the informal assessment method is then transferred onto anassessment tool.
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Behaviours of concernAlthough assessment tools may differ, they all capture the same informationabout the antecedent to the behaviour, what the behaviour is, and theconsequences of the behaviour. This is information referred to as the ABC ofbehaviours.
Identify need for assessmentPrior to assessment, look at what can be achieved if the assessment is conducted.Determine whether the person actually requires assessment, and if so, consider whichform of assessment is most appropriate.Here is further information to consider when identifying the need for assessment.
Determine assessment method
XX The following will assist in determining the required assessment method:– Review a referral letter addressing why and how assessment should takeplace.– Check with the person to ensure they agree to undergo an assessment ofneeds.– Interview the person about their needs.– Where relevant, interview the individual’s family about their specific needs.– Observe verbal and nonverbal cues and check with the person to ensure youhave captured all relevant information.
Consider required outcomes
XX Consider the required outcomes by asking the following questions:– What will assessment achieve?– How will outcomes affect the person?– Is the person capable of undergoing assessment?– Has assessment been recommended by another party?
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 5TopiC 1 PREPARE FOR ASSESSMENT
Determine resources
XX Resources required may include:– funding requirements for assessment– expertise to carry out assessment– assessment instruments or tools– the location of assessment; for example, a safe location.
Organisational policies, procedures and guidelinesAssessment, like all aspects of community services, should follow organisationalpolicies, procedures and guidelines. Policies will specify the intention for conductingassessments, and procedures and guidelines will specify how to determine whether anassessment is required.Work contexts will vary, as will reasons and types of assessments. Ensure youunderstand the policy and procedure implemented by your workplace when preparingto conduct an assessment. These may outline methods for determining whetherassessment is required; for example, the organisational procedure may requireassessment for all people entering a service. Another organisation may only requireassessment if the person has not previously been assessed.Identify and use assessment tools and processesYou may use different methods of assessmentdepending on the context and the person’sspecific needs. These methods include astrengths-based assessment, a domain-basedassessment, a norm-based assessment and acompetency-based assessment. A combinationof these methods may be used, dependingon the person’s needs. Discuss the types ofassessment used in the organisation with yourmanager or supervisor, and ensure that you followorganisational policies, procedures, protocols andguidelines when conducting assessment.Strengths-based assessmentCommunity services operate from strengths-based service delivery models. Strengthsbased assessment focuses on a person’s strengths and competencies. This approachsees the individual potential and focuses on the resources the person already hasaccess to. A strengths-based approach looks at building on individual strengths.In contrast, problem-focused assessment limits the person’s potential and emphasisesthe diagnosis or limitations. Give attention to what is not functioning with the person,which makes it easy for the person to become discouraged and/or develop furtherdependencies.6 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS
Advantages of the strengths-based perspective
XX Empowers the individual by avoiding victimisation and focusing on the person’sresourcesXX Limits stigmatising languageXX Gives the individual being assessed a sense of ownership of their situationXX Enhances participation, encouraging people to identify their own strengths andavailable resourcesXX Gives the person a sense of hope and encouragement
A strengths-based assessment toolAn example of a strengths-based assessment tool is the Behavioural and EmotionalRating Scale (BERS), a standardised assessment tool developed to focus on strengths.The BERS is a 52-item scale that measures the behavioural and emotional strengthsof children and adolescents. It measures how well the young person can regulate theirbehaviours and emotions, evaluates the quality of the young person’s relationship totheir family and measures the young person’s perceptions of their achievements andcompetencies.Domain-based assessmentDomain-based assessment, also called criterion-referenced assessment, occurs whenassessing a person against a predetermined criterion or set standard. The assessmentfocuses on using a holistic approach to assess a number of domains of health andfunctioning, such as mental health, physical abilities, social needs or alcohol and otherdrugs (AOD). This is important for people with complex needs, as it is likely that theirneeds will fall across multiple domains.Judgments are made about a person’s performance; they either meet the criterion,or they do not. Consider the following examples of and advantages in using domainbased assessment.
Criterion
An example of domain-based assessment is a student who wants to study medicineat university. To do so, they must score 99 per cent on their final exams in highschool; that is, 99 per cent is the criterion.
Demonstrating skills
Another example of domain-based assessment is demonstrating designated skills ata required level when attempting a driving test to gain your licence. The level of skilland the number of skills the driver is required to demonstrate are the criteria.
Advantages
A key advantage is that you do not need to assess the person against a largesample, so smaller, specific assessments can be conducted. Also, particular areasof the person’s life may be assessed; for example, family relationships or cognitivefunctioning.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 7TopiC 1 PREPARE FOR ASSESSMENTNorm-based assessmentNorm-based assessment, or norm-referenced assessment, assesses the individualin relation to a predefined population, known as a sample. It is a way of assessingan individual against their peers. Utatistical methods are used to interpret normreferenced assessment. Assessment data is collected from a standardised sample.The raw scores on the assessment are standardised into a bell curve. The mean,median and mode are calculated, as well as the standard deviation.Here is some more information on norm-based assessment.
raw score and bell curve
XX The raw score is the actual score on the assessment, prior to standardisation.For example, 6/10 is the raw score on an assessment where 10 is the highestscore.XX A bell curve is a symmetrical curve that represents the normal distribution ofscores. A rank of 50 is the middle score (at the highest point on the curve),indicating that 50 per cent of people score higher and 50 per cent score lower.
Mean, median and mode
XX The mean score is the average score. For example, to obtain an average of thefollowing scores, add each score and divide by the number of scores: 5 + 6 + 2+ 6 = 19 ÷ 4 = 4.75XX The median is the middle score. If you ordered the given scores, the medianscore is between 5 and 6 = 5.5XX The mode is the score that appears most frequently. In the given set of scores,the mode score is 6.
Standard deviation
XX Standard deviation describes the variance or dispersion of a sample; that is,how spread out the scores are and how far away they are from the mean.XX A small standard deviation implies that scores are clustered around the mean.XX A larger standard deviation means scores are more spread out.
Advantages of norm-based assessment
XX This assessment gives the individual scores a context. It allows the assessor todetermine how the individual compares with other people in a similar situation.For example, norm-based assessment can determine that a child’s score of5/10 on a skills assessment is below average when compared to other childrenin their age group, who average 6/10.
Wechsler intelligence Scale for Children
XX An example of norms-based assessment is the Wechsler Intelligence Scale forChildren, an intelligence test that assesses children against normative samples.Scores are given as percentages and compared to scores in the sample. Forexample, if a child scores 85 per cent on an item, and the norm mean for thatparticular item is 81 per cent, the child has scored above average on thatparticular item.
8 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSCompetency-based assessmentCompetency-based assessment is the process of assessing a person’s competenciesin different areas. The person being assessed must demonstrate a skill under a setof conditions, and demonstrate evidence of competency. They are then deemedcompetent or not yet competent.Here is further information about competency-based assessment.
Competency-based toolsCompetency-based assessment is often used in a work oreducational context. The person being assessed can build on theirskills and competencies through training.A variety of assessment techniques and procedures can be usedwhen assessing competency, including observation, written tests,oral tests or questioning, simulation exercises and role-plays, casestudies or reports and portfolios.
Assessment emphasisAssessment emphasises resources, rather than problems, andencourages participation. In mental health and social work,competency-based assessment focuses on person’s strengths,coping and management strategies, and how environmentalstressors affect the individual. It also takes a holistic approach,assessing the individual in their social, biological and psychologicalcontexts.As assessment used in community services is more strengthsbased than problem-focused, it is more empowering to theindividual being tested than some types of assessments.
functional assessmentCompetency-based assessment can be used to assess theindividual’s current life situation, such as their:XX cognitive functioning, including perception, motivation andproblem-solving abilitiesXX emotional functioning, including current stressors that mayaffect emotional stabilityXX behavioural functioning, including the person’s physicalappearance, mannerisms and speechXX interpersonal or family issues, including the person’srelationship to family members and current stressors.
Assessment questionsAssessment can be performed through observation, testing and asking questions.Most assessments need to be completed over time to ensure the information collectedis an accurate depiction of needs. For example, assessing for dementia should not bedone in one assessment setting.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 9TopiC 1 PREPARE FOR ASSESSMENTThese questions may need to be answered when carrying out an assessment:XX What skills, attitudes, motivations, perceptions, strengths and potentialities doesthe person possess?XX How does the person demonstrate coping strengths?XX How does the individual demonstrate resilience?XX What social support networks enable coping mechanisms?XX What resources are available to the person?XX How has the individual used coping mechanisms in the past?Assessment tools or screening instrumentsMost organisations have standard procedures and tools for collecting andassessing a person’s information. Using these ensures the information you obtainis comprehensive and covers all the issues you need to examine. Within yourorganisation’s assessment protocols, you may use a range of tools and methods toassess people’s needs including interviewing them, reviewing their files or healthrecords, direct observation, consulting others, asking them to fill in questionnaires, oradministering specialised screening or assessment tools.There are many specialised screening and assessment tools to assess specific areasof wellbeing or functioning.
examples of tools
XX The Mini-Mental State Examination (MMSE) is a commonly-used test designed toquickly evaluate a person’s current mental state and cognitive skills.XX The Severity of Dependence Screening Instrument (SDS) is used to assess thedegree of a person’s drug or alcohol dependence.XX The Caregiver Strain Index (CSI) is designed to identify caregiver stress and needfor support.XX The Geriatric Depression Scale (GDS) is used to identify depression in olderpeople.XX The Duke Social Support Index (DSSI) is used to measure a person’s level ofsocial support.XX The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)screens for levels of substance use in adults.XX The DMI-10 Self-Report Questionnaire is designed to determine the severity andduration of depression.XX The Edinburgh Depression Scale is a 10-item self-rating scale used to screenpregnant women and postnatal women for depression.XX The Antenatal Risk Questionnaire (ANRQ) is used to identify risk factors fordepression in pregnant women.XX natal Risk Questionnaire (PNRQ) is used to identify risk factors fordepression in women following the birth of a child.
10 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSAdministration of assessment toolsIt is important that workers only use tools and procedures that their organisation hasadopted or approved of. Do not use a tool or procedure that you used while working foranother agency. When you use the tools adopted by the organisation you are currentlyworking for, you are following their approved procedures and guidelines. This meansyou are fulfilling your responsibility to the organisation and meeting your duty of careobligations to people using the service and others.A professional, such as a psychologist, who is trained to interpret the results, mustadminister some assessment and screening tools. Others can be used by anyoneworking in human services as an additional tool for obtaining information aboutindividuals. Many of these instruments are available on the internet.Reliability and validity of assessment toolsAssessment tools must be as reliable and as valid as possible. Reliability and validityare affected by how objective the variable is and the conditions under which theassessment is conducted.Here is some more information on reliability and validity.
factors to consider
Imagine you are assessing an individual’s happiness. Assessing happiness isdifficult, because the conditions in which you assess a person’s happiness will varydaily. At nine o’clock, the person may rate their level of happiness as high, but atthree o’clock, they may rate the level of happiness as low. Which score would youuse? Some of the factors that may affect responses are the weather, time of day,where the test is conducted and the assessor’s tone of voice. Furthermore, theperson may have a different interpretation of happiness than the assessor.
error and standardised instruments
Assessment instruments always contain an element of error. The variable you aretesting for will affect how accurate the testing instrument is. There is also error whentesting for constructs such as intelligence and happiness, because these conceptsare less concrete than factors like height and weight.Assessment instruments should be standardised, which is the process ofimplementing guidelines so as many variables as possible are controlled, and thereliability and validity of the instrument is increased.
Assessment reliabilityReliability is the extent to which measurements are consistent. To be reliable, theassessment should produce similar results on separate occasions. Height and weightare considered reliable measurements. For example, if a set of scales is reliable, it willweigh an orange as 200 grams one day and as 200 grams again the following day.An intelligence test is reliable if it produces similar results on two separate occasions,when testing has been done under similar, standardised conditions. However, anintelligence test is less reliable than a set of scales, because intelligence is a morefluid construct than weight. Here is an example of four different forms of assessmentreliability.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 11TopiC 1 PREPARE FOR ASSESSMENT
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Internal consistencyInternal consistency refers to how strongly the items on the assessment relateto one another.Internal consistency is high if a respondent agrees with the item, ‘I havedifficulty getting out of bed in the morning’ and disagrees with the item ‘Igenerally wake up feeling happy and energetic’.
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Test–retest reliabilityTest–retest reliability refers to how stable the assessment is over differentconditions.Test–retest reliability is high if a person is found to have an overall IQ of 91 onone administration, and, when tested again with variations of the questions, isfound to have an overall IQ of 91.2.
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Parallel forms of reliabilityParallel forms of reliability refers to how strong the correlation is between twodifferent tests that have been constructed and administered in a similar way.Parallel forms of reliability are high if two similar scales for depression areadministered in succession in the same room under the same conditions andproduce similar results.
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Inter-rater reliabilityInter-rater reliability refers to how similar assessment results are when anassessment instrument is administered by two different assessors.Inter-rater reliability is high if a personality test is administered by twodifferent assessors under similar conditions and produces similar results.
ValidityValidity of an assessment relates to its usefulness or accuracy in measuring what it isintended to measure. For example, a set of scales are valid if they measure weight. Anintelligence test is valid if it measures intelligence.Here are examples of four different types of validity.
face validity
XX Face validity refers to whether the assessment instrument appears to measurewhat it claims to measure.XX Face validity of a self-efficacy assessment is high if the assessor reads throughthe questions and believes they accurately assess self-efficacy.
Content validity
XX Content validity refers to whether the assessment instrument covers the range ofcontent it claims to cover.XX Content validity of an assessment for coping and resources is high if all thequestions in the assessment refer to coping mechanisms and resources.
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Criterion-related validity
XX Criterion-related validity refers to how well the assessment instrument can beused as a predictor for another related variable.XX Criterion-related validity is high if an assessment of drug and alcohol usagecorrelates with how much and how often drugs and alcohol are consumed.
Construct validity
XX Construct validity refers to how well the assessment instrument represents theunderlying construct.XX Construct validity of a happiness assessment is high if the assessment toolproduces similar results to a different happiness assessment.
Organisational checks for validity and reliability ofassessment toolsAn organisation will have procedures in place to guide assessors into usingassessment methods that produce valid and reliable measurements.
ensuring assessment methods are valid and reliable
XX Consult organisational procedures to determine validity and reliability ofscreening tools and assessment instruments used by the organisation.XX Clarify with supervisor, colleagues and relevant social networks, such asprofessional body, to determine reliability and validity of screening tools andassessment instruments.XX Ask questions in interview that have been suggested/ approved by organisation/accredited body.XX Follow organisational procedures for conducting interviews and makingobservations, to ensure that assessment procedures are reliable and valid.XX Consider variables that may impact of the reliability and validity of assessment,such as timing and environment for assessment.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 13TopiC 1 PREPARE FOR ASSESSMENT
Example
identify need for assessmentThe following example follows the steps followed by a worker who notices a change ina person that she provides care to.ScenarioXX Judy is a 60-year-old lady with Down Syndrome, and is being cared forby her mother, Nancy, who is 85 years old. Judy usually attends a daycentre program five days a week, but lately the staff have noticed that herattendance has been sporadic. On the days she attends, the staff noticedthat she has lost weight, her clothes are unwashed and her hair is notbrushed. Judy tells staff that she has not had a shower for several daysbecause ‘Mum has been too sick to help me’.What will be achieved?XX Wendy is a carer at the centre. She knows Judy well and believes thatthese changes are very out of character for Judy. Wendy has discussedher concerns with her supervisor who suggested that Nancy and Judy maybenefit from an assessment. The supervisor explains that an assessmentwill help to determine what factors have contributed to the changes beingobserved, to identify needs that require support for both Nancy and Judyand to identify possible funding options available to access services.Wendy and her supervisor agree that an assessment would enable Nancyto care for Judy by providing support where required and to enable Judy toreturn to her optimum weight, level of personal care and participation inher usual daily activities.Does the person require assessment?XX Wendy is aware that the organisation’s guidelines stipulate thatassessment is deemed necessary in response to a change in a person’scircumstances or condition. Due to the significant changes in Judy’sappearance, participation in daily activities, and circumstances at home,Wendy decides that an assessment is warranted to determine Judy’spersonal care, hygiene, nutrition and activity of daily living needs. Wendyalso decides that an assessment is warranted for Nancy due to her age, illhealth and responsibilities as sole carer for Judy.Which assessment is most appropriate?XX Wendy consults the organisation’s procedures and guidelines, whichindicate the assessments required are outside the scope of herorganisation. The guidelines outline the process for engaging anassessment team, so Wendy refers Judy to an appropriate agency that iscapable of conducting assessment of her mobility, hygiene, personal care,diet and emotional needs and social activities. She also refers Judy for aGP assessment to determine if there are any underlying physical causesfor her weight loss. Wendy also refers Nancy to the agency to undergo aCaregiver Strain Index Assessment to assess her current situation and toidentify possible support requirements. She refers Nancy to her GP for aphysical assessment to identify any underlying illness that may requiretreatment.
14 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 11. What are the benefits of applying a strengths-based approach to an assessment?2. How should the need for assessment be determined?3. List two types of assessment tools that an agency can use to conduct assessmentfor new people accessing a service for the first time. What is the aim of conductingassessment for a new person entering the service for the first time?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 15TopiC 1 PREPARE FOR ASSESSMENT4. List two factors that may affect the reliability of an assessment. How can thesefactors influence assessment results?5. What is a bell curve and what does a rank of 50 indicate?Click to complete Practice task 116 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS1B Gather existing information about the personWhen preparing for assessment, you need to gather existing information about theperson. The assessment process will vary from case to case, and organisation toorganisation. The type of questions asked also depends on the person’s needs and theassessment circumstances. Always ensure you give the individual the opportunity toask questions and consent to the process before proceeding.The elements of gathering information for assessment are explored here.
Assessment types
XX Self-report – Interviewing the person while considering the factors that mayaffect the person’s ability to self-report accurately, such as acute illness orconfusionXX Informant reports – Information from GPs, other health professionals, familymembers or other service providersXX Health records – Medical records, previous assessment reports and referralsfrom health professionalsXX Direct observation – Asking the person to perform a certain taskXX Indirect observation – Observing the overall presentation of the person; forexample, their body language, tone of voice and personal hygiene
Key areas
The assessment process generally covers the following key areas:XX Obtaining essential information, such as the person’s contact details, date ofbirth and next of kinXX Obtaining the person’s medical/family history, such as history of mental illness,history of drug abuse or hereditary factorsXX Obtaining information about the person’s current situation, such as currentmedications, current feelings and experiences, and current financial situationXX Determining future or predictive risk factors, such as medical risks, risks of drugoverdose, risk of homelessness or risk of financial stress
other processes
Other assessment processes that may be used include:XX a genogram – a diagram of family relationships and interrelationships, includinghistory of family stressors and traumatic eventsXX an eco-map – a visual representation of family and social support networks andresourcesXX specially-designed scales and rating systems – such as the environmentalcleanliness and clutter scale.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 17TopiC 1 PREPARE FOR ASSESSMENTGather existing informationThe stages of the assessment process include gathering a range of information aboutpeople from a variety of sources; collating and analysing the information to interpretthe result; and presenting a report that summarises the most relevant information andprioritises the person’s needs for service delivery.Consider the sources of information and the use of a combination of procedures, asexplained here.
information sources
You may have obtained assessment information from a range of sources, including:XX interviews with the personXX questionnairesXX specific screening tools, such as the Severity of Dependence ScreeningInstrument (SDS)XX speaking with the person’s family members, guardian, carers and friendsXX speaking to other workers and service providersXX observing people.
Combination of procedures
You may have used a combination of these assessment procedures to assessmultiple needs. For example, you may have:XX used the alcohol and other drug (AOD) screening tool to determine the person’sdegree of alcohol dependencyXX spoken to the person’s family members and interviewed the person about theirfinancial situationXX consulted medical records and reports from medical professionalsXX conducted an interview to determine the person’s current mental state.
Analyse informationHow you analyse information depends on the type of assessments conducted, theassessment tools used and your organisation’s guidelines.The following information illustrates different types of assessment information you mayneed to consider when analysing assessment results.
Assessment domains
It is likely that you will consider information in a range of domains of the person’slife; for example, their psychological, social/emotional, physical, spiritual andcultural needs. Much of this information can be obtained by talking with people andthose familiar with them. You may also consider information from observation andscreening tools; for example, you may refer a person to a psychologist to assesslevels of depression.
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Competency-based assessment
To assess and interpret personal needs in some areas, you may need to observepeople or have specialists conduct competency-based assessment. This may involveusing a checklist to observe a person as they undertake specific activities. Thechecklist helps to assess a person’s skills in a consistent way and across a numberof areas, allowing you to draw conclusions about their competency in these areas.
norm-based assessment
Norm-based assessments let you compare a person’s level of functioning or othercharacteristics against other people in their particular situation or age group. Thiswill tell you where a person is on a standardised scale for a particular characteristic;for example, a person may be considered very underweight based on norms for theirheight and age.
Assessment tools – reliability and validity
It is important to consider the reliability and validity of the results when usingquestionnaires and screening tools. The tools should accurately measure what theyare supposed to, and they should be reliable in that they produce the same resultsacross time and can be interpreted in the same way by different workers.
Consulting with others
You may need to consult with workers or service providers who have provided inputto the assessment process. For example, where a psychologist has identified thata person is depressed, you may need to discuss how this may affect areas of aperson’s life, such as their ability to engage in self-care tasks and relate to others.Do not attempt to interpret results outside your own scope of practice.
person individuality
When analysing an individual’s information, always be mindful that each personis an individual with unique characteristics and needs. Take a person-centredapproach by recognising that the person is the expert in their own life, and that theneeds and concerns they identify themselves are usually the most important tothem. Always take person strengths into account, as well as areas of concern.
Analyse existing issuesWhen analysing existing issues, it is importantto take a structured approach to ensure that youidentify and explore the needs of the person. Youmust consider their goals and desired outcomesalong with options and possible solutions. Youcan achieve this by adopting a problem-solvingstrategy.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 19TopiC 1 PREPARE FOR ASSESSMENT
Example
use existing informationTake time to review the following problem-solving process.Problem-solving process1Step 1: Identify the problemA person presents with an AOD dependency, signs of domestic abuse andindications of depression.2Step 2: Explore the problemConduct a multi-disciplinary team meeting to discuss assessment results.Discuss the implications of results and needs priorities. Involve the personin discussions. Present the results and ask how they would assess theirown safety and which actions would be of greatest benefit.3Step 3: Consider goals or desired outcomesMeet with the person and relevant stakeholders to discuss goals anddesired outcomes. Prioritise safety. For example, the person may decidethe most important outcome is to move away from domestic abuse, andthen begin to address mental health and AOD issues. Record goals andoutcomes.4Step 4: Look at alternativesConsider options for achieving the desired outcome. For example, assistthe person to consider where they will move to when they leave theabusive relationship, and how planning should proceed to allow them toleave safely. As well as the person with support needs, you may need toconsult others, such as your supervisor.5Step 5: Select a possible solutionChoose a solution that seems to best resolve the issue and meet theneeds of the parties involved. For example, develop a plan of action forsupporting the person to leave the relationship and begin to address othercomplex issues.6Step 6: Implement the possible solutionRecord goals, actions and outcomes, seek agreement with the personabout proceeding with a plan, and support the person to implementactions. For example, liaise with a refuge about supporting the person inthe short-term, and facilitate the person with the transition.7Step 7: EvaluateEvaluate how this solution worked. If after a time it does not seem to havegiven suitable results, consider other options. For example, if the personwas unable to leave the abusive relationship, discuss alternative options,such as counselling.
20 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 2Read the case study, then complete the questions that follow.
Case study
Rory is at risk of homelessness, as the psychiatric facility he has been living in isclosing down. A team conducts an assessment to determine which of Rory’s needsrequire priority, and how they can meet these needs.Rory has an intellectual disability, paranoid schizophrenia and an alcoholdependency. He has no family in the area, and no financial means to supporthimself.A norm-based assessment determines that Rory is eligible for a disability pension,as well as funding to support him living in a residence for people with disabilities.He can also access funding for ongoing psychiatric support.Results of a competency-based assessment determine that Rory is able to preparemeals and attend to personal hygiene without assistance, but he requires supportwith finances and behavioural management.
1. You are part of Rory’s assessment team and have been asked to help analyse theresults of the assessment. Explain how you would use a problem-solving approachto analyse the assessment information and prioritise Rory’s needs.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 21TopiC 1 PREPARE FOR ASSESSMENT2. List three ways that you could collect further information about Rory to ensure thatyou have sufficient information for assessment.Click to complete Practice task 222 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS1C Seek additional information from specialists and othersourcesTo be clear on which assessment procedures lieoutside your scope of practice, you can consultyour supervisor, colleagues, organisational policyand professional body. You may identify theneed to engage a specialist to assist with theassessment process.A specialist can help you in a range of ways,including administering the assessment, analysingthe assessment results, making decisions abouta person’s needs and determining developmentgoals.Methods to collect informationThe methods used to collect information will vary depending on the person’s needs orthe issues you are assessing. Your agency guidelines for assessment will outline theapproved methods of assessment for your organisation. Assessors must ensure thata person’s right to privacy and confidentiality are maintained when collecting, storing,handling or discussing information.Common methods of information collection include:XX conducting an interview with thepersonXX direct and indirect observationsXX the use of assessment or screeningtoolsXX reviewing recordsXX interviews with family/carersXX discussion with other service providersXX discussion with other staff orsupervisorXX reviewing referral letters orcorrespondence from other serviceprovidersXX reviewing case files, reports and notesXX participating in case conferencesXX participating in multi-agency meetingsXX discussion at in-house staff meetingsXX reviewing referral letters orcorrespondence from other serviceprovidersXX reviewing case files, reports and notes.Seek additional informationA comprehensive assessment involves gathering a range of information from avariety of sources. Accessing information from other service providers requiresinformed and written consent from the person who you are assessing. All informationrequested must be relevant and necessary for that assessment. All documentation,correspondence and consultation must be managed in accordance with yourorganisation’s records management and its privacy and confidentiality policies andguidelines.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 23TopiC 1 PREPARE FOR ASSESSMENTRequest informationYou will need to complete a request for information form when requesting documentsfrom a third party service provider. This form contains information about the identityof the person and the reason for request. This form also contains a section to becompleted and signed by the person to indicate consent to release information. Yourorganisation must approve the request for information form for use. Check with yourorganisation’s policy and procedures and discuss with your supervisor to identifyand locate your organisation’s approved request for information form. Take time tofamiliarise yourself with your agency’s approved process for obtaining records andinformation.
Ways of obtaining additional information
Requesting a meeting to discuss patient with other service providers
Participating in case conferences
Discussion with other service providers
Interview or discussion with family or carers
Discussion or meeting with your supervisor
Requesting documentation, reports or correspondence from a third party serviceprovider
Engage the assistance of specialistsThere may be occasions when you need to consult specialists about higher-levelassessment or specialist needs assessment. Here are examples of various specialistswho you may consult while assessing people with complex care needs.
Supervisor
Your supervisor can provide you with guidance regarding assessments and may bequalified to conduct higher-level assessments. They may also have access to furtherinformation about analysing assessment results.
Health professional
Health professionals conduct medical or functional assessment and provide specificservices such as counselling, medication, and therapy. For example, a nurse,GP or psychologist should conduct a depression-screening questionnaire. Thehealth professional should also provide information about assessment results andoutcomes.
Clergy – pastoral care
Clergy/pastoral care providers and other religious figures can provide comfort andguidance when people require spiritual or religious support. If an assessment revealsthat an individual has a spiritual interest and they express a need for emotionalsupport, a pastoral care provider may be appropriate.
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grief and loss
The National Association for Loss and Grief (NALAG) can provide the names ofcounsellors who specialise in supporting people who are experiencing grief, lossand trauma. Palliative care associations can provide referrals to palliative careprofessionals and hospices for people with terminal illnesses.
Specialist association
Many associations and community organisations that provide support to people withspecific health issues and conditions such as diabetes, cancer, multiple sclerosis,mental health conditions, AOD issues and disabilities. There are also organisationsto support veterans and war widows.
Support groups
Support groups exist for many issues and conditions. The purpose of these groupsis to provide self-help and mutual support for people with a range of concerns andconditions. Group members can share experiences and their coping strategies.
Work with specialistsEstablish sound working relationships with specialists and other service providersthrough regular liaison. For example, if you are working with a person who requiresan AOD or mental health assessment, you need to liaise and exchange informationwith the appropriate people (with the individual’s consent) to provide effective andcoordinated services.Building a good working relationship involves:XX being courteous and respectfulXX using appropriate communication skills, including clear written communicationXX returning phone calls and emails promptlyXX making yourself familiar with their service guidelines, such as their referralprocedures and opening hoursXX attending case management meetings as requiredXX keeping your records and person file notes up to dateXX providing reports and relevant information as requested.Determine the range of issuesEach person has their own unique set of circumstancesand issues that impact on their individual needs. Todetermine the range of issues and their impact on aperson’s needs, you should adopt a holistic approachwhen conducting assessment. A holistic assessmenttakes into account a number of domains of health andfunctioning such as mental health, physical abilities,social needs or alcohol and other drugs (AOD) use.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 25TopiC 1 PREPARE FOR ASSESSMENTHolistic approach to assessmentDuring a needs assessment, it is important to take a holistic approach to ensureyou address the various domains of the person’s needs. Since domains can affectone another, it is important to consider the person’s needs collectively (rather thanindividually) when conducting a complex needs assessment. For example, a personwho is experiencing pain because of a medical condition may have crossover effects inother domains, including social and psychological or emotional areas. Pain can causea person to feel anxious or withdrawn, leading to social isolation. Relevant supportstaff should continually assess the effects of one domain on others.Here is an explanation of the domains of needs.
The domains of needs
Social – a person’s social interactions with others, including family members,program or service staff and other service users
Cognitive – a person’s ability to understand rules, and participate effectively;examples include dementia and intellectual disabilities
Spiritual/cultural – beliefs and cultural practices can play an important role inlifestyle; examples include religious beliefs and customs
Physical/medical – a person’s ability to participate in tasks that require dexterity;examples include physical disabilities and medical conditions
Psychological/emotional – can impact on their desire and ability to benefit fromactivities; examples include grief and depression
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Example
Seek additional informationThe following is an example referral form to communicate with a specialist whenseeking secondary consultation.referral formClient detailsName: Emmanuella SalakoDate of birth: 1/2/1991Address: No current fixed addressConsent to release informationCompleted: Yes  No Filed: Yes  No Copy attached: Yes  No Date: 1/4/2017Referred to: Psychologist, Ana ValourReason for referral: During the intake interview, Emmanuella advised that shefrequently thinks about suicide to the point of making plans. She stated duringthe assessment interview that she would like counselling to address this.Relevant historyEmmanuella presents with:• a heroin dependency• borderline personality disorder• risk of kidney failure.Emmanuella has been involved in sex work and drug trafficking. She currentlyhas no medical or psychological support and is unemployed.Emmanuella has made one suicide attempt six months ago and washospitalised as a result.Name: Signature:Position: AOD intake assessor Contact details:
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 27TopiC 1 PREPARE FOR ASSESSMENTPractice task 3Read the case study, then complete the task that follows.
Case study
A-Mei Chang has been experiencing the early stages of dementia and lives at home.She has Type II Diabetes Mellitus and Stage 1 Renal Failure. She wears hearingaids due hearing impairment. A-Mei is of Chinese decent, she has lived in Australiafor 40 years. At home, A-Mei speaks English and she has declined interpreterservices – she speaks, reads and writes English fluently . A major service providerhas conducted an assessment to determine A-Mei’s current needs and priorities.A-Mei lives at home alone, with the assistance of daily carer visits arranged toassist with showering. Her daughter lives close by and visits weekly. A competencybased assessment and strengths-based questionnaire reveals that A-Mei can safelycontinue to live at home, with the assistance of continued home visits from carers.However, an interview with A-Mei reveals that she may be experiencing depression.A-Mei stated that since her husband died six months ago, she has been feelingvery down. She reported that she is sleeping for long periods during the day, haslost interest in things that she usually enjoys and always seems to feel sad. Shedescribed feeling as though she is walking around in a big, black cloud. A-Meidenies suicidal thoughts or plans and says she has not attempted self-harm. Sheis willing to take part in assessment and any recommended course of action thatfollows on.
Write a letter to a relevant specialist to seek secondary consultation about A-Mei’ssituation. Identify relevant health professionals in your local area who you couldcontact. Your letter should include a description of language needs, family situation,care arrangements, interests and social activities (details that you create).28 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSClick to complete Practice task 3UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 29TopiC 1 PREPARE FOR ASSESSMENT1D Organise practical aspects of assessment in consultationOrganisation of the practical aspects ofassessment involves coordination of the timeand place of the assessment in consultation withthe person who you are assessing, their family/carers and other service providers. It is importantto ensure that you have informed the personabout the assessment process, about the needfor assessment and about who will have accessto information. If you do, the assessment processcan take place with informed consent. The serviceprovider has a responsibility to ensure that theytake into account legal and ethical considerationswhen organising assessments. The serviceprovider must also ensure that the appropriate resources to carry out the assessmentare available.Organise settingIt is important that you choose or set up the assessment environment to promotethe feeling of security and comfort for the person with support needs. Ensure younegotiate with the person prior to scheduling the assessment location to ensuretheir needs are met, and assessment can take place in a way that increases theassessment’s reliability.Ideally, the environment for the assessment should:XX suit both the person and the assessorXX increase the person’s comfort and securityXX be private and allow for confidentialityXX not be noisy or disruptiveXX be safe and comfortable; for example, have adequate lightingXX be easy to access; for example, have wheelchair access if necessaryXX be appropriate for the type of assessment; for example, if a person is beingassessed for mobility, they need enough room to demonstrate their current mobilityskillsXX have the required resources; for example, there should be enough light, tables, andchairs available if a written assessment is being conducted.Schedule a suitable timeYou should always schedule assessment times in consultation with the person withsupport needs. The time of assessment should meet the requirements of both theassessor and the person. You may be arranging an assessment that involves otherparties, such as the person’s family members or a health professional. Ensure thescheduled time suits all relevant parties and that you inform all people of the time andplace well ahead of schedule so they can make arrangements.In all contexts, it is important to arrange an appropriate time and place for assessmentto occur.30 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS
Considerations for scheduling an assessment
XX Comfort of the person in the assessment environment
XX Effect on the assessment if the person does not feel comfortable in theassessment environment
XX Ability of the person to access the assessment location
XX Suitability of the scheduled time for the person, the assessor and any otherrelevant parties
XX Need for a reminder about assessment time/place prior to the scheduledassessment
Organise assessmentTo ensure assessment results are both reliable and valid, you need to ensure thescheduled time of day does not confound the results. A confounding variable refersto a hidden variable that confuses the appearance of the results. For example, if youwere assessing attention, tiredness would be a confounding variable. The time of dayyou conduct the assessment is important in this scenario, because assessment in themorning would produce different results than late in the day, when the person is tired.Speak to the referrer, such as the nurse or medical professional, about the person’sindividual requirements before scheduling an assessment.Work directly with the person and the referrer, if necessary, to schedule anassessment time that is appropriate for everyone involved. It may be necessary toremind the individual and relevant parties about the appointment time. Always followorganisational guidelines for reminding others about scheduled assessments.
factors to consider when arranging a time for assessment
XX Can all parties make the scheduled assessment time?
XX Will the time of day affect the results of the assessment? For example, if theperson has medication with food, is it appropriate to arrange an assessmentafter meal times?
XX Is the assessment location available at the time of the scheduled assessment?
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 31TopiC 1 PREPARE FOR ASSESSMENTConsult the personThe following provides guidance on ensuring the person being assessed can make aninformed decision.
Briefing the person
You should make all decisions in consultation with the person being assessed. Ifthe individual is not able to communicate, ensure that an interpreter, guardian oradvocate is engaged to represent the person’s interests.You should also formally brief the person about the assessment results. Dependingon what the person wants and needs, you may be able to do this over the phone, orin a face-to-face interview. In addition, you may be required to prepare and present adocument that summarises the reports. Organisational guidelines and protocols forcommunicating with people will guide this process.
presenting options
Present options and informing the other person of their rights.Present the options for service delivery to the person, focusing on areas to beprioritised. For example, a person with a disability and AOD issues should beinformed about:XX relevant disability support and AOD agenciesXX how to access the agenciesXX the cost and whereabouts of the agenciesXX how the agency can meet their needs.Also, inform the person about their right to make a complaint or refuse a service.You need to explain in detail the avenues for making a complaint, so the person isempowered to make a complaint or refuse a service if the need arises.
respect and consent
When liaising with the person about assessment results and service deliveryoptions, be sure to:XX be calm and courteousXX treat them with respectXX be fair; present the person with all alternatives and make available allinformation.Ensure the person has the support required to access and understand the providedinformation.Always obtain consent from the person before you take action, or before personalinformation is released to other agencies.
32 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSObtain informed consentThe Victorian Charter of Human Rights statesthat ‘Consent must be voluntary, and the personmust be given sufficient information aboutassessment to make a decision’. This is knownas informed consent. Other state and territoriesuse different words in official policy. For example,in Queensland the term ‘informed decisionmaking’ is preferred, as it implies a less passivetransaction for service users. There is a broadrange of definitions that reflect the ethical, legaland practical conceptions of this term. Peoplehave a moral right to autonomy over their ownbodies.Record of service user’s decisionsYou must obtain a record in writing of any informed decision that the person who youare assessing has made. The record of consent must detail exactly what the personhas consented to. If you need to share the assessment results, you must inform theperson about where results will be shared, and the purpose of sharing results. Youshould file a record of consent according to organisational policies. The requirementprotects the legal and ethical rights of service users, protects organisations andimproves communication between service users and the people who providehealthcare or support services to them.The following outlines the requirements for obtaining individual consent.
prerequisites
XX Information, competence, willingness, understanding and voluntariness
Decision-making process
XX Willingness and ability to analyse and make decisions
outcomes
XX The right to accept or reject assessment
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 33TopiC 1 PREPARE FOR ASSESSMENT
Example
organise practical aspects of assessment in consultationThe process of organising practical aspects of assessment in consultation issummarised here.need for assessmentIdentify the need for assessment; refer to workplace procedures and guidelines.Select toolIdentify most appropriate type of assessment and assessment tool by referringto workplace procedures and guidelines.Ability to consentDetermine the following:XX Is the person is physically, emotionally and intellectually capable ofundergoing assessment? Arrange support or advocacy if required.XX Can the person give their informed consent? If not, a family member orguardian may be required to consent.XX Is the person willing to undertake assessment process?offer to arrange supportIf appropriate, offer the following support persons to attend assessment:XX InterpreterXX AdvocateXX Family member or friendXX CarerXX Cultural or spiritual support personexplain the assessmentExplain the type of assessment that will take place, the purpose of assessment,how you will conduct the assessment and how results and personal informationwill be disseminated to other relevant parties.obtain supportObtain written informed consent on agency-approved consent forms. This shouldoutline exactly what is the person is consenting to.Arrange timeNegotiate an appropriate time to conduct the assessment in consultation withthe person and other parties attending. Consider factors that may influence thereliability and validity of the assessment.
34 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS
Arrange locationIdentify the most appropriate location in negotiation with all parties attending,taking into account safety, the type of assessment, privacy and other factors thatmay influence the validity of the assessment. Consider factors that may influencethe reliability and validity of the assessment.Arrange resourcesArrange the use and availability of any equipment and resources required toundertake the assessment.Send remindersSend reminders prior to assessment. Refer to workplace procedures andguidelines for approved reminder process.Take your timeMake sure you allocate enough time to set up and conduct the assessment. Ifthe assessment is rushed, the person may feel uncomfortable or uneasy and youmay miss valuable information.
Practice task 41. Obtain a copy of the privacy policy from the organisation you work for, or anorganisation that conducts assessments. What privacy principles does the policycover?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 35TopiC 1 PREPARE FOR ASSESSMENT2. Speak with your supervisor, or the supervisor at an organisation with whichyou are familiar, and investigate how people consent to personal informationand assessment results that is shared for assessment purposes. Write a reportoutlining the process for obtaining consent.Click to complete Practice task 436 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS1E Provide information about the assessment process and obtainconsentWhen conducting a needs assessment, it is important to make the person awareof their right to privacy and relevant organisational policies and procedures. Tounderstand privacy is empowering for the person, and gives them the confidence toshare necessary information. It is also important that the individual consent to eachstage of the process, including the release of assessment result to other services. Thisis an ethical requirement as well as the person’s basic right.Explain privacy principlesPrior to assessment taking place, the assessor should inform the person about theirright to privacy and confidentiality.The Privacy Act 1988 (Cth) protects the individual’s right to privacy of information.The Act identifies 13 Australian Privacy Principles (APPs), which regulate howagencies must manage personal information. These must be applied throughout theassessment process.Privacy, confidentiality and disclosureWhen discussing an individual’s situation, alwaysbe aware of maintaining their privacy. You mustprotect confidential details. You always need theindividual’s consent if you wish to talk about theirsituation. Often people are happy to give theirconsent because they know you want to help.Maintaining confidentiality is part of respectinga person’s privacy and individual rights. Inpractice, confidentiality means not discussingan individual’s personal information unless theyhave given their consent. There are exceptionalcircumstances that do enable you to discloseprivate information, but this is generally only when you become aware that someonemay be harmed.You can read more about privacy, confidentiality and disclosure at the following site:XX http://aspirelr.link/law-handbook-privacy-confidentialityPrivacy regulationsAccording to the Privacy Act 1988 and the Information Privacy Principles (IPPs), theindividual is entitled to have personal information protected.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 37TopiC 1 PREPARE FOR ASSESSMENT
Service providers have a legal and ethical obligation to adhere to these principles
1
Manner and purpose of collectionInformation obtained from the individual must be necessary and obtainedfairly. If the person has difficulty communicating, you may need to engage withan interpreter or advocate.
2
Collecting information directly from individualsYou need to inform individuals of the reason for the collection of information,the privacy laws that apply, and to whom you may disclose the information.Prior to conducting assessment, you should clearly explain the assessmentprocess.
3
Collecting informationAgencies must ensure the information they collect is relevant, current andcomplete and is not collected in a way that is in any way intrusive. You mustensure assessment methods are appropriate and non-intrusive.
4
Storage and securityInformation must be stored securely to prevent loss or misuse. All informationobtained in assessment must be stored securely and not released without theperson’s permission.
5
Access and amendmentIndividuals must have access to their own information, and workers need tocorrect information if necessary.
6
Information useInformation must be accurate, complete and current, and used for relevantpurposes. You may only use this for purposes with the individual’s consent.
7
DisclosureThe agency must disclose policies about circumstances under which theywould give information to someone else.
Explain rightsEach sector and organisation you work for will provide an outline of the rights andresponsibilities of individuals – this should include information about their rights toprivacy. For example, the Charter of Residents Rights and Responsibilities, whichoutlines aged care residents’ rights and responsibilities, states that people have theright to personal privacy.
Know your organisation’s privacy policy
XX An organisation’s privacy policy is usually located on their intranet. You needto know any special circumstances under which workers can release personalinformation; for example, mandatory reporting of child abuse requires sharingpersonal information. In these circumstances, consult the agency’s disclosureprinciple in the privacy policy.
Explain privacy and confidentiality
XX Ensure the person understands what this involves. If they speak a language otherthan English, you may need an interpreter to communicate the information. If theperson has impaired cognitive or intellectual functioning, or is underage, consulta relative or guardian before sharing personal information. You must inform thelegal representative or guardian about the person’s right to privacy.
38 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSObtain consentPrior to the assessment, clearly explain to the person the assessment process, yourduty of care, and the organisation’s policy and processes for mandatory reporting.The strategies used to explain this information need to take into account the person’scomplex needs.There are factors may influence how you provide information to people.Factors include the individual’s:XX level of functioning and comprehension; for example, people with dementia requireadditional support, such as the presence of family membersXX mental health status; for example, do not attempt to conduct an assessment whena person is extremely agitated or experiencing delusionsXX cultural background and preferred language; for example, arrange for aninterpreter, translated documentation or cultural support.Informed consent prior to assessmentBefore assessment commences, the person must fully understand the process. This isan ethical and legal obligation. Without the person’s full consent, assessment shouldnot take place.The person must consent to:XX the assessment taking placeXX the purpose of assessmentXX how the assessment is conductedXX the dissemination of results and personal information to other relevant parties.
Example
provide information about assessmentThe following is an edited excerpt from the Aged CareAssessment Guidelines (2015). Later sections in thisdocument address the need to obtain consent in writing,and the procedures to follow when a person cannotprovide informed consent.Aged Care Assessment Teams (ACATs) must obtainconsent from the person/guardian prior to undertakingan assessment. The ACATs must ensure that peoplereferred for an ACAT assessment understand whatthe assessment process involves and their rightsand responsibilities. ACATs should explain the role of both themselves and serviceproviders when obtaining the person’s consent to the assessment, and inform themthat information ACATs gather will be provided to appropriate service providers.Before contacting the individual’s General Practitioner (GP), other healthprofessionals, or family members/carers as appropriate, the ACAT should ask theperson for, and obtain consent from them, to do so. The ACAT should document this.You should also make the person aware that the information gathered on the AgedCare Person Record (ACCR) is part of a national, de-identified data set, which assistsin the monitoring and management of the Aged Care Assessment Programme.From Aged Care Assessment Guidelines; reproduced with permission of the Australian Government.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 39TopiC 1 PREPARE FOR ASSESSMENTPractice task 5Read the case study, then answer the questions that follow.
Case study
A community services agency is assessing a community member, Kostya, who wasidentified in an anonymous report as living in a hoarding situation. The house isdilapidated. Car and truck parts are in piles in the front garden.Erik, the assessor, contacts Kostya, who is strongly resistant to assessment. On thethird attempt, Kostya agrees to make an appointment.On arrival, Erik establishes rapport by remaining non-judgmental and makingKostya feel comfortable. He sits down with Kostya and explains the assessmentprocess clearly. He says he would like to ask Kostya some simple questions abouthis past living situations and hoarding tendencies, medical history and currentliving situation.Erik also explains that, depending on the results of the assessment, Kostya maybe eligible for mental health care assistance and funding, and support to reducehis hoarding tendencies. He explains the importance of addressing the issue,as hoarding and squalor pose a serious health and safety risk to Kostya and hisneighbours.Erik invites Kostya to ask questions about the assessment process. He also seeksKostya’s consent. Although Kostya appears uncomfortable, he agrees to theassessment process.
1. What factors would Erik have considered before seeking to obtain Kostya’s consentto assessment?2. List four elements of the assessment process that would require Kostya’s informedconsent before any assessment takes place.40 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS3. Which element did Erik fail to explain when obtaining Kostya’s consent?Summary1. Refer to organisational policies and procedures when identifying and preparingassessment tools and processes.2. Gauge the need for assessment prior to assessment taking place.3. There are four types of assessment approaches: strengths-based; domain-based;norm-based; and competency-based.4. Existing information about an individual can be gathered from a variety of sources.Ways of collecting information include:XX interviews with the personXX questionnairesXX specific screening toolsXX speaking with the person’s family members, guardian, carers and friendsXX speaking to other care workers and service providersXX observing the individual.5. Follow your organisational guidelines to request additional information fromspecialists or other sources to determine the range of issues that may be affectingthe person.6. Assessment approaches may be used in conjunction, and should be suitable forthe purposes of the assessment.7. Use a problem-solving approach when analysing information about existing issues.8. The location of the assessment can affect the results. Prior to the assessment,arrange an appropriate environment and a time that suits all relevant parties.9. Explain assessment process prior to obtaining consent and consult with the personwhen organising assessment.10. Make the person aware of their right to privacy and any relevant organisationalpolicies prior to assessment.11. The person must grant informed consent before assessment is conducted or anypersonal information is shared.Click to complete Practice task 5UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 41TopiC 1 PREPARE FOR ASSESSMENTLearning checkpoint 1Prepare for assessmentThis learning checkpoint allows you to review your skills and knowledge in preparingfor assessment.1. List four assessment tools in the following table. Identify the assessment type foreach tool and explain the purpose for use of each assessment tool.
Assessment tool
Assessment type
purpose ofassessment
2. How can an assessor ensure that assessment methods are reliable and valid?42 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS3. In relation to preparing for a holistic assessment of the needs of a person you aresupporting, answer the following:a. What domains must you consider when applying a holistic approach toassessment?b. What are five factors that will determine whether there is a need to conductassessment?c. What methods/processes will you use to gather information?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 43TopiC 1 PREPARE FOR ASSESSMENTd. Which organisational policy and procedures will you follow?4. According to the Privacy Act 1988 and the Information Privacy Principles (IPPs),a person is entitled to have personal information protected. Explain how thelegislation and IPPs apply to the following:a. The manner and purpose of collection of informationb. Collecting information directly from individualsc. Collecting information generallyd. Storage and security44 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSe. Information usef. Access and amendmentg. Disclosure5. Explain the process for and importance of gaining informed consent when planningassessment and disseminating information.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 45TopiC 1 PREPARE FOR ASSESSMENT6. List two practical aspects of assessments that should be considered whenplanning assessment. Who should be consulted when organising these practicalaspects, and how would you would organise them?7. How would you seek additional assistance from other specialists or sources toobtain information about the person being assessed? What types of informationmight you request in order to determine the range of issues that may be affectingthe person?8. List two specialist service providers that a person may be referred to forassessment. For each, provide an example of the type of assessment they arecapable of conducting.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 47Topic 2In this topic you will learnhow to:2A Work within scope ofown role2B Empower the person toidentify and prioritisetheir own needs2C Evaluate needs2D Identify and analysecomplex, multiple andinterrelated issues2e Evaluate issues ofurgency and eligibility2f Assess potential riskfactors for servicedeliveryAnalyse the person’sneedsThe analysis and prioritisation of needs identified duringassessment should be undertaken in collaboration withthe person and, if necessary, through consultation with aspecialist. A specialist’s input is of particular importanceif the person’s needs are complex and urgent. Oncethe needs are identified, information about availableservices can be compiled and the person’s eligibility toaccess the services can be determined. Decisions abouthow to proceed can then be made by the person.48 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2A Work within scope of own roleIt is imperative when assessing individuals with complex needs that you understandthe limitations of your work role and expertise. Community service providers have aduty of care to the person accessing their service and teamwork is often necessaryto meet this requirement. Operating outside the scope of your work role or level ofqualification poses the risk of a failure in your duty of care to the person. Where aperson needs assessment or services beyond your scope of practice, the individualmust be referred to a service that is better suited to meet their needs. If this occurs,you will need to liaise with and report to the people or agencies responsible for theassessment. Some individuals with complex needs can be a risk to themselves andothers, so if assessment is beyond your scope of practice, you need to seek assistancefrom colleagues, senior staff and/or experts in the area.There are a range of factors and guidelines that determine the limitations of your workrole and responsibilities in assessing and addressing needs. These are outlined here.
your assessment role and responsibilities
XX Your position description
XX The organisation’s policies and procedures
XX Your qualifications and accreditation
XX Your duty of care
XX Legislation
XX Scope of practice
Position descriptionYour position description details:XX the purpose of your roleXX main dutiesXX reporting requirementsXX responsibilities and outcomesXX capabilities, behaviours andknowledgeXX the experience and minimumqualifications required to effectivelyperform your role.Your position description is a key document to refer to when seeking clarification aboutyour limitations in assessing and addressing people‘s needs.Organisational policies and proceduresThe limitations of your role will also be guided by your organisation’s policies andprocedures. These specify what your organisation is capable of assessing.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 49TopiC 2 ANALYSE THE PERSON’S NEEDSHere is some more information about working within your organisation’s policies andprocedures.
Assessment tools
It is important to only use assessment tools and procedures that have been adoptedor approved by your organisation. This means you are fulfilling your responsibility tothe organisation and meeting your duty of care obligations to people who access yourservice and others.
your training
It is your organisation’s responsibility to ensure you have the necessary trainingand/or accreditation to assess people with complex needs. If a person’s needs falloutside the criteria nominated by organisational policy (for example, individualsunder the age of 16), consult your supervisor to determine an appropriate referral.
Qualifications and accreditationSome forms of assessment require you to hold specific qualifications or accreditation.Here are some examples of the types of qualifications required to undertake specificassessments.
Type of assessment
required accreditation
The Wechsler Adult Intelligent Scale– FourthEdition (WAIS-IV)
Clinical psychologist
The Wechsler Preschool and Primary Scale ofIntelligence–Third Edition (WPPSI-III)
Clinical psychologist
Clinical (physical) examination
Medical professional (nurse,registered nurse, doctor)
Physiotherapy assessment
Accredited physiotherapist
Maintain qualificationsQualifications and accreditations must be keptup to date. For example, clinical psychologistsneed to accumulate a certain number ofprofessional development points annually byattending conferences and training and fulfillingsupervision requirements to maintain theiraccreditation. Professional bodies, such as theAustralian Psychological Society (APS), determineaccreditation requirements. Consult with yoursupervisor or relevant professional body todetermine the accreditation requirements of yourjob role, as assessing persons outside your scopeof practice can have serious legal consequences.50 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSScope of practiceCommunity services workers are bound by the rules of scope of practice. These rulesare set out in your organisational policies, procedures and guidelines; limitations ofyour qualifications; relevant legislation; and guidelines of some professional bodies.It is imperative that community services workers understand and adhere to theparameters set out in the most current laws and guidelines to work within their scopeof practice.Some community services workers have qualifications that extend their scope ofpractice by allowing them the ability to carry out a boarder range of tasks. Often anindividual with complex or specialised needs will require services that fall outsideyour own scope of practice. In circumstances where this occurs, the person will needreferral to a suitably qualified or specialist service provider. If you are unsure if a taskis within your own scope of practice, consult your supervisor or the regulatory body ofyour field of work.Needs that you may identify as beyond your scope of practice include:XX an assessment you are not qualified to conductXX a person requiring medication to be administered; for example, a sedativeXX a person committing a criminal offence, such as assault or sexual abuseXX a suicide in progressXX an underage personXX a person who is violentXX a person who is placing you in imminent dangerXX a person who is in imminent danger.Deal with behaviours of concern within your own scopeof practiceIt is important to be aware of your own scopeof practice when dealing with behaviours ofconcern. Multiple and complex issues cansometimes result in behaviours of concern,which include aggression, violence, insults andinappropriate sexual behaviour. Dealing withsome behaviours of concern may be beyond thescope of your qualifications and training, and yourorganisation’s responsibilities.Restraining people can only be done undercircumstances mandated by the organisationalprotocols. You must be trained and only use therestraining practices you are trained to use. Where possible, use alternative methodsof responding to behaviours of concern. If the person, staff or others are at risk, youshould contact emergency personnel and/or the police.Seek assistanceThe information you gather about the existing needs and issues of individuals willguide your decision to seek assistance. If there is no risk of imminent danger, but theperson’s needs fall outside your scope of practice, consult your supervisor about howUNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 51TopiC 2 ANALYSE THE PERSON’S NEEDSto proceed with a referral. If you are unsure about whether the person’s needs arewithin your scope of practice, consult your supervisor, colleagues or experts in thefield.It is essential that you understand the roles and responsibilities of a variety of serviceproviders in order to determine the most appropriate service provider or specialist tomeet the person’s needs. If you are unsure about which service to refer to, consultyour supervisor, organisational policies and procedures or contact professional bodies.In some instances, referral agencies can clarify the most appropriate referral options.If a person is in imminent danger to themselves or others, consult emergencypersonnel and your supervisor immediately. Most facilities have an alert button to usein the case of an emergency to notify others you are in danger. If you are conductingan assessment in the person’s home, ensure you have access to a working mobilephone and always have an escape route planned. For example, try to position yourselfbetween the door and the person you are assessing.
Example
Work within scope of own roleAntonio works for Aged Care Assessment Team (ACAT)and is required to conduct a complex assessment of anindividual, Graham. During the assessment, Grahamcomplains about feeling dizzy. He then explains he hasType 1 diabetes and requires an insulin injection. Heasks Antonio to assist him with the injection.Antonio is not sure whether this is within his positiondescription. He uses his mobile phone to contact hissupervisor. His supervisor tells him that he cannotassist Graham with an insulin injection, as it is not in hisposition description and he does not have the necessary training. Graham is unable toadminister the insulin himself, so Antonio seeks assistance by calling Nurse on Call.He decides that if the situation escalates he will call 000.
Practice task 61. What are three factors and guidelines that determine your roles andresponsibilities with regards to conducting assessment?52 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2. List two examples of qualifications that are required to perform specificassessments.3. List three examples of needs that may be considered beyond your scope ofpractice.4. Provide an example of teamwork being necessary to fulfil duty of care requirementsfor a person you are providing support to.Click to complete Practice task 6UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 53TopiC 2 ANALYSE THE PERSON’S NEEDS2B Empower the person to identify and prioritise their own needsWhen a person with co-existing needs presentsfor assessment, they can sometimes find theexperience quite daunting. There are a rangeservice specific processes and procedures inplace that may be unfamiliar to them. The personmay be required to navigate through a variety ofdifferent services. Staff often possess an indepth knowledge of their area of expertise dueto extensive training and experience, whereasthe person’s own knowledge and experienceabout these things may be limited. The way that aperson is engaged by staff can also impact on theperson’s sense of power and control.Circumstances where a person feels a loss of power or control lead to a sense ofreliance upon staff, incapacity and uncertainty. The way staff engage and interact withthe person, and the approach that is taken when conducting assessment can greatlyreduce these feelings of disempowerment. The support worker plays a vital role inempowering a person to identify, prioritise and make decisions about their own needs.Ensure individuals are assisted to identify their ownneeds and risk factorsWherever possible, encourage people to identify their own risks and needs. Thisincreases the likelihood that they will participate in intervention and engage withservices. For example, a person with support needs is asked to identify their ownneeds and risks. They say they need support with showering and bathing, and possiblysupervision when preparing meals. They are worried about falling when using theshower or spilling hot substances when cooking. The person and the care worker canwork collaboratively to develop appropriate solutions.Assessments can be intimidating. Engaging people with support needs to participatecan minimise their distress and resistance to assessment. It also produces moreaccurate results, as the person is given the opportunity to express their specific needs.DisempowermentDisempowerment in community services relates to acting in ways that demoralisethe person with support needs and the ultimate decline of their human rights. Whilecare workers generally have the best interest of the individual at heart, they mayoccasionally act in a way that disempowers the person they are providing supportto. Working in such a way can say a lot about the care worker – they may be trying toexercise personal power by taking power from others, or they may be acting throughignorance. A worker acting in this way might believe they are doing the best theycan for a person by doing everything for them; however, this approach is just asdisempowering because it can lead to further dependency, a lack of control for theperson being supported and the individual’s rights not being upheld.54 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSHere are some tips to help workers develop an empowerment practice.
Reflect on your practice
XX Ask yourself, “Did I provide services in ways to do myself out of a job?” If youanswered ‘no’, you need to ask yourself why. Check your approach to your work.
empathise
XX Think about how you would want to be treated if you were in a roles werereversed with the person you support. Would you want people providing supportin ways that stripped you of your dignity and personal control over your own life?If you think you be acting in this way, consider how you can change your practice.
find a mentor
XX Talk to your supervisor and ask them to mentor you to build the skills towork from an empowerment model. Make a time to meet regularly with yoursupervisor to discuss how well you have handled situations. Be honest withyourself.
EmpowermentAs a professional working in the communityservices sector, you will work using anempowerment approach to support people.Empowerment refers to a state that people arriveat, that sees them take control of their own lives.A large number of people in receipt of supportservices are often vulnerable because of theircare needs and the myths and stereotyping thatoccurs.Your approach to your work should always bebased on trying to ‘do yourself out of a job’ andif your focus is to provide information, resourcesand support to assist people to build capacity, gain confidence and take controlof their lives, then you will always be working to uphold people’s rights through anempowerment approach.Empowerment through communicationUse communication skills to establish rapport before assessment is conducted. It isalso important to use effective verbal and nonverbal communication and interpersonalskills to identify and clarify the person’s needs. Positive, strengths-focused languageshould be used. Avoid using stigmatising language and be cautious not to uselanguage that is authoritative; for example, use the term ‘collaboration’ rather than‘intervention’. Effective communication is vital to providing information to enhance theperson’s knowledge and understanding of the assessment process, the person’s rightsand the service options available to them. Knowledge gained from the communicationprocess will empower the person to make informed choices about their own needs.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 55TopiC 2 ANALYSE THE PERSON’S NEEDSUse interpersonal skills to identify needsPositive rapport can help to establish trust and make the person feel morecomfortable in the assessment environment, which will increase the effectiveness ofthe assessment. Good interpersonal skills are central to establishing this rapport.Here are examples where interpersonal skills are used to effectively clarify complexneeds.
empower the individual
A family is being assessed for multiple needs following a report of domesticand child abuse. The assessor uses language like ‘collaboration’ rather than‘intervention’. She takes a strengths-based assessment approach and focuses onthe resources the family already has access to.
Collaboration
A person with a disability is being assessed to live independently. The case managercollaborates with the person during the assessment by asking them open-endedquestions and to identify possible needs and solutions and existing strengths andresources.
Being polite
A person is being assessed in their home. They have paranoid schizophreniaand are very cautious around people they don’t know. The assessor arranges anappointment, knocks on the door, thanks the person for letting them in and politelyexplains the reason for the assessment and how it will be conducted. The assessorgives the person plenty of personal space.
respect and dignity
An older man is being assessed in hospital. The man is very nervous and concernedabout being moved to a higher care residence. The assessor closes the curtainaround the bed for privacy and asks how the person is feeling, listening attentively.When they say they are worried about the outcomes, the assessor validates andnormalises their experience.
Confidentiality
A person being assessed for drug and alcohol use and mental health issues uponadmission to a rehabilitation centre is concerned about being caught by the police,so does not disclose truthful information. The assessor informs the person abouttheir right to confidentiality and reminds them of the assessment’s purpose and howthe results will be used.
Ask appropriate questionsBy asking appropriate, open-ended questions, the assessor can identify the needsof the individual. Open-ended questions give the person the opportunity to answertruthfully. If the assessor guides the person by asking a directive question such as,‘Do you feel safe living at home?’, the assessor can impart their own judgment on theperson and influence their answer.56 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSClosed questions can be useful for clarifying information, and are particularly usefulin an emergency situation. For example, if a person has vaguely indicated that they donot feel like living any more, an appropriate closed question would be, ‘Are you thinkingabout committing suicide?’
open-ended questions that may be asked in a complexassessment
XX How have you felt in the last week?
XX How are you feeling now?
XX How would you describe your state of mind at this moment?
Dignity of riskThe rights of people to dignity and choice, upheld inlegislation and service standards, also require that duty ofcare or safety is not used as a reason to limit a person’sfreedom or personal choice. A support worker’s adherenceto duty of care and safety must be coupled with the conceptof dignity of risk, which means that a person has the right tomake their own choices and to take risks.Rights-based approachesAs services evolve to provide support to people with care needs, their models ofservice delivery continue to further develop to support people‘s rights and qualityof life. The rights-based approach was initiated in the disability sector in the late1970s, and was based on the work done around social role valorisation (SRV) ornormalisation.The rights-based approach focuses on people being able to access and enjoy the samerights as other people in the community.Here are some examples of how a rights-based approach applies when providingservices.
rights in practice
Opportunities to participate in elections. The person may require assistance to get tothe voting booth.
Not being woken early to accommodate staff working schedules; that is, sleeping into a time that suits the person.
Having meals routines that suit the person, and not just according to staff workschedules.
Opportunities to celebrate milestones such as birthdays.
The right to develop relationships and express sexuality.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 57TopiC 2 ANALYSE THE PERSON’S NEEDSService modelsService models are industry-specific guidelines setout by an organisation, government department oragency. Service models are developed based on bestpractice and guide service priorities. In the communityservices sector, service models focus on a personcentred approach to service delivery, consumer-directedcare and flexible service models. All of these promoteempowerment of the person accessing the service.Person-centred practicePerson-centred practice (PCP) is a service model that places the person at the centreof their own care. The service responds to the whole person and focuses on a socialmodel of care rather than a medical model. A social model of care considers allfactors that affect or influence a person’s life (social, psychological, physical, cognitive,cultural), whereas a medical model focuses on the problem or illness.PCP philosophy embraces a process that sees the person making decisions abouttheir own care needs, which forms part of their human rights. Person-centred practicerelies on person-centred planning. This is where the person, or in instances where theperson cannot make sound judgements, their advocate, family and/or primary carer,state what they want their plans to focus on. The plans are driven by the person‘s goalsand aspirations. For example, the person can choose what service they want, the timethe service is given to them and when they how long they receive the service.Consumer-directed careKnown as CDC, consumer-directed care enables people with support needs (andtheir primary carer) to make decisions about their own care. In the past, thesedecisions have been made by service providers. It allows for flexibility in the timing andscheduling of services.This approach to service provision and model of funding is central to people havingchoice and control over their own lives. It is built on the premise of person-centredpractice, but with the added opportunity to use their funding to get the services theyneed and in ways that suit them.CDC is used in conjunction with programs such as home care packages.
How CDC works
XX Individuals have more say in the type of services, how they are delivered and bywhom.
XX Individuals direct their own care plan with the service provider based on owngoals.
XX Individuals direct how much involvement you want in managing the package.
XX Individuals are involved in monitoring and reviewing own package of care.
58 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSFlexible service modelThe flexible service model looks at how and where services are delivered. Servicescan be provided in a range of settings in aged care, such as transitional care, multipurpose services and innovative care, as well as providing support at a time that suitsthe person.Service systemsThere are many different funded programs and services that operate in this sectorto empower people with care needs. It is important that you understand what theseprograms are, why they are provided, what they do and who they are for. It may behelpful for you to understand how the program you work in is the same or differentfrom other programs. Programs change and funding is sometimes redirected byGovernments, so keeping up to date with what the service system can provide issomething you need to continually work on.Here are links to where you can get further information on service systems in yourstate or territory.
Queensland
XX Department of Communities, Disability Services andSeniors: http://aspirelr.link/community-services-qldXX Community support: http://aspirelr.link/communitygroups-qld
New South Wales
XX Community services directory: http://aspirelr.link/community-services-nswXX Family and Community Services: http://aspirelr.link/family-and-community-services-nsw
Australian CapitalTerritory
XX Functions and services directory: http://aspirelr.link/government-directory-act
Victoria
XX Community directories: http://aspirelr.link/community-directories-vicXX Service Seeker: http://aspirelr.link/service-seeker
Tasmania
XX Department of Health and Human Services – Find aservice: http://aspirelr.link/dhhs-tasXX Tasmanian government organisations: http://aspirelr.link/government-organisations-tas
South Australia
XX Find community organisations: http://aspirelr.link/community-organisations-saXX SA Directory of Community Services: http://aspirelr.link/sa-community
Western Australia
XX Department of Local Government and Communities:http://aspirelr.link/communities-waXX Communities and Vulnerable People: http://aspirelr.link/dss-vulnerable-people
Northern Territory
XX Department of Health: http://aspirelr.link/health-ntXX Department of Local Government and CommunityServices: http://aspirelr.link/housing-communitydevelopment-nt
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Example
empower the individual through assessmentSome community services sectors base their practice on a wellness framework. Thistype of framework is designed to empower the person by helping them to achieveas much self-management as possible by increasing functional gains, building theperson’s capacity and enhancing their autonomy.The following outlines the three approaches to providing support to people in receiptof support or care.Wellness approachXX The wellness approach focuses on minimising the impact of functional lossor not setting up further dependencies. The worker gets the person to doas much as they possibly can for themselves. Where the person requiressupport, the worker does the task with the person, rather than for them.XX The worker uses encouragement to get the person to do tasks they havedifficulty with, to increase their confidence and skill level at doing the tasks,or as much of it, themselves. This approach builds capacity and selfmanagement to support the person to retain as much autonomy as possible.XX The wellness approach also identifies whether there is an ongoing need forservices and how to assist the person to reconnect with the community.reablement approachXX The reablement approach works toward positive change in developing theperson’s ability to care for themselves. It builds on the person’s strengths(what they can do) by providing short-term intervention to support the personto regain their skills and abilities. This might include ensuring the person hasaccess to and can use assistive technologies and aids.XX Reablement is aimed at reducing or minimising the need for ongoingsupport.restorative care approachXX The restorative care approach is provided by a multi-disciplinary team tosupport the individual to make functional gains after a setback or illness.Services may include podiatry, speech therapy, physiotherapy, occupationaltherapy, nursing services, social work, speech therapy, diversional therapyand specialist services such as continence support.
60 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 7Read the case study, then answer the questions that follow.
Case study
Noni is an Indigenous Australian woman who is pregnant with her third child, andhas gestational diabetes. Noni has antenatal depression and a history of postnataldepression. She is a single mother and lives on a disability pension. Louise, a socialworker, is conducting an assessment to determine Noni’s current financial, mentaland emotional needs during her pregnancy and following the baby’s birth. Noni isafraid of losing custody of her children, and is worried about interventions takingplace that will affect her baby, such as needing to take antidepressant medication.Noni is resistant to assessment, so when identifying Noni’s complex needs, Louiseuses a range of interpersonal and language skills, including using open-endedquestions, active listening, reflection, paraphrasing and maintaining eye contact.Noni is resistant to assessment.
1. What skills does Louise use to empower Noni to identify and prioritise her ownneeds?2. Explain what Person Centred Practice (PCP) is? How has this model of care beenapplied in the case study? Could Louise do more to ensure that the Person CentredPractice is applied?Click to complete Practice task 7UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 61TopiC 2 ANALYSE THE PERSON’S NEEDS2C Evaluate needsIt is essential to take a holistic approach whengathering information for assessment. Thisapproach takes into account a number of domainsof health and functioning such as mental health,physical abilities, social needs or alcohol andother drugs (AOD) use. It ensures that a full rangeof relevant information is available to the assessorwhen conducting an evaluation of the person’sneeds. Evaluation of a person’s needs requires anunderstanding of the nature and impact of diverseand multifaceted needs and issues. You mustconsider how these issues and needs interrelate.Methods of evaluationEvaluation should take into account the person’s strengths and capabilities, availableresources and desired outcome. The person’s wishes, personal goals and prioritiesshould also be considered throughout the evaluation process. Apply analytical andcritical thinking skills to examine the full range of issues and needs identified, and toconsider the potential implications of issues for the person being assessed.Evidence-based judgements can then be made based on the complexity and priorityof needs and the nature and level of support required. Decisions are based on theassessment data, organisational guidelines and protocols and best practice guidelinesspecific to your sector.Here is more information on evaluation.
Consult the individual
XX When undertaking evaluation of a person‘s needs, it is important to gain aninsight into how a person perceives their own situation. What aspects of theirlife do they feel they require support? What aspects do they feel that they canmanage independently? What are their priorities? What outcomes do theydesire? This information should be used to direct the evaluation process.
Consult with specialists
XX In circumstances where issues or needs fall outside your own scope of practice,you may be called upon to work in consultation with a specialist to evaluate theperson‘s needs. Case conferences are an effective way of taking a multi-agencyapproach to evaluating a person’s needs. Case conferences are particularlyuseful in instances where a person has a diverse range of multifaceted issuesand needs. By bringing together specialists from a range of agencies, theperson’s needs can be examined and discussed to achieve a more holisticevaluation.
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examine information
XX When undertaking evaluation of a person’s, needs it is important to establishwhether the information/data collected is sufficient to cover the range ofdomains that require assessment. Information should be relevant to theperson’s current set of circumstances. The types of tools and processes usedto collect the information must be appropriate to the individual’s circumstancesand individual characteristic. For example, an age-appropriate assessmenttool is used when conducting a child health assessment to ensure that themost appropriate stages of development and milestones are covered by theassessment. Information must be valid, reliable and represent an accuratedepiction of the person’s level of functioning, circumstances and capabilities.
evaluate existing issues
XX Methods used to evaluate existing issues will vary depending upon theguidelines of the agency conducting the assessment, type of assessment beingconducted and reason for the assessment. Issues affecting the person must beidentified and examined to determine how these issues impact upon the needsof the person. The relationship between issues and needs should be establishedto identify cause and effect. Prioritisation of issues must be considered takinginto account safety and security, the person’s own priorities and the extent towhich issues are affecting a person’s life.
evaluate needs
XX Methods used to evaluate a person’s needs will vary depending on theguidelines of the agency, types of needs being assessed, types of assessmentand reason for assessment. Some agencies have guidelines and procedures inplace that outline the evaluation process. When evaluating a person’s needsit is imperative that the assessor possesses an in depth understanding ofphysical, psychological, social, cultural and spiritual needs of a person and theinterrelatedness of these needs. This knowledge will be applied when identifyingpotential and existing needs of the person being assessed, and when prioritisingthose needs.
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Example
evaluate needsThe following is an example of an evaluation process, which may vary depending uponyour agency guidelines and requirements.Here is an outline of the evaluation process.Evaluation process1Step 1: Gap analysisGap analysis is performed by identifying a current situation, comparingthe current situation with a desired or necessary situation, then identifyingthe difference (gaps) between these situations. This will aid in identifyingneeds and potential support service requirements.2Step 2: Identify prioritiesThe needs and potential support service requirements will be examinedand prioritised by taking into account significance of the need; severity ofthe need; impact of the need on other aspects of the person’s life; safetyand security; personal priorities and goals of the person being assessed;desired outcome; available resources; cost effectiveness and availabilityof funding.3Step 3: Identify aspects of the need to be addressedOnce a need has been identified, a more in-depth examination should beconducted to determine the specific aspects within the need that mustbe addressed. Consider the cause of the need and how it relates to otherneeds. Identify opportunities such as the existing capabilities the personhas, existing resources the person has access to and potential service andfunding options available.4Step 4: Identify possible solutionsDraw on your knowledge of the services and funding options availableto identify possible solutions to address the person’s needs. Consideralternative solutions and negotiate support options with the person andrelevant service providers.
64 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 81. Describe how you would apply the evaluation process when conducting a needsassessment, using a scenario form the workplace or one that you have researched.Outline what steps you would take to evaluate the person’s needs.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 65TopiC 2 ANALYSE THE PERSON’S NEEDS2. When examining information, what should the assessor consider?3. What should the assessor take into account when evaluating priority of needs?Click to complete Practice task 866 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2D Identify and analyse complex, multiple and interrelated issuesHaving multiple and complex issues can increase a person’s vulnerability and make itmore difficult to identify their needs. Consider the following definitions of multiple andcomplex issues.
people with multiple and complex issues
Those experiencing issues with two or more of the following:
XX Mental healthXX Alcohol and other drugs (AOD)XX ImprisonmentXX Child protectionXX Family violenceXX HomelessnessXX Poverty
XX HealthXX AgeXX DisabilityXX Behaviours of concernXX EmploymentXX Culture and religion
Assess needs
You need to identify and assess each complex issue individually. Purpose of theassessment; for example, to apply for funding or additional support services.Hierarchy of needs; for example, immediate safety, security, food and shelter, areprioritised over ongoing psychological support and a permanent housing solution.Immediate health and safety risks.
prioritise needs
Prioritising needs is determined by the nature of the organisation. For example, acentre concerned with assisting women living with domestic violence will prioritisethe woman and her children’s safety.Additional factors, such as drug or alcohol abuse, poverty or mental illness should beidentified and addressed incrementally, depending on the immediacy of the need.
The potential impact of dual or multiple issuesPeople with dual or multiple issues are some of the most disadvantaged people inAustralia. Complex issues increase vulnerability to other complex issues, leading tocomorbidity. Comorbidity is the presence of two or more coexisting mental or physicalconditions, disorders or diseases.
Common outcomes of comorbidity
XX Poor physical health, complex diagnoses and poor treatment outcomes, whichlead to greater impairment
XX A lack of social networks and support and a risk of homelessness
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XX Poor interpersonal relationships
XX Greater risk of violence and aggressive behaviour, including a greater risk ofviolence to self, such as self-harm, suicide or substance abuse
XX Resistance to change
XX A cycle of abuse
XX Disruptive, inappropriate behaviour, such as criminal behaviour or inappropriatesexual behaviour
Complex issuesIn the context of assessment, complexity can be viewed as having two elements. Thebreadth of need refers to dual or multiple needs that are interconnected. The depth ofneed refers to dual or multiple needs that are profound, severe or intense.Here is some information about what should be established and what could bedetermined in a complex needs assessment.
What should be established
In a complex needs assessment, the following should be established:XX The severity or intensity of each needXX The interrelationship between needsWhen planning service delivery, complexity of issues may cause a person to beineligible for the service. For example, a person with a mental health issue and adisability may be ineligible for mental health support because the service views theperson‘s disability and behaviour as the need to be addressed.
What should be determined
A person with Alzheimer’s disease, for example, may present with an AODdependency and depression. The needs assessment should determine the severityof the AOD dependency; the severity of their depression; relationship betweenAlzheimer’s disease, AOD dependency and depression; that is, how each affects theothers and which need demands priority.
Mental healthMental health issues can impact upon a person’s physical and social wellbeing.Depression, anxiety, mood disorder and psychosis can affect cognitive functionand behaviour. This may result in difficulty maintaining personal care, hygieneand nutritional needs; relationship breakdown; difficulty accessing or maintainingemployment; financial strain or homelessness.A general practitioner or health professional such as a psychologist or psychiatrist isresponsible for diagnosing mental health issues. You may, however, use appropriatescreening devices to identify whether mental health issues exist and their severity. Youmust be trained in using the screening devices and these must have been approvedfor use by your organisation. The individual must consent to their use.Here is more information about assessing mental health.68 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS
Assessment instruments
XX Examples of assessment instruments include the following:– The Beck Depression Inventory (BDI) – a 21-question, multiple-choice, selfreport inventory for assessing the severity of depression– The Geriatric Depression Scale (GDS) – a scale used to identify depression inolder people– The Caregiver Strain Index (CSI) – a tool designed to identify caregiver needfor support
use the interview process for screening
XX Tips for the interviewing include the following:– Pose open-ended questions, or closed questions such as ‘Does leaving thehouse makes you anxious?’– Ask probing questions for further information; for example, ‘You haven’tvoluntarily left the house for days. Can you help me understand this?’– Observe body language, tone of voice, personal hygiene and self-care.
refer undiagnosed issues
XX Mental health is often stigmatised. Be aware that people with mental healthissues may not reveal what they are experiencing. For instance, a person may bemotivated to disguise symptoms of depression because they feel ashamed. If youidentify a mental health issue that has not yet been diagnosed, refer the personto a relevant medical professional for a formal diagnosis.
ensure safety
XX If a person experiences a mental health episode, such as a hallucination or apanic attack in your presence, ensure the person is safe and help them to remaingrounded and in the present moment. Bringing the person’s attention back totheir breath is a helpful strategy for calming and grounding the person.
Consult the person and professionals
XX Always consult people with mental health issues to identify their needs. Thesemay include ongoing psychological support, ongoing support with medicationand coping strategies. With the person’s approval, you should also consult withthe person’s mental health professional and refer to existing medical history andrecords to help identify their specific needs.
Alcohol and other drugs (AOD)People with drug and alcohol addictions commonly experience mental health issuessuch as depression and anxiety. Mental health management is therefore oftendependent on minimising drug and alcohol consumption.AOD addictions or heavy use are also often linked with an increased risk of family andother forms of violence and child neglect and abuse.You need to work collaboratively with people to assess their immediate, short-term andlong-term needs. Be aware that the person may downplay drug or alcohol use for fearUNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 69TopiC 2 ANALYSE THE PERSON’S NEEDSof intervention or legal implications. Emphasise the person’s right to confidentialityand privacy, and remind the person of the importance of seeking support. A range ofscreening tools have been designed to assist with the needs identification process.Here is some information about two commonly used screening tools.
ASSiST
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) compriseseight questions and is designed to screen for all levels of use of risky substances,including tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants(including ecstasy), inhalants, sedatives, hallucinogens, opiates and other drugs.Scores are grouped into low, moderate and high risks, and are used to indicate whichinterventions are appropriate.
SDS
The Severity of Dependence Scale (SDS) is used to assess the degree of a person’sdrug or alcohol dependence. The SDS requires the person to rate their response toquestions, such as:XX Do you think your use of [drug] is out of control?XX Do you wish you could stop?
ImprisonmentCorrectional services have a duty of care toensure the safety and wellbeing of people undertheir care. People who are held in custody mayhave a range of multifaceted and diverse issuesand needs, such as existing mental health issues,AOD dependence, physical health issues, physicalor intellectual disabilities, behaviours of concernor gambling addiction. Correctional services arerequired to undertake assessment of the personupon intake to the service to identify needs andservices required.Risk assessments are conducted to identifyissues that may place the person, other inmates or staff at risk of harm and to identifychanging needs or risks. Assessments will also be carried out to identify service needsrequired to prepare the person for social integration upon release from prison.Each state or territory has their own department of corrections, guidelines on theassessment of inmates and approved assessment tools. The guidelines indicate who isresponsible for carrying out specific assessments. For example, in NSW a psychologistwho has been trained to undertake a Historical Clinical Risk-20 assessment (HCR-20)is required to conduct the risk assessment to determine the risk of harm a person maypose to others.You can read more about correctional services assessment tools at:XX http://aspirelr.link/compendium-of-assessments70 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSChild protectionChild protection involves the protection of all children and young people from harm orneglect. There are many different causes of harm that can have a detrimental effecton a child’s physical or emotional health, development and wellbeing. Forms of childabuse include neglect, physical, sexual or emotional. Children who require protectionare those who have suffered harm, are presently suffering harm or those who are atrisk of suffering significant harm. These injuries can impact upon a child’s mentalhealth. Children who suffer from abuse or neglect may experience effects of low selfesteem, anxiety, depression or PTSD. Neglect can impact upon a child’s cognitivedevelopment due to lack of adequate cognitive stimulation. Physical health may alsobe impacted due to poor nutrition, injury and lack of medical care.There are many factors that may contribute to child abuse, and poverty has beenconsidered the single best predictor of child neglect. Whilst these issues alone are notindicative that child abuse is occurring, in some instances they may impact upon theparent’s ability to ensure that a child is safe from harm or neglect.Here is more information about potential indicators of child abuse.
Lack of supportParents may have limited resources available to provide support,which can lead to feelings of being overwhelmed or stressed; aninability to cope; and social isolation.Social isolation of the parent or caregiver can occur due to a lackof support networks or family support, and may lead to feelingsof being overwhelmed, isolation, loneliness and stress, and aninability to cope.
StressFactors such as unemployment, financial pressures, poverty,relationship breakdown and homelessness can contribute to aperson’s stress. Mental health issues can impact on a person’s,behaviour, mood, emotional, cognitive and social abilities thatin some cases (but not all) may significantly interfere with theperson’s ability to provide adequate parenting skills, such assupervising a child or providing a safe hygienic environment for thechild.
Limited parenting skillsSome parents may not have an understanding of parenting skills orchildhood development; this may be the case in some (but not all)circumstances where they themselves may have suffered abuseor neglect as a child. In some (but not all) cases, a parent whohas an intellectual disability may have a limited understanding ofparenting skills and childhood development.
AoD dependenceUse of alcohol and other drugs can significantly impair a person’sreasoning and judgement, and affect a person’s behaviour,mood, social interactions and cognitive ability. These effects cansometimes limit the parent’s ability to supervise a child, provide asafe environment or provide for the child’s needs.
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family violenceIn circumstances of family violence, a child may be at risk ofemotional and physical harm, witnessing violence can have atraumatic emotional effect on a child. Being in the vicinity ofviolence places the child at risk of physical harm, this may be dueto a direct threat of abuse targeted at the child or an indirect threatwhereby the child is not the intended victim but may suffer injuryas a bystander.
Mandatory reportingEach State and Territory government is responsible for the administration andoperation of child protection services. Each jurisdiction has their own legislative Actsthat govern these services. It is essential that you understand your child protectionobligations and adhere to the processes set out in these Acts.Reporting suspected or known child abuse, neglect or maltreatment is mandatory inAustralia, although legislation varies slightly between states/territories. Exposure todomestic violence also requires mandatory reporting in some states and territories.You can read more about Child Protection and Mandatory Reporting in your State orTerritory at:XX http://aspirelr.link/child-protection-legislationXX http://aspirelr.link/mandatory-reporting-child-abuseFamily violenceDomestic abuse is considered violence, and is illegal. When assessing a person’sneeds, be aware of the many forms family violence can take.Here is further information about different types of violence in the home.
Violence in the home
1
PhysicalXX Physical assault; throwing objects and threatening with or using weaponsXX Locking out of property and damaging possessionsXX Withholding access to medical helpXX Murder
2
Psychological/emotionalXX Threatening suicideXX Emotional blackmail and eroding self-esteemXX Constant criticism and undermining character; humiliation; mind games
3
SocialXX Isolating from friends and family; preventing social outingsXX JealousyXX Monitoring phone calls and internet use; smashing or hiding mobilephone
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4
SexualXX Rape; pornography; sex in front of children; bestialityXX Denying use of contraceptionXX Forced abortion
5
FinancialXX Controlling finances; controlling expendituresXX Lying about money; gamblingXX Concealing assets
6
StalkingXX Excessive phone calls; continuous emailing or contact via lettersXX Driving past house unnecessarilyXX Following victim
7
SpiritualXX Disrespecting or ridiculing spiritual choices and beliefsXX Denying choices; imposing beliefsXX Preventing participation in worship
Impact of family violenceViolence in the home can severely impact a person’s sense of empowerment. Oftenthey feel responsible for the violence. A characteristic of violence in the home is theperson’s self-worth and self-esteem being worn down by the constant cycle of abuse,causing them to feel powerless and unable to leave the situation. Furthermore,threatening to leave their situation often increases their vulnerability to abuse.When working with people who are experiencing family violence, it can sometimes bedifficult to understand why they choose to remain in the situation. It is important toavoid judging the person; instead, seek appropriate advice and refer them to servicesthat can help.The key priorities when working with people experiencing violence are to:XX assess the person‘s safety and the safety of their childrenXX determine if threats of violence have been made, and the details of threatsXX assess the person’s internal resources, such as strength, resilience and selfesteemXX assess the person’s external resources, such as close friends and family memberswho are deemed safe to stay with, and access to transportation.HomelessnessThere are many factors that contribute to homelessness, which may include: poverty,family violence, relationship breakdown, unemployment, mental health issues, AODdependence and gambling addiction. Being homeless can have an impact on physicalhealth, mental health, ability to gain employment, personal safety and security,nutrition and hygiene needs and social interaction.Assessment methods and services vary depending upon the role of the agencyand the state, territory and region. There are many and varied government andUNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 73TopiC 2 ANALYSE THE PERSON’S NEEDSnon-government run programs to address homelessness. Some agencies provideassessment and referral, some are specifically focused on housing and others providefood, living essentials and financial services. Due to the multifaceted issues thatcontribute to and result from homelessness, it is essential that support is provided byway of a coordinated, multiagency approach to ensure that all factors contributing toand resulting from a person’s homelessness can be identified and addressed.People who are homeless may be living in the following places:XX Refuges, crisis accommodation or other temporary accommodationXX Couch surfing or staying with friends or family temporarilyXX Cheap hotels or living out of a carXX Overcrowded dorms or housesXX Buildings that fail to meet basic living standardsXX Boarding housesXX Caravan parksXX Public placesPovertyPoverty can significantly impact the needs assessment process. Some support optionsfor people may be unaffordable. It is important to understand what is meant bypoverty, and have a sound understanding of the service network that can be of somesupport to the person.There are a range of reasons why a person may be living in poverty, including mentalillness, drug and alcohol use or disability.You can read more about poverty in Australia at: http://aspirelr.link/acoss-povertyTake these factors into account when conducting an assessment.
Strategies for conducting an assessment
Focus on the person’s current situation; for example, determine the individual’scurrent income, expenses and employment possibilities.
Focus on the person’s resources; for example, identify the training and financialmanagement skills they currently have.
Empower the person; for example, help the individual identify resources, focus onstrengths and participation in decision-making.
Empathise with the individual’s unique reality; poverty is a different experience forevery person, so it is important to empathise with the individual.
Definition of healthIn 1946, the World Health Organisation (WHO) defined health as ‘a state of completephysical, emotional and social wellbeing, and not merely in the absence of disease orinfirmity’. This definition has become universally recognised. It is particularly relevantwhen considering how multifaceted needs and issues are interrelated, as it impliesthat a person’s health is not just based on their physical abilities or dysfunction.Instead, it focuses on a holistic concept that a person’s health is determined byphysical, psychological and social dimensions.74 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSHere are examples of ways in which aspects each dimension relates to and impactsupon the other.
physical health affecting wellbeing
XX Ways in which physical health can impact social and emotional wellbeing:– There are some illnesses that may cause delirium, confusion, agitation thatmay result in behaviours of concern, such as hypoxia, low blood sugar levels,fever.– Poor physical health can also contribute to social isolation, depression andanxiety.– Poor physical health can impact upon a person’s employment and financialstatus; this may be due to time absent due to illness or difficulty accessingemployment opportunities.
issues affecting physical health
XX Physical health can be impacted upon by mental health issues in the followingways:– Social issues such as poverty or homelessness can have an effect onphysical health, due to limited or no access to health services and unsuitableliving conditions.– AOD dependence may have adverse effects on the body resulting in illness orinjury, the effects of AOD on behaviour and cognitive function may increase aperson’s risk of injury.– AOD dependency can lead to an inability to maintain a sufficient standard ofhygiene, nutrition or personal care, which can impact on the physical healthof the person.
AgeThe age of a person has an influence on factorsaffecting their health and wellbeing. Throughoutthe lifespan, the types of issues a personexperiences will evolve. The impact of aging andfrailty on a person’s physical health may includerisk of falls due to decreased mobility, loss ofcognitive function or memory due to illnesssuch as dementia, visual impairment, hearingimpairment. Mental health may be impacted dueto social isolation, poor health or grieving. It isimportant to understand how a person’s needschange throughout the lifespan to ensure thatassessment is age appropriate. Age-appropriateassessment will take into consideration factors that affect a person at different stagesthroughout their life.You can read about healthy ageing and the determinants of health relating to olderpeople at:XX http://aspirelr.link/healthy-ageingUNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 75TopiC 2 ANALYSE THE PERSON’S NEEDSGrowth and developmentGrowth and development are the processes of maturation that occur from birth andcontinue throughout a person’s life. Growth is described as the physical changes thatoccur in the body throughout the lifespan, such as weight as height. Developmentis described as the psychological and social changes that a person experiencesthroughout their lifespan. Growth and development can be measured usingassessment tools based on benchmarks or milestones.Benchmarks or milestones are used as a guide to determine the rate of growthand development of a person. The benchmarks are a collection of physical, social,emotional or cognitive functions that have been proven to occur at certain stagesof the lifespan. It is important to keep in mind that these benchmarks should beused as a guide only, as no two people are the same. Growth and development mayvary, therefore an appropriate timespan should be allowed to assess benchmarkachievement.You can read more about developmental milestones at:XX http://aspirelr.link/developmental-milestonesDisabilityThe needs of individuals with a disability may differ depending on the type and degreeof the disability. Cognitive disabilities, such as an intellectual disability or dementia,can impact on the person’s ability to communicate. Physical disability can have animpact on a person’s mental health due to issues relating to body image and socialinclusion. When assessing the needs of a person with a disability, it is essential thatthey have the ability to understand and actively participate in the assessment process.If necessary, engage an advocate to represent them. A sign language interpreter mayalso be appropriate if the person is hearing impaired.A disability may be:XX mobile; for example, the person uses a wheelchairXX cognitive; for example, dementia or acute brain injuryXX learning; for example, dyslexiaXX a sensory impairment; for example, a hearing or vision impairment.Assessment and disabilityEnsure you adhere to the Disability Discrimination Act 1992 (Cth), which protectsindividuals against any form of discrimination.Here is some guidance on identifying needs.
What you need to review
To identify the person’s needs, you may refer to the following:XX Medical historyXX Records of interviews with the person or the person’s advocateXX Information gathered from family members and carersXX Recorded observation
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What you need to assess
You may also need to assess:XX the level of physical support required, such as mobility aidsXX the level of support required for activities of daily living, such as hygiene or mealpreparationXX whether funding is required for additional resources.
Behaviours of concernBehaviours of concern are behaviours that put the person and others’ safety at risk, orbehaviour that causes a person to be denied access to community facilities, servicesand experiences. These behaviours can impact the assessment process or hideunderlying issues and needs that require assessment, as outlined here.
Behaviours
Behaviours of concern include:
XX aggression and/or physical abuseXX resisting careXX abusive languageXX agitated repetitive acts and/orshadowing
XX inappropriate sexual behaviour orsexual harassmentXX taking unnecessary risksXX toileting issues.
reasons
Reasons behind behaviours vary greatly between persons. They may include:XX disabilitiesXX mental health issues, such as bipolar disorder, schizophrenia and delusionsXX medical conditions, such as dementia, which can lead to aggression andfrustrationXX drug and alcohol intoxication.
patterns
Observe patterns of behaviours of concern and identify situations or specific peoplewho trigger the behaviour, as this can help reveal the reason for the behaviour. Youmust always prioritise safety when dealing with persons with behaviours of concern.If the situation is escalating, and you, the person or others are at risk, you may needto involve security or emergency personnel, or use restraint if you are trained to do soand it is necessary.
Employment factorsThe economic health of an area is often associated with the level of unemployment.The amount and type of jobs available can be directly affected by the area’s economy.Other factors that have a potential to impact upon a person’s access to employmentinclude mental health, physical health, disability or illness, geographic isolation,education, homelessness and poverty.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 77TopiC 2 ANALYSE THE PERSON’S NEEDSIn order to protect people from discrimination and promote equal opportunity theCommonwealth, State and Territory Governments have introduced laws prohibitingdiscrimination. The Fair Work Act 2009 (Cth) is one of the many legislations enactedto address issues of equality. The act prohibits discrimination by employers or otheremployees on the basis of ‘race, colour, sex, sexual orientation, age, physical or mentaldisability, marital status, family or carer responsibilities, pregnancy, religion, politicalopinion, national extraction, and social origin’. The aim of this act is to ensure equity ofaccess to employment, protection from unfair treatment and equality for all employees.You can read more about Australian Discrimination laws at the following site:XX http://aspirelr.link/discrimination-laws-guideImpact of employment on health and wellbeingThere are many factors of a person’s health and wellbeing that may be influencedby undertaking paid work. The benefits of undertaking paid work include increasedphysical activity, decreased use of AODs, positive self-esteem, less financial stress, andan increased opportunity to participate in social engagement. These benefits promotepositive outcomes for a person’s health and wellbeing. However, it is important toconsider that work in high stress positions and working long hours can sometimeshave a negative impact on a person’s psychological and physical health, parenting andrelationships.The physical, psychological, social and economic impact of unemployment should alsobe considered when conducting assessment of a person’s needs. It is important tokeep in mind the flow on effects of these factors for other family members includingchildren.Here is more information on how unemployment can affect different factors of healthand wellbeing.
economicThe economic impact of unemployment may include:XX financial stressXX less money to access food education, health care and housing.
psychologicalThe psychological impact of unemployment may include:XX stressXX anxietyXX depressionXX suicideXX low self-esteem.
78 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS
physicalThe physical impact of unemployment may include:XX less money to access medication and health careXX increased risk of diabetesXX obesityXX heart diseaseXX respiratory illnessXX AOD useXX poor nutritionXX inactivity.
SocialThe social impact of unemployment may include:XX isolationXX homelessnessXX relationship breakdownXX family violenceXX poverty.
Culture and religionWhen conducting an assessment with a person from a culturally and linguisticallydiverse (CALD) background, it may be necessary to access interpreting services. Wherepossible, persons from CALD backgrounds should also be linked to resources andservices provided by their community.A holistic assessment should take into account the person’s spiritual and culturalneeds. Failure to address these needs can impact upon a person’s overall health andwellbeing. Some implications of failure to address these needs may include; socialisolation, confusion, fear, uncertainty, embarrassment, humiliation, poor nutritiondue to inappropriate diet offered, misunderstandings, conflict, stress, anger anddepression.Specific needs may relate to:XX languageXX cultural norms, such as communication stylesXX dressXX foodXX religion and spiritualityXX social connections with others from a similar cultural background.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 79TopiC 2 ANALYSE THE PERSON’S NEEDSIndigenous Australian heritageHaving an Indigenous Australian backgroundmay increase a person’s vulnerability tomultiple and complex issues. For example,Indigenous Australians have a higher rate thannon-Indigenous Australians of incarceration,disability, and alcohol and drug abuse. IndigenousAustralians also have a significantly lower lifeexpectancy due to health problems, disability andpoverty.If possible, link people of Aboriginal and TorresStrait Islander background to resources andservices, including assessment services, providedby Indigenous Australians. There are cultural issues, such as communication styles,language and spirituality, that Indigenous Australian people will be mindful of.
Example
Complex, multiple and interrelated issuesWhilst the World Health organisation (WHO) definitionof health takes into account physical, psychological andsocial dimensions of health, there are many other factorsthat impact on a person’s health. These factors arereferred to as the social determinants of health. In 2013,the WHO identified the social determinants of health asbeing the ‘conditions to which people are born, grow, live,work and age’. This view takes into account the social,economic, political, cultural and environmental factorsthat influence and impact upon a person’s health and thehealth of communities as a whole.Understanding the social determinants of health and how the dimensions of healthinterrelate is essential when conducting assessment. Being able to apply thisknowledge will enable the assessor to identify how a person’s health needs arerelated and what contributing factors must be considered and addressed.You can learn more about the social determinants of health and how all of thedimensions of health interrelate at:XX http://aspirelr.link/australias-health-2016
80 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 9Read the case study, then answer the questions that follow.
Case study
Clare is an Aboriginal lady who has diabetes and schizophrenia. Clare is homeless,unemployed and lives in poverty. She also has an alcohol addiction. She hasbeen referred for assessment for social services support. Sally is conducting theassessment. She has read Clare’s case notes and understands her medical historyand other relevant information.During their first meeting, Sally clearly explains the process of assessment. Sallysays she wants to identify Clare’s specific issues and needs. Sally explains that overthe next two sessions, she will use a variety of scales and interview questions todetermine the:XX extent of Clare’s drug and alcohol dependencyXX support that Clare requires to manage schizophreniaXX financial support requiredXX support required to find employment and appropriate housing.During the interview, Clare begins to get agitated. She is due to take hermedication. She throws one of the pens at Sally. Sally tries to remain calm. Shenotifies security by pressing the alert button. They come and check on Sally andClare. By this stage, Clare has calmed down, as Sally encourages her to take hermedication.
1. Identify the existing complex, multiple and interrelated factors and/or issues thatSally will need to address to undertake a holistic assessment of Clare’s needs.Present these according to category; for example, psychological factors/issues,and physical factors/issues.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 81TopiC 2 ANALYSE THE PERSON’S NEEDS2. Explain how each of these issues can interrelate.Click to complete Practice task 982 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2E Evaluate issues of urgency and eligibilityWhen assessing complex needs, one or more needs may demand more acuteattention than others. For instance, if a person is at risk of homelessness, theiraccommodation needs will demand more urgency than their other issues.Here are some issues to consider in assessing urgency.
urgent needs
Needs that demand urgent attention include the risk of:XX deathXX suicideXX harmXX homelessness.
Assessment processes
Multiple processes can be used to assess urgency. For example, you could interviewthe person to determine how likely they are to self-harm and whether they havemade plans to do so. Use this information in conjunction with case notes or medicalhistory. Other issues, such as AOD or mental health issues may increase a person’svulnerability, so these needs and their relationship to the acute needs must also beassessed.
emergency response
While assessing for urgency implies that an immediate response is needed, it isequally important that critical information is not overlooked. For instance, if theperson is suicidal, AOD issues should also be assessed, as they increase a person’svulnerability to suicide. In this situation, assess whether an emergency response isrequired and, if so, follow organisational guidelines for implementing an emergencyresponse.
Assess for eligibility for service deliveryAccessing services can be more difficult for people with complex issues, becauseone or more issues may deem them ineligible for service delivery. For instance, anAOD agency may not have the facilities or resources available to meet the needs of aperson with a severe intellectual disability.By maintaining a close working relationship with relevant service providers, you aremore likely to understand which services have the resources to meet a particular need.To keep track of the range of services available, attend service network meetings andlink into online service networks. Discuss the complexity and urgency of the person‘sneeds with the potential service providers. This is an efficient way of determining theperson’s eligibility for the service.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 83TopiC 2 ANALYSE THE PERSON’S NEEDSPrioritise delivery of servicesA person-centred approach using problem-solving strategies shouldbe used to determine how to prioritise services. Involve the personin discussions about prioritising services. Inform them about theassessment results, and which needs appear to demand priority overothers.Discuss options with person for meeting their needs. If a particularneed has been identified as a priority, focus your discussion uponservices that can meet this need. For example, mental health maybe prioritised, so discuss with the person the need to visit their GPto obtain a mental health care plan. Adopt a problem-solving approach to establishingwhich needs to prioritise.UnemploymentThe complex and interrelated factors that maycontribute to or result from unemployment mustbe considered when determining a person’sservice requirements. For instance, if a personwho is unemployed, homeless, has an untreatedmental illness and a physical illness, they mayrequire a coordinated multi-agency approach.Housing and financial services, medical andmental health services may all be required tosupport the person to address needs in order tocontribute to the person’s work-readiness.Employment services vary across the countryand include services run by private companies and not-for-profit organisations. Somespecialise in employment for certain groups of people: people with disabilities ormental illness, Aboriginal and Torres Strait Islander peoples, youth and refugees.The role of employment services may vary depending upon the type of serviceprovided, however the basic features of all service providers is to provide supportto the job seeker to broker job opportunities, identify suitable job opportunitiesfor the individual, help the person prepare for the recruitment process and obtainemployment.The Commonwealth Government of Australia initiated a service in 2015 calledJobactive, which service can be used to identify and access service providers in yourlocal area. You can learn about Jobactive, employment services in your area and othergovernment employment programs, at the following websites:XX http://aspirelr.link/jobactive-helpXX http://aspirelr.link/jobactive-searchv0257chcccs00484 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPhysical and mental healthThe Australian health system is a complex network of services, providers andorganisational structures that are designed to address the physical and mental healthneeds of the Australian population. The complexity of the health system is largely dueto the multifaceted needs of the community it serves, it is also tailored for optimalinclusion of all members of the community.The health system is made up of public and private providers, as well as governmentand non-government agencies. Some of the main staffing specialties includemedical practitioners of a variety of specialties, nurses, allied health professionals,psychologists and psychiatrists. Areas of operation include clinics, hospitals andcommunity settings such as a person’s home. Services delivered include, publichealth, preventative health, primary health care, hospital-based care, outpatientclinics, community-based assessment and care, and palliative care.In order to help people to navigate their way through the complex network of services,the Australian Government initiated the Australian Health Services Directory. The aimof this directory is to provide people with access to reliable and consistent informationabout their local physical and mental health services.HousingThe Commonwealth Government Department of Social Services provide fundedprograms to assist people who are homeless or need help to access affordablehousing. State and territory government deliver housing services to support people toaccess accommodation.Accommodation support options include:XX private rental assistanceXX private rental subsidiesXX temporary accommodationXX emergency temporary accommodationXX supported and crisis accommodationXX affordable housing for low to moderate income earnersXX social housing, including public, community and housing for Aboriginal and TorresStrait Islander peoples.Housing servicesA large selection of non-government providers provides a variety of housing services,including outreach support and access to refuge and hostel accommodation.Here is more information on state and territory housing services.
NSW
Department of Family and Community Services:http://aspirelr.link/housing-nsw
Vic.
Department of Health and Human Services:http://aspirelr.link/housing-vic
Qld.
Homes and housing: http://aspirelr.link/housing-qld
NT
Department of Housing and Community Development:http://aspirelr.link/housing-nt
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 85TopiC 2 ANALYSE THE PERSON’S NEEDS
Tas.
Housing Tasmania: http://aspirelr.link/housing-tas
WA
Department of Communities Housing: http://aspirelr.link/housing-wa
SA
Department for Communities and Social Inclusion:http://aspirelr.link/housing-sa
ACT
Housing and Community: http://aspirelr.link/housingact
Community supportThere is a vast range of community support services throughout Australia. Theseservices are provided by both government and non-government organisations. Theymay be office based or community based. The range of specialty areas covered bysupport services includes disability and carers, education, employment, family anddomestic violence, health, housing, legal, mental health, financial, older people,parenting, relationships, separated parents and travelling.The Commonwealth Department of Human Services Service Finder is an excellentresource to find and access information about support services in your local area. Tofind out more, visit: http://aspirelr.link/service-finder-dhsSocial inclusionA person’s set of circumstances can contribute tosocial disadvantage. Social disadvantage occursin instances where a person or group of peopleare deprived of the things that society perceivesas being essential such as education, health care,employment and money. Another contributingfactor to social disadvantage is social exclusion.Social exclusion involves instances where aperson has limited or no access to opportunitiesdue to lack of participation in social or communityactivities, lack of access to services and restrictedaccess to finances. All of these factors limitopportunities available to a person and impacttheir ability to get the most out opportunities.Social inclusion aims to overcome the person’s social disadvantage by enhancing aperson’s opportunities to participate in society. This can be achieved by increasingaccess to targeted services to help overcome any obstacles that have contributedto the person’s social disadvantage and support to achieve equitable access toopportunities such as education, training and employment.Education and trainingThere are a range of services to support education and training available throughoutAustralia. These targeted services address the needs of specific groups of people topromote inclusion, enhance learning and development and access to opportunitiessuch as employment and higher education. Services are tailored to address the needsof children, young people and adults.86 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSTarget groups for specific services may include people with disabilities, cultural andlinguistic diversity, refugees and Aboriginal and Torres Strait Islander peoples. Othergroups may include people living in areas that are socially disadvantaged due togeographical remoteness, poverty or high unemployment rates. Services are deliveredby Commonwealth, state and territory government, government and non-governmentorganisations.Here is more information on state and territory education and training services.
Commonwealth
Australian Government Department of Education and Training:http://aspirelr.link/det
NSW
Department of Education:http://aspirelr.link/education-nsw
Vic.
Department of Education and Training:http://aspirelr.link/education-vic
Qld.
Department of Education:http://aspirelr.link/education-qld
NT
Department of Education and Training:http://aspirelr.link/education-nt
Tas.
Department of Education:http://aspirelr.link/education-tas
WA
Education and Training:http://aspirelr.link/education-wa
SA
Department for Education:http://aspirelr.link/education-sa
ACT
Education Directorate:http://aspirelr.link/education-act
Financial supportFinancial pressures or disadvantage due to poor financial literacy, gamblingaddiction, unemployment, homelessness, illness or family breakdown can impactupon a person’s social, emotional and physical wellbeing. In order to addressfinancial disadvantage, the Commonwealth government has initiated a range offinancial support initiatives. These cover a variety of key factors that contribute tofinancial disadvantage. These include emergency or crisis relief assistance, financialcounselling, money management services, microfinance and matched savingsprograms and information services for retirement investment. There are a rangeof income support benefits available through Centrelink that have been tailored toaddress the financial needs of people from a variety of groups within the community,these include young people, unemployed, students, parents, older people, people withdisabilities, people of Aboriginal and Torres Strait Islander decent, refugees and peopleliving in remote communities.There are a range of non-government organisations that also provide financial supportservices within the person’s community. The types of services can range based on thecharter of the organisation. Services may be specific to the needs of particular groupswithin the population; for example, homeless, unemployed, youth, Aboriginal or TorresStrait Islander peoples, or people with a disability. Services may include financialsupport, food and essential donations, housing, financial counselling, counselling andsupport for gambling addiction.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 87TopiC 2 ANALYSE THE PERSON’S NEEDS
Example
prioritise delivery of servicesIdentifying and prioritising individual needs can be difficult. The ability of a person withsupport needs to think clearly and rationalise can affect their ability to prioritise theirneeds. Abraham Maslow’s hierarchy of needs may be a useful tool to assist with thisprocess.Use Maslow’s hierarchy of needs to help establish which needs are most important tothe person. The hierarchy is based on the premise that an individual must satisfy lowlevel basic needs before progressing to meet higher level growth needs.The person’s values and priorities may not be the same as yours. Remember that theyhave the right to decide what is most important to them.If a person with support needs is unable to make rational decisions independently,it may be necessary to involve their guardian, family member or carer. Bear in mindthough, that their feedback may reflect what the family member or carer would wantfor themselves in the same circumstances, rather than what the person wants andneeds.physiological:Breathing, food, water, sex, sleep, homeostasis, excretionSafety:Security of: body, employment, resources, morality, thefamily, health, propertyLove/belonging:Friendship, family, sexual intimacyesteem:Self-esteem, confidence, achievement,respect of others, respect by othersSelfactualisation:Morality, creativity,spontaneity, problemsolving, lack of prejudice,acceptance of factSelf fulfillmentneedsPsychologicalneedsBasicneeds
88 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 10Refer to two different cases of individuals with multiple issues, either from yourworkplace or researched on the internet. Write a one-page report to identify:XX the potential impact of dual or multiple issuesXX the difficulties these issues can pose when identifying and prioritising individualneedsXX strategies that can be used to prioritise needs.Click to complete Practice task 10UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 89TopiC 2 ANALYSE THE PERSON’S NEEDS2F Assess potential risk factors for service deliveryWhen conducting an assessment with a person who has multiple and complex needsor providing support needs, you may find yourself in an unsafe or threatening situation.It is therefore imperative to have risk management processes in place before anassessment is conducted.Here is some more information on the different aspects of rick management.
risk management
Identify hazards – objects, situations and processes that have the potential to causeharm to people, property or the environment.
Assess risks – the likelihood of the hazard causing harm to people, property or theenvironment.
Control the risks – determine appropriate ways to eliminate or control risks.
Your duty of careDuty of care is your legal obligation to protect the wellbeing of those being assessed asfar as is reasonably practicable. If you identify that an individual or another person isat risk of harm, you are legally responsible to act in a way that minimises this risk.You must uphold your duty of care when conducting complex assessments. If you areunsure of how to respond to minimise risk, immediately consult your supervisor oremergency personnel.Identify hazards and rate risksA risk assessment involves thoroughly reviewingan environment to identify hazards. In the contextof assessment, this involves assessing the risksto you, the person or others present. When ahazard has been identified, you need to considerhow likely it is that the risks you have identifiedwill occur (the likelihood), and what the effectsmay be if the risk occurs (the impact). Then youcan decide what control measures should be putin place to effectively remove or control the risk.You can use a risk assessment matrix to evaluatea risk, where you assess likelihood and impact,and determine the level of the risk where theseintersect on the matrix.90 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSViolence in the homeIf a person is experiencing violence in the home, it is important to assess the risk ofharm to yourself and the person and seek to minimise risk and enhance the safety ofthose involved. Ask the person to provide a self-assessment of the potential dangerthey are in before the assessment. Risk management processes are of particularimportance if the risk is high, such as if an immediate threat has been made and theperpetrator’s whereabouts are not known.This risk of harm to a person may also be heightened if the abuser suspects theperson will leave them. From the abuser’s perspective, assessment is an undesirableand threatening option.
in cases of high-risk family violence assessment
XX Clarify whether it is safe to proceed with the interview.XX Conduct the assessment without the perpetrator present.XX Ensure the perpetrator’s whereabouts are known; if not, ensure the interview isconducted in a place where the victim will be secure.XX Make security personnel available to secure the premises or relocate the victimto a safe place.
Unpredictable behaviourThere are a range of reasons why a person may demonstrate unpredictable behaviour.It is important to be aware of the factors that can exacerbate unpredictable behaviour,particularly when scheduling an assessment. Here are some factors to consider.
reasons for behaviour
XX AggressionXX Dementia
XX Mental health issuesXX Alcohol and other drugs (AOD) issues
forms of aggressive behaviour
XX Shouting and/or cryingXX Physical abuse
XX DisorientationXX Walking away without explanation
exacerbation
XX Unfamiliar people and environmentsXX Changes in routines
XX Feeling frightened or humiliatedXX Feeling frustrated or confused
Minimise unpredictable behaviourAlways follow organisational guidelines when developing and implementing riskmanagement processes to minimise and respond to unpredictable behaviour. If it is ahigh-risk situation, such as if the person has recently committed or threatened assaultor violence, conduct the assessment with security present. You should have accessto an alert button and the ability to phone the police, if you require it. Here are somestrategies for minimising unpredictable and volatile behaviour.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 91TopiC 2 ANALYSE THE PERSON’S NEEDS
Strategies
The following may help to minimise unpredictable behaviour:XX Conduct the assessment in a familiar environment.XX Conduct the assessment with familiar people present; for example, a carer orfamily member.XX Clearly explain the assessment process to minimise confusion and surprises.XX Be assertive.
Containment skills
Containment skills can be used in a volatile scenario to help reduce a person‘sanxiety or aggression. This involves containing a person’s emotions to managethe situation so assessment can proceed. Grounding is an effective method ofcontainment in which you help the person come back to the present moment.Phrases such as, ‘Let’s sit down for a moment so you can focus on your breath’, canhelp the person feel grounded and contained.
Health and safety risksThe person’s needs and the context for assessment will determine where theassessment is conducted. Some assessment environments can be hazardous for theperson and possibly the assessor. A work health and safety (WHS) risk assessmentshould be conducted prior to assessments to identify any hazards in the assessmentenvironment and put control measures in place. Your organisation may require you tocomplete a hazard report. If the environment for assessment is deemed hazardousto either a person or a worker, and hazards cannot be removed or minimised, analternative location should be found.Hazards may include:XX poor lightingXX poor ventilationXX tripping hazardsXX unsafe electrical equipmentXX poor hygiene.Manage risk through assessmentEnsure that you manage the risks once identified. The following provides someinformation about health and safety risk management processes.
fire dangerXX Ensure fire equipment is located and up to date.XX Ensure fire exits are accessible.XX Ensure access to a telephone in case of emergency.XX Remove fire hazards.
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Medical riskXX Review person’s medical history and care plan.XX Ensure person has access to medication, if required.XX Ensure access to a first-aid kit and use required PPE.XX Maintain currency of first-aid certificate.XX Ensure access to a telephone in case of emergency.
Task hazardsXX Ensure task being observed is appropriate for the person beingassessed.XX Have access to first-aid supplies.XX Provide first aid, if required.XX Contact emergency services.
Self-harmXX Identify if the person has access to self-harm implements.XX Consult carer and relevant records about self-harm and risk ofself-harm.XX Consult the person if you believe they are at risk of self-harm.
SuicideXX Identify suicide indications, such as depression, talk of ‘endingit all’ and cutting off connections.XX Clarify intention to commit suicide by asking the persondirectly.XX Minimise risk by helping the person to move away from suicideaids, such as weapons or medication.XX Help connect person to resources to minimise risk of suicide.
Example
Assess potential risk factorsThe following is an example of a risk assessment matrix that can be used to assessthe potential risk of a work activity. Consider the likelihood and impact of a workactivity you have been involved in and use the following matrix to estimate the risklevel.LIKELIHOODVERY LIKELY Acceptable riskMediumUnacceptable riskHighUnacceptable riskExtremeLIKELY Acceptable riskLowAcceptable riskMediumUnacceptable riskHighUNLIKELY Acceptable riskLowAcceptable riskLowAcceptable riskMediumMINOR MODERATE MAJORIMPACT
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 93TopiC 2 ANALYSE THE PERSON’S NEEDSPractice task 11Read the case study, then answer the questions that follow.
Case study
Vicky contacts Lee, who is reportedly experiencing domestic abuse. Vicky wants toschedule an assessment. She first needs to make sure Lee is currently safe. Leeconfirms there is no immediate threat. Vicky asks Lee if she is safe to talk. She saysshe can’t talk right now, because her partner (the perpetrator) is in the next roomwatching television.Vicky asks Lee if she can come to the Women and Family Centre in town. Leeconfirms an appointment for that afternoon. Vicky tells Lee not to give any detailsabout the phone call or the appointment to her partner.At the interview, Vicky once again assesses Lee’s immediate risk. Lee says herpartner overheard their conversation, and threatened her until she told him whatit was about. Lee told him she was talking to a friend; however, she is worried heknew she was lying, and may have followed her to the centre.As a precaution, Vicky phones security to ask them to inform her if anyone is foundto be behaving suspiciously near the entrance.
1. What risk was there to Lee and Vicky and other workers?2. How did Vicky minimise risk to Lee, herself and other workers?94 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS3. Give three examples of how risk is managed in your place of work. If you are not yetworking in the industry, research a relevant community service and identify threeexamples of risk management processes.4. Explain what is meant by duty of care?Click to complete Practice task 11UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 95TopiC 2 ANALYSE THE PERSON’S NEEDSSummary1. It is important to clarify your own work role, and work within organisationalprotocols, your scope of practice, your position description and your qualifications.When necessary, refer individuals to an appropriate service, or seek assistance.2. Empower the person to identify and prioritise their own needs. Use verbal andnonverbal communication skills such as empathy, active listening and maintainingeye contact when identifying the diverse needs of people with support needs.Effective interpersonal communication skills can be used to communicate respectand empower people with support needs. Prepare individuals for assessment byclearly explaining assessment procedures in a way the person will understand. Byassisting people with support needs to identify their own needs and risk factors,you will empower the individual and enhance their participation in the assessmentprocess.3. Evaluation should take into account the person’s strengths and capabilities,available resources and desired outcome. Evaluation of a person’s needs requiresan understanding of the nature and impact of diverse and multifaceted needs andissues. You must consider how these issues and needs interrelate.4. Identify and analyse complex, multiple and interrelated issues – Apply yourknowledge of complex issues to identify specific needs. This includes working withan awareness that a complex issue will often obscure another.5. Prioritising needs should to be done in close collaboration with the person withsupport needs and, if necessary, with the individual’s family, guardian or carer.Maslow’s hierarchy of needs is a useful tool for guiding this process.6. The safety of the person with support needs, yourself and others must be treatedas a priority. To achieve this, identify and manage risks according to organisationalguidelines.96 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSLearning checkpoint 2Analyse the person’s needsThis learning checkpoint allows you to review your skills and knowledge in analysingneeds.Part A1. List five factors or guidelines that determine the limitations of your work role whenconducting assessment.2. Give two examples of circumstances where you may be required to seekassistance. In each example, identify the most appropriate specialists or personnelthat you should seek assistance from, and how you would seek assistance.3. Why it is important to empower people with support needs to identify and prioritisetheir own needs?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 97TopiC 2 ANALYSE THE PERSON’S NEEDS4. List five strategies that you can use to empower clients to identify and prioritisetheir own needs.5. Explain why it is important to take a holistic approach when evaluating a person’sneeds.6. Explain what is meant by duty of care.98 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPart BRead the case study, then answer the questions that follow.
Case study
Greg works for an AOD agency and has conducted an intake assessment of a clientwith complex issues. This is the information he notes:Name: Emmanuella SalakoBorn: 1/2/1988, ChileNationality: ChileanCitizenship status: Permanent residentReligion: None statedAddress: No current residenceContact phone: Mobile 0404 040 040Emergency contact: Freda Salako (Mother) Ph: (08) 8000 8000Education: St Mary’s High School, Year 10Emmanuella presents with:XX a heroin dependencyXX borderline personality disorderXX risk of kidney failure.During the intake interview and assessment, Greg also learns that Emmanuellahas been involved in sex work and drug trafficking. She has a criminal convictionfor possession of heroin. He learns that she frequently thinks about suicide, to thepoint of making plans. She has made one suicide attempt six months ago and washospitalised as a result.Emmanuella currently has no medical or psychological support. She has noemployment or income and has no permanent address. She has been sleeping onthe street or at friend’s houses. She has $50 to her name, which is in cash, and isdue her next Centrelink payment on Thursday. She has no private health insurance.
1. List all of the issues and factors that you have identified in the case study.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 99TopiC 2 ANALYSE THE PERSON’S NEEDS2. Using examples from the case study, explain how physical, psychological, socialand cultural issues and factors can be interrelated.3. Explain the evaluation process that you would use to identify and analyseEmmanuella’s needs.100 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS4. When assessing complex needs, what issues should be considered as urgent?5. What type of services would you recommend to address the issues thatEmmanuella requires support for?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 101TopiC 2 ANALYSE THE PERSON’S NEEDS6. What strategies can Greg use to determine Emmanuella’s eligibility to access theseservices?7. Prior to conducting the assessment of Emmanuella’s needs, Greg was required toundertake a risk assessment. What is the purpose of a risk assessment?8. What considerations must Greg make when a hazard is identified during the riskassessment process?
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 103Topic 3In this topic you will learnhow to:3A Consider service deliveryand referral options3B Evaluate internalcapability and otherservice networks3C Provide the person withservice information3D Encourage the person toadvocate on their ownbehalfDetermine appropriateservicesIt is rare that one service alone can meet the needs ofpersons with complex issues. You need to implementprocesses to ensure appropriate services are locatedand referrals are made. Where possible, encourageindividuals to identify and independently access theservice. You may also be required to conduct an activereferral, which means engaging with the person at eachstage of the process to ensure services are deliveredand individual needs are met.104 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS3A Consider service delivery and referral optionsWhen considering service delivery and referral options,it is important to take a person-centred and strengthsbased approach. When considering the allocationof resources, a strengths-based approach will takeinto account a person‘s existing strengths in terms offunctional capacity and access to existing resources.Service delivery should be aimed at complimenting aperson’s strengths while supporting individual needs.This approach will empower the person to maintainindependence in areas of existing strength and willpromote achievement of optimal independence in areaswhere they may require support. A person-centred approach will optimise servicedelivery by directing more efficient use of resources that are specific to a person’sindividual needs. The person-centred approach will also ensure that service delivery isaimed at promoting and supporting a person’s self-management and engagement indecision-making.Service deliveryIn the past, community services agencies delivered services in conjunction to otherservices. This method of operation may have afforded organisations independenceand autonomy; however, it posed issues in regards to departmentalisation or servicesor ‘the silo effect‘. In modern times there has been a shift in the delivery of services toa more coordinated, integrative approach. Coordinated and integrated service deliveryis focused on a holistic approach to supporting people’s needs.By working together, agencies can share resources to deliver a more effective,efficient and individualised response to a person’s needs. Delivery of coordinated andintegrated services enhances streamlining of service delivery to provide more userfriendly navigation of services for the person. Multi-agency cooperation can contributeto better information and skill sharing. Developing better links between services leadsto less duplication of services, more appropriate use of resources and an increase inthe efficiency of service delivery.Service delivery frameworksDelivery of community services is guided by sector specific service delivery frameworksset out by the state or territory government and the organisation delivering services.These frameworks outline information about the types of services offered by the sectoror agency, protocol for accessing these services, key relationships between services,target groups or specialisations covered by each service, setting the service takesplace i.e. community, in-patient etc. and the capabilities of services. The frameworksguide the integration of service delivery by identifying the charter of services and thelinks between services. When planning and organising referral to other services, theservice framework is a useful guide to identify appropriate service options, processesfor engagement of services and links between services.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 105TopiC 3 DETERMINE APPROPRIATE SERVICESService delivery standardsGovernment and non-government organisations measure performance based onservice delivery standards. The standards outline the intended performance targetsof a service or sector. Performance targets are based on best practice principlesto achieve the most ideal level of service. The standards outline the obligations orcommitments of the service provider and what the person accessing the serviceshould expect from that service.Services delivery standards in the community services industry incorporate theprinciples in relation to service provision:XX Equity and accessXX InclusionXX person-centred practiceXX strengths-based approachThe standards also encompass the legal and human rights of the people accessingservices. It is important when planning and organising service delivery that youunderstand and apply the service delivery standards to your work.An example of service delivery standards – the National Standards for DisabilityServices – can be found at:XX http://aspirelr.link/national-standards-disability-servicesReferral optionsThere are many factors that must be taken into account when considering referraloptions for a person with complex needs. When making decisions about the mostappropriate referral options, the service provider must apply critical thinking skills totake into account knowledge about the person, the issues being addressed and theservices available.When determining appropriate referral options, the following factors must beconsidered.
The personFactors include the following:XX The capacity to consentXX Willingness and ability to participateXX Ability to access the serviceXX Personal prioritiesXX Goals and expectations
issues being addressedFactors include the following:XX The type of issueXX Impact of issue on other aspects of a person’s wellbeingXX Complexity of the issuesXX Coexisting issuesXX Urgency of the issue
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The services availableFactors include the following:XX Criteria for eligibilityXX Type of servicesXX Capacity/capabilities and resources availableXX Funding or cost of the serviceXX Location of the serviceXX Referral procedureXX Roles and responsibilitiesXX LimitationsXX Level of care and method of communication
Critical thinking skillsWhen making decisions about the most appropriate referral option for a person, youmust employ critical thinking skills. Critical thinking involves the application of clear,rational and open-minded thinking about a problem in order to identify a solution orjudgement based on evidence. The critical thinking process involves gathering relevantinformation, analysing the information, interpreting information, evaluating andproblem-solving. Throughout this process, it is important to think laterally or considerall aspects of the issue. Consideration should also be made about the prioritisation ofissues.Plan and organise service deliveryPlanning and organisation of service deliveryoccurs at several levels. The government levelof planning has a strong focus on the economicsustainability of programs and the governanceof funded programs. Organisations are requiredto report regularly on key performance indicatorsto funding bodies in order to advise of currentperformance levels. This information is useful inthe planning of ongoing resource allocation, andthe determination of sustainability of programs.Service delivery planning and organisationalso takes place on an organisational level.The organisation incorporates service deliveryframeworks, and service standards into the development of policies and proceduresand service delivery plans. Service delivery plans are the blueprints that outline detailsof the method, purpose, expected outcome, roles and responsibilities and charter ofservice delivery.Guidance for completing government-level service delivery plans can be found onstate-level community service department websites.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 107TopiC 3 DETERMINE APPROPRIATE SERVICESIndividual service plansIndividual service plans or care plans are developed by service providers for peopleaccessing services. These plans are based on information obtained from theassessment process. Care plans provide information about the person’s strengths,as well as issues or needs that require support. They also identify intended goals oroutcomes, and strategies to achieve them. Care plans include specific sections onsupport, funding and services. It is important to keep in mind that service deliveryis a dynamic process – circumstances change and evolve, as do a person’s issuesand needs. It is therefore essential that assessment and planning be a consultative,recurrent and cyclic process.To read more about individual service plans at:XX http://aspirelr.link/wa-ndis-individualised-planningStandards guiding service delivery and referral optionsIndustry standards help ensure quality services are provided by setting guidelines forpractice in specific areas of community services work. These service standards arebased on the rights of people using a service, ethical conduct and practice principles.Some standards are specific to a state or territory, such as Victoria’s Department ofHuman Services Standards, which cover empowerment, access and engagement,wellbeing and participation. When assessing multiple needs, you may need to refer tomore than one industry standard.Here are federal standards for provision of support. Each standard has expectedoutcomes. There are also federal standards that apply to the National Aboriginal andTorres Strait Islander Flexible Aged Care Program Quality Review.
Aged Care Quality Standards
XX Standard 1: Consumer dignity and choice – Reflects concepts that recognisethe importance of a consumer’s sense of self. It highlights the importance of theconsumer being able to act independently, make their own choices and take partin their community. These are all important in fostering social inclusion, health andwellbeing.XX Standard 2: Ongoing assessment and planning with consumers – Describes whatorganisations need to do to plan care and services with consumers. The plannedcare and services should meet each consumer’s needs, goals and preferences, andoptimise their health and wellbeing.XX Standard 3: Personal care and clinical care – Describes that consumers and thecommunity expect the safe, effective and quality delivery of personal and clinical care.The Standard applies to all services delivering personal and clinical care specified inthe Quality of Care Principles 2014.XX Standard 4: Services and supports for daily living – Explains that a consumer mighthave some challenges in their health and abilities, but they still have goals they wantto achieve. They also have roles that have meaning, and they want to manage theirday-to-day life and live as well as they can. Services and supports cover a wide rangeof options that aim to support consumers to live as independently as possible andenjoy life.
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XX Standard 5: Organisation’s service environment – This applies to the physical serviceenvironment that the organisation provides for residential care, respite care and daytherapy centres. It aims to make sure that the service environment, furniture andequipment support a consumer’s quality of life, as well as their independence, abilityand enjoyment. This means that the service environment suits the consumer’s needs,and is clean, comfortable, welcoming and well maintained. It includes how the safetyand security, design, accessibility and layout of the service environment encourage asense of belonging for consumers.XX Standard 6: Feedback and complaints – The organisation must have a system toresolve complaints. The system must be accessible, confidential, prompt and fair. Itshould also support all consumers to make a complaint or give feedback. Resolvingcomplaints within the organisation can help to build the relationship between theconsumer and the organisation. It can also lead to better outcomes.XX Standard 7: Human resources – Requires an organisation to have and use a skilledand qualified workforce sufficient to deliver and manage safe, respectful and qualitycare and services.XX Standard 8: Organisational governance – The intention is to hold the governing bodyof the organisation responsible for the organisation and the delivery of safe, qualitycare and services.
Disability Service Standards
XX Standard 1: Rights – Freedom of expression, dignity, respect, self-determination,choice, confidentiality and privacy.XX Standard 2: Participation and inclusion – Promote a valued role for people withdisabilities, include people with disabilities in activities of their choice.XX Standard 3: Individual outcomes – People direct their own supports, service planning,collaboration and consultation.XX Standard 4: Feedback and complaints – Mechanisms for people to have theirconcerns addressed.XX Standard 5: Service access – Accessible information to make informed decisions,transparency, and regular reviews.XX Standard 6: Service management – Governance, communication, continuousimprovement, legislative compliance.
Mental health service standardsThere are two sets of very similar standards for mental health services: the NationalStandards for Mental Health Services (2010), and the National practice standards forthe mental health workforce 2013.The following is an outline of the National Standards for Mental Health Services.
National Standards for Mental Health Services
1
Standard 1. Rights and responsibilitiesThe rights and responsibilities of people affected by mental health issues and/ormental illness are upheld by the mental health service (MHS) and are documented,prominently displayed, applied and promoted throughout all phases of care.
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2
Standard 2. SafetyThe activities and environment of the MHS are safe for consumers, carers, families,visitors, staff and its community
3
Standard 3. Consumer and care participationConsumers and carers are actively involved in the development, planning, deliveryand evaluation of services.
4
Standard 4. Diversity responsivenessThe MHS delivers services that take into account the cultural and social diversityof its consumers and meets their needs and those of their carers and communitythroughout all phases of care.
5
Standard 5. Promotion and preventionThe MHS works in partnership with its community to promote mental health andaddress prevention of mental health issues and/or mental illness.
6
Standard 6. ConsumersConsumers have the right to comprehensive and integrated mental health care thatmeets their individual needs and achieves the best possible outcome in terms oftheir recovery.
7
Standard 7. CarersThe MHS recognises, respects, values and supports the importance of carers to thewellbeing, treatment, and recovery of people with a mental illness.
8
Standard 8. Governance, leadership and managementThe MHS is governed, led and managed effectively and efficiently to facilitate thedelivery of quality and coordinated services.
9
Standard 9. IntegrationThe MHS collaborates with and develops partnerships within in its own organisationand externally with other service providers to facilitate coordinated and integratedservices for consumers and carers.
10
Standard 10. Delivery of careThe MHS incorporates recovery principles into service delivery, culture and practiceproviding consumers with access and referral to a range of programs that willsupport sustainable recovery.
Example
A service that meets a person’s interestsTazmin is considering attending a disability dayservice. She has an active mind and enjoys meditation,socialising and learning.Her support worker has identified the criteria foreligibility, the type of services, cost, location and referralprocedure of a service that might meet Tamzin’sneeds. The two of them consider that these are needsfor community engagement, friendship, achievement,creativity, confidence and respect. Through collaborationand consultation, Tamzin decides on a service thatoffers meditation, yoga, cooking classes and social activities, and meets her needs.
110 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 121. What factors must you take into account when considering referral options for aperson?2. What is the critical thinking process?3. Explain the role of service delivery standards in the community services sector.Click to complete Practice task 12UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 111TopiC 3 DETERMINE APPROPRIATE SERVICES3B Evaluate internal capability and other service networksWhen making decisions regarding selection ofservices that best fit a person’s need, you mustfirst evaluate the internal capabilities of yourorganisation. You will need to consider:XX the scope of practice of staffXX scope of activities of your organisationXX mission and values of the organisationXX policies and proceduresXX available resourcesXX funding allocation and constraintsXX capacity to undertake services required tomeet the person’s needs.In circumstances where your organisation is not equipped to provide services that bestfit the person’s needs, you will need to draw on information and networks to identifyservices that will be more suited to the person’s needs.Identify appropriate internal servicesThe organisation you work for provides specific services; for example, emotional,physical, social, financial and legal support. Consult the person and the assessmentinformation gathered to determine which services within the organisation will meettheir needs. For example, a person with AOD issues may be supported by an agency’sindividual and family counselling, drug withdrawal and group support services. Thepriority, however, is drug withdrawal support, so this service is arranged as a matter ofurgency.Listed below are examples of different agencies and the services they may offer.
Disability agency
Examples of disability agency:
XX Day programs, including skillbuilding, recreation, physicalrecreation, arts and crafts, music,meditation and yogaXX Counselling
XX Financial managementXX Physical therapyXX Respite servicesXX Family support
Aged care residence
Examples of aged care residence:
XX Palliative care and dementia careXX Short-term care and respite servicesXX Physical therapy and fitnessXX Cognitive, social and spiritual/religious activities
XX Counselling, including services forfamily membersXX Medical support
112 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSEvaluate other servicesIn order to determine the most appropriate service for referral, it is essential toevaluate the services available to identify the types of services offered, suitability ofthese services to meet the person’s needs and funding options available.The assessment process may identify individual needs that require services beyondyour agency’s scope. For example, if the person with AOD issues sustains a physicalinjury while under the influence of drugs and requires ongoing physical therapy, youwould need to locate an external service to provide this.Examples of types of external services and what they offer are provided here.
financial support services
Financial support services offer the following:XX General information about managing financesXX Resources to assist financial management, such as budgeting supportXX Financial counsellingXX Information about saving for retirementXX Support for problem gamblingXX Emergency relief fundsExamples of financial services:XX Commonwealth Financial Counselling (CFC)XX Emergency Relief funded under the Financial Management ProgramXX National Information Centre on Retirement InvestmentsXX Gambling Help Online
employment services
Employment support services offer the following:XX Links to employersXX Job search supportXX Job skills trainingXX Support when initially placed in a job, including on-the-job training and co-workerand employer supportXX Ongoing support in a job when requiredExamples of employment services:XX Disability Management ServiceXX Employment Support ServiceXX CentrelinkXX Local Connections To Work
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recreation and transport services
Recreation and transport services offer the following:XX Physical recreationXX Connection to othersXX Community interactionXX Emotional supportXX Skill buildingXX Transport to and from events, facilities and appointmentsExamples of recreation and transport services:XX Men’s ShedXX BlueScope Steel Sports Ready ProgramXX Links to LeisureXX Community Transport Services TasmaniaXX Newcastle Community Transport
Care and support services
Care and support services offer the following:XX Disability supportXX Mental health supportXX CounsellingXX Skill buildingXX Meal preparationXX Support with personal hygiene and groomingExamples of care and support services:XX Respite and holiday careXX Day clubsXX Home and community care programsXX Rehabilitation Appliances Program – Department of Veterans’ Affairs
Ensure person is referred to appropriate servicesCommunity services organisations do not exist in isolation. They are part of the widercommunity and, as such, have links with different groups, services and individuals. Asa care worker, you need to identify and access relevant networks to ensure the personis referred to appropriate services.114 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSHere is some general information about community services networks.
Community service networks
XX The term ‘networking’ is often used to describe the process of making contactwith others to foster mutually beneficial and supportive relationships. Networksinvolve individuals or groups working together to share information, ideas andresources to help them meet common goals. Different sectors within communityservices have their own networks. These networks may be based on a crosssection of organisations within a particular community, or focus on a particularissue, such as housing.
formal and informal networks
XX The networks you access may be informal or formal. Informal networks are thosethat are self-made and do not have formal reporting structures. Examples ofinformal networks in the community services sector include:– other workers within and external to your organisation– trainers, teachers and academics– contacts in policy and funding bodies.
Formal community service networksUnlike informal networks, formal networks generally involve agencies and services thathave a structure and an agreed mechanism for communication. Having establishedlinks with other agencies helps ensure the person receives coordinated services.Here are examples of formal networks found in community services.
Local networks
Your organisation has links with a range of other agencies and service providers inthe local area. Persons may be assisted by more than one organisation or requirereferrals to other services. For example, a person with AOD issues may also requiremental health, accommodation and health services.Examples:XX Government services such as CentrelinkXX Housing departments and other accommodation servicesXX Employment servicesXX Health services and local councilsXX Education providersXX Welfare and charitable organisationsXX Local AOD, disability, homelessness, youth services and aged care agencies
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interest and support groups
Interest and support groups are usually consumer-based. They include self-helpgroups aimed at providing support to their members.Examples:XX Carers’ groupsXX Mental health groups such as ARAFMI, Grow, Neami National, Mental HealthFoundation of Australia, and PANDAXX Groups aimed at supporting people with AOD concerns such as AlcoholicsAnonymousXX Special interest groups such as mothers’ groups or Riding for the Disabledgroups
regional, specialist and peak associations
These associations represent the interests of a particular region, specialist serviceor sector. For example, there are peak organisations for every sector. The aim ofthese organisations is to ensure that community services in each sector have aunified voice. They can raise awareness of relevant issues and lobby for funding at anational or state level.Examples:XX Aged and Community Services AustraliaXX Cairns Youth Services NetworkXX Carers AustraliaXX Ethnic Communities CouncilXX Mental Health Council of AustraliaXX National Disability ServicesXX Black Dog Institute wellbeing groups
professional or occupational associations
These associations include groups representing different professions ororganisations such as community and welfare workers, social workers andpsychologists. They each represent the group’s interests and promote professionaland ethical practice and standards.Examples:XX Australian Community Workers AssociationXX Australian Association of Social WorkersXX Youth Workers AssociationXX Australian Community Counselling AssociationXX Australian and New Zealand Mental Health AssociationXX The Australasian Professional Society on Alcohol and Other Drugs
116 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSIdentify networks to assist referralThe needs of the individual determine which networks are accessed for additionalassistance. When accessing a network, ensure that the individual’s confidentiality isnot breached. Only share information you are authorised to share.Determine best fit to meet needsWhen assessment results have been collated and analysed with the person, the nextstage is to identify the services that meet the person’s needs. To do this, consult withyour supervisor, colleagues and the individual to determine what services are availableand how accessible they are.The organisation you work for may have access to a database that provides the detailsof the services offered and the eligibility criteria. You may also need to consult yoursupervisor or colleagues and search the internet to identify a broader range of serviceproviders. The required services may be within or external to your organisation.Here are a range of services that may be required to meet needs:XX Mental health servicesXX Medical servicesXX Employment servicesXX Criminal justice servicesXX Social servicesXX Housing servicesXX Culturally specific servicesXX Welfare servicesXX Counselling servicesXX Financial supportXX Drug and alcohol management
Example
evaluate capability of services to meet needsThe Ningal Youth Workers Cooperative aims to inform and support the work of youthand other related organisations within the community. The network holds regularinformation sessions designed to highlight the concerns of young people in the areaand help workers learn about issues that may be outside their areas of expertise,such as youth crime, mental health or AOD issues. The network consists of communityservices organisations and individuals working in a range of areas such as disability,justice, education, mental health, AOD, arts, family and sporting and recreationservices.Laura is a youth worker who is working with Moira, an individual with complex needs.She is trying to find suitable psychological support for Moira, who presents withsymptoms of post-traumatic stress disorder. She contacts the Ningal Youth WorkersCooperative to inquire whether they can recommend an appropriate specialist. Shedoes not disclose Moira’s personal details. The network recommends two appropriatespecialists who work with young people.Laura then discusses these specialists with Moira, chooses one and asks Moira’spermission to share their information with the specialist for referral.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 117TopiC 3 DETERMINE APPROPRIATE SERVICESPractice task 131. When evaluating services to determine those that best fit a person’s needs, whatshould you consider?2. What strategies could you use to locate external services that best fit a person’sneeds?3. Explain the role of networks in the community services sector.Click to complete Practice task 13118 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS3C Provide the person with service informationPeople making decisions about service optionsrequire access to information that is clear,comprehensive, accurate, current and relevant.Your role as service provider is to provide theindividual with information about services, andto ensure that information is understood to allowinformed decisions to be made. Informationmust be delivered in a way that promotesunderstanding, clear and plain language shouldbe used. Interpreter services should be offeredto people from culturally and linguistically diversebackgrounds and for people who are hearing orvision impaired.Your role is to support the decision-making process of the individual you are workingwith.Information provisionThe organisation you work for should be able to provide you with access to informationabout internal or external services they generally refer to and work with. If you arereferring the person to services beyond the organisation’s network, gather appropriateinformation about the services to present to the person.Information can be accessed from a range of sources, including brochures, posters,promotional DVDs, websites, person testimonials, and/or emailing and speakingdirectly with the provider.The following sets out the important information the person needs to make decisions,with an example provided for each detail.
Location
If the service is difficult to access, it will be less suitable than a service in theperson’s local area.Example: Wilson is deciding between two AOD programs. One is located in the nextsuburb. The other is located on the other side of the city; however, it offers morespecific services that meet his immediate needs. Wilson decides he is more likely toattend appointments if he accesses the closer service.
Cost
The person should know all costs involved, including whether funding, such as apension, will cover the cost. If a person has private health cover, inform them of theprivate service gap fee.Example: Janice is deciding which psychologist will best be able to help her withdepression. Her private health insurance covers most of the cost. She decides to seea practitioner whose fee is only $15 more than what her health insurance covers.
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needs
Explain to the person exactly how the service will meet their needs. For example,they should be informed that a drug and alcohol rehabilitation centre will providecounselling support for them and their family, and drug withdrawal programs.Example: Sandra is considering a disability day service. The service offers swimmingclasses, horse riding, cooking classes and social outings. Sandra decides that theseprograms meet all her needs.
practical details
The person should understand practical details, such as whether lunch is provided ata day program, and if so, whether dietary requirements are met.Example: Gary is considering a day service for older people to stay socially active. Heinquires about whether lunch is provided. The organisation coordinator tells him thatindividuals bring their own lunch, but morning tea is provided.
privacy
Inform the person about the service’s confidentiality and privacy policy. They shouldknow that their personal details will be protected.Example: Bahar wants to tell the psychologist very private details about her history.She is nervous about sharing such personal details. When booking an appointmentwith the psychologist, she asks him over the phone about his privacy policy.
right to refuse
Inform the person about their right to refuse a service, if it does not meet theirneeds.Example: Tammy has a mobility impairment and has started a new day program.After a week, Tammy realises she is unable to participate in any of the providedactivities due to her disability. Tammy becomes distressed. Her case managersuggests they meet to discuss alternative services.
Information accessibilityIt is important to consider the individual needs of the person and ensure thatinformation about services is accessible. The more accessible the information, thebetter equipped the person will be better equipped to make decisions.
issues and needs to consider
XX Literacy issues – can the person read the information? Is it easy to read andunderstand?
XX Cultural and linguistic diverse (CALD) issues – does the person require aninterpreting or translation service?
XX Vision impairment – is there an audio version of the information, or isinformation available in large print?
XX Hearing impairment – is there visual or reading material available?
XX Clarity – if information is about more than one provider, avoid confusing theperson with too much information.
120 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSProvide information in plain EnglishThe individual will be better equipped to make decisions if the information they needabout services is provided in plain English.Documents written in plain English meet the following criteria:XX Put the reader’s needs first, with the main message not buried in detailXX Structured to place the most important information firstXX Include an adequate amount of white space so the page is not clutteredXX Use a formal but friendly tone and familiar languageXX Avoid jargon and the use of unnecessarily long sentencesXX Use correct spelling, grammar and punctuationXX Include diagrams or images to clarify meaning where appropriateThe decision-making processIt is a basic human right for a person to be able to make their own choices anddecisions. However, in some cases this right may be limited or revoked based on aperson’s lack of capacity or competence to make an informed decision. Capacityto make an informed decision is determined by a health and practitioner based onclinical assessment, and competence to make an informed decision is determined bythe court. You are required to presume that a person possesses the capacity to maketheir own decisions unless a clinical assessment provides evidence to the contrary. Inthese exceptions an advocate will be appointed; this may be a family member or carerand in some cases the guardianship board may be called upon to make decisions onthe person’s behalf.The role of the support worker in the decision-making process is to facilitate andsupport the person to access sufficient information on which to base decisions.
Assess information required
Information required may include the following:XX Information the person may want or needXX Factors that the person may find significantXX The person’s level of knowledge or understanding of services and relevantfactorsXX The person’s wants, needs and prioritiesXX Family, social, financial circumstancesXX Medical history or current condition
Provide sufficient information
Information should:XX be discussed in a frank, honest, non-biased, well balanced and empatheticmannerXX use simple, non-medical, non-jargon termsXX include all information that a person requires to make informed decisionsXX include all information that you or any support worker should reasonably knowXX include information that the person wants to be given before making decisions.
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Level of detail
Information provided should include the following:XX Enough detail presented that a reasonable person would require to make aninformed decisionXX All information that the person wants to be givenXX Discussion should address person’s individual circumstances, such as:– physical, social, cultural, psychological, financial factors– urgency of issues being addressed– complexity of services– likelihood and potential for harm– persons attitude and level of understanding– questions asked by the person or information requested
present the information
When presenting information, consider the following:XX Methods should address the person’s individual circumstance, expectations,fears, beliefs, disabilities, values, and cultural background.XX Techniques include:– visual aids– print material– video resources– audio resources– verbal discussion.XX Interpreter services, cultural liaison services or disability support services may becalled upon to provide assistance.XX Time should be allowed to process information and to consult with family or othersocial support networks.XX Clarification should be provided and the person informed of options for seekingsecond opinions.
Check understanding
The following will assist in checking your understanding:XX Ask a person to explain what has been discussed in their own words.XX Ask questions about the information provided to assess level of understanding.XX Provide the person with the opportunity to ask their own questions, answering ina manner they can understand.
obtain response
When receiving a response from the individual:XX ensure the person understands the situation and the implications of theirdecisionXX ensure that a clear statement or written consent is made that outlines the exactelements of the decision.
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Document decisions
Consider the following when documenting decisions:XX Document discussions and elements of decision-making process in case notes.XX Obtain written consent.
Example
provide information about servicesHarriet has dementia and an intellectual disability. Shehas lived in a disability residence with another personfor 20 years; however, a recent assessment reveals thatHarriet requires specialist dementia services.A meeting is arranged with Harriet and her daughterElisabeth, at which the information is presented.The assessment team have gathered brochures anddocumentation about the organisation, which includecosts, location and privacy policies.Elisabeth and Harriet discuss what each service offersand how each might meet Harriet’s needs. Harriet’s first preference is residentialcare close to where Elisabeth lives, but Elisabeth points out that the cost will exceedHarriet’s pension. Harriet decides to access the public residential care facility.
Practice task 141. What sources can you use to access information about internal or externalservices?2. What information about services should you provide to an individual to facilitatethe decision-making process?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 123TopiC 3 DETERMINE APPROPRIATE SERVICES3. Outline the role of a support worker in supporting the individual’s decision-makingprocess.124 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSClick to complete Practice task 14UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 125TopiC 3 DETERMINE APPROPRIATE SERVICES3D Encourage the person to advocate on their own behalfEvery person has a right to make their own decisions. It should be assumed thatall people have a capacity to make decisions for themselves. Support workers havean important role to play in supporting people’s self-determination. The role of thesupport worker is to provide the person with opportunities for decision-making, selfexpression and self-advocacy.If the person has the ability, encourage them to advocate on their own behalf to accessservices. Successfully advocating for themselves is empowering. It is your job topromote peoples’ autonomy while making sure they are adequately supported.The process of self-referral can be effective if the person:XX is aware of how to approach service providers and make their needs knownXX has the communication skills to express what they needXX has the confidence to ask questions and approach new peopleXX can read information from the service provider and fill out relevant forms.Refer and facilitate access to servicesPeople with complex and multiple issues oftenhave difficulty navigating their way throughdifferent internal and external services. While itis important to encourage the person to advocateon their own behalf to access services, it isalso important to facilitate a smooth referralprocess, and review referral once it has beenmade. This important, as it ensures that peoplewith complex issues do not ‘fall through the gap’and cease treatment altogether. Maintain opencommunication with the person about theirindividual needs, and adjust the referral processaccordingly.Provide assistance to complete referral processPeople with cognitive, intellectual or visual impairments or people from culturallyand linguistically diverse (CALD) backgrounds may require additional assistancewhen completing the referral process. You may also need to provide this assistanceto people who are unmotivated or resistant to planning. In these situations, it maybe necessary to contact the service on the person‘s behalf, with their consent andpreferably in their presence.When completing the referral process, assistance options may include:XX providing an interpreting service to assist with completing referral forms orcontacting the service to make an appointmentXX providing a referral form or information about the service in large print or in braillefor people with vision impairmentsXX presenting and seeking information verbally to complete forms on behalf of peoplewith vision impairments126 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSXX phoning the service on the person’s behalf to make an appointment if the personhas a hearing impairmentXX phoning the service on the person‘s behalf in the person’s presence if they are notmotivated to contact the service themselvesXX ensuring an advocate or legal representative is engaged to complete the referralprocess, if required.Provide assistance to access the serviceOnce the referral has been made, the person may also require assistance accessing aservice. Here are examples of the type of assistance a person may require.
provide assistance to access services
Transport assistance
Access funding or financial information
Arrange an advocate or legal representative to act on the person’s behalf
Organise an interpreting service
Contact social networks, such as members of the person’s cultural community
Types of referral processesThe referral process involves contacting the service provider to confirm accessibilityand eligibility, providing the person with information about the service, and completinga referral form and/or providing the service with relevant information about theperson, with their consent.Here are four main types of referral processes, with examples of each.
urgent referral
If a person requires urgent medical or psychiatric assistance, complete anemergency or urgent referral.Example: You are required to contact the Crisis Assessment and Treatment (CAT)Team because a person tells you they are planning to commit suicide and have themeans to do so. Note that area health services have a crisis assessment team ormental health triage service. The name of the service will depend upon the state orterritory in which you work.
passive referral
The person is given the contact details of the external service, and other relevantinformation. The person is encouraged to contact the service and make anappointment.Example: A person has described the experience of having panic attacks in theassessment interview. You suggest that the person should contact their GP. Theyleave the meeting telling you that they plan to call their GP that afternoon to arrangean appointment.
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facilitated referral
The person is assisted to contact the referral service. For example, the workercontacts an external service with the person‘s permission to make an appointmentfor them. The person is given necessary assistance to access the service, such ashelp with transport.Example: A person has presented with dementia and is at risk of homelessness.The case worker consults the person about available public care facilities and asksif they require assistance. The person does require assistance, so in the person’spresence the case worker phones the unit on the person’s behalf.
Active referral
The worker contacts the other service with the person’s permission, in the presenceof the person, to make an appointment. With the person’s consent, the workershares relevant information with the service, and ensures the person has the meansto access the service. The worker reviews the referral to ensure that the servicecontinues to meet their needs.Example: A person has presented to an AOD agency with suicide ideation and riskof homelessness. Following agreement, the person is referred to the appropriateservice. The worker phones the service after each appointment to update theperson’s care plan.
Example
encourage people to advocate for themselvesAzziza works at a women’s crisis centre. She isfacilitating an assessment of Joelle for intake. Joelle hasreceived an injury to her arm during the last physicalencounter with her husband. Azziza takes down personalinformation because Joelle is unable to complete theform herself. She consults with Joelle to obtain theanswers then interviews Joelle about her needs.Joelle reveals that she wants to leave her relationship,but she is afraid of her husband’s response. She reportsthat she often experiences anxiety and panic attacks.Joelle reports that her arm is very painful.Azziza asks Joelle what she believes the first priority is, and Joelle says she needs herarm looked at as soon as possible.Azziza ask whether Joelle has a GP she sees regularly. Joelle says she does, but doesnot want to go to him, because he is also her husband’s doctor. Azziza suggests thatJoelle access emergency services at the local hospital. Joelle is worried about how toget there. She says that she can’t drive, as her arm hurts too much. Azziza suggeststhat she arrange a taxi to take her to emergency. She phones ahead to tell the triagenurse that Joelle is expected.Azziza asks Joelle’s consent to send a copy of the referral form to a new GP in thearea, Dr Mary Collins. Joelle consents.
128 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 151. Describe two types of referral processes that you may use for referral of a personto an external service provider. Provide an example of circumstances where eachprocess may be applied.2. Give five examples of assistance you can provide to help a person access services.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 129TopiC 3 DETERMINE APPROPRIATE SERVICES3. Explain how you could support a person to advocate for themselves.Summary1. Identify appropriate internal and external services in conjunction with the person.This will help ensure the person’s needs are met.2. Consult with individuals, supervisors, colleagues and relevant networks to identifyappropriate agencies and services for referral.3. Your informal or formal networks can be used to locate the most appropriateservices for the person.4. Provide the person with service information to ensure the person is able to makeinformed decisions about their service options.5. Encourage and empower persons to make decisions about services and advocateon their own behalf. This can be achieved by providing relevant information aboutthe available services, including eligibility requirements.6. Follow appropriate processes for referral. Encourage the person to advocateon their own behalf to access services. Where required, facilitate the referralby providing appropriate support. In some instances, you will be required toparticipate in the referral process on the person’s behalf.Click to complete Practice task 15130 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSLearning checkpoint 3Determine appropriate servicesThis learning checkpoint allows you to review your skills and knowledge in supporting aperson to make decisions about service delivery and referral options.Part A1. Following assessment, how can you identify appropriate services to meet theindividual’s needs? How do you employ a strengths-based perspective?2. Outline the role of the support worker when assisting a person to make decisionsabout appropriate servicesUNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 131TopiC 3 DETERMINE APPROPRIATE SERVICES3. Why it is important to empower people to identify and access services?132 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS4. Identify five strategies that can be used to empower people to identify and accessservices themselves.5. When evaluating the internal capabilities of an organisation, what are five factorsyou must consider?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 133TopiC 3 DETERMINE APPROPRIATE SERVICESPart B1. Research two different agencies or organisations in your local area that provideservices for people with complex issues. Using the information found, complete thefollowing table.
Organisation/agency
Services provided to meetcomplex needs
How people can accessservices
2. Research formal service networks by accessing the internet, organisationaldatabases or discussion with your colleagues. Using the information you havefound, fill out the table below. Your response should include a brief description ofeach type of network and list two examples for each type of network.
Type of formalnetwork
Description
Example
Local networks
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Type of formalnetwork
Description
Example
Groups
Associations
Professionalnetworks
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 135Topic 4In this topic you will learnhow to:4A Document outcomes ofthe assessment4B Maintain and store theperson’s information4C Provide the person’sinformation to otherservicesComplete reportingCommunity service providers must adhere toorganisational policy and procedures, which are basedon Commonwealth and state legislation. It is essentialthat community service workers document, maintainand store a person’s information by following theorganisational policies and procedures. When providingpersonal information to a third party, community serviceproviders are also required to gain informed consentfrom the individual and follow organisational procedureswith regard to sharing information.136 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS4A Document outcomes of the assessmentReports generally follow a standard format, depending on the nature of the report. In acommunity services organisation, you may be required to write assessment summaryreports, incident reports and mandatory reports. Regardless of the type, professionallanguage and excellent written language skills are critical for writing an effectivereport.Once the necessary assessments have been conducted and results are collated, asummary report should be developed so decisions can be made. These decisionsneed to be made in consultation with the individual. If requested, the person and theirguardian or advocate should be given access to the completed report. Requirementsfor format and content of reports will be outlined in organisational guidelines.Here is more information on the purpose and contents of a summary report.
purpose of summary report
The purpose of a summary report includes:XX summarising the person’s assessment informationXX identifying priority areas for service deliveryXX providing findings from external assessmentsXX informing supervisors or managers about the person’s needsXX suggesting appropriate service optionsXX providing information to other service providersXX fulfilling regulatory and duty-of-care requirements.
Contents of summary report
The contents of a summary report include the:XX person’s name, date of birth and contact detailsXX next of kin and emergency contact detailsXX specific needs, including how these are prioritisedXX strengths and resourcesXX service delivery options and recommendations.
Reporting requirementsThere are legislative requirements for reporting in all states and territories. Mandatoryreporting regulations vary depending on the jurisdiction. It is important that communityservice workers are aware of their legal obligations to report child abuse or neglect,elder abuse, work health and safety risks, incidents and assessment outcomes. Itis also necessary to follow your organisation’s policy and procedures with regard toformatting reports.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 137TopiC 4 COMPLETE REPORTINGReport abuse and neglectAny kind of abuse is illegal, and you have a dutyof care to report all forms of abuse as soonas you become aware of it. You should reportsituations of abuse directly to your supervisor. Ifyour supervisor is not available, go directly to themanager.Abuse in aged care services is referred to elderabuse. All adult victims of abuse have the rightto decide whether or not to report abuse issues.However, under the Aged Care Act 1997 (Cth),workers in aged care are required to report sexualabuse of residents. Abuse is illegal and thereforethe person can be encouraged to report issues ofsexual and physical abuse directly to the police.The Aged Care Act 1997 states that ‘… if the approved provider receives an allegationof, or starts to suspect on reasonable grounds; a reportable assault, the approvedprovider is responsible for reporting the allegation or suspicion as soon as reasonablypracticable, and in any case within 24 hours …’ (Section 63-1AA).NeglectNeglect occurs when the person with care needs is neglected either throughintentional or unintentional acts that result in the person not being provided with basicnecessities. Here is further information about neglect.
What is considered neglect?
Neglect can include the following:XX Not providing enough food or drinksXX Not spending time with the person, and leaving them alone for prolonged periodsXX Inadequate provision of clothing or personal itemsXX Unwillingness to allow for adequate medical, dental or personal careXX Inappropriate use of medication; for example, overdosing a person so they sleepfor longer periods of the dayXX Leaving the person in the same continence aid for the whole day
indicators of neglect
Indicators of neglect include:XX weight loss, dehydration, poor skin qualityXX the person appearing unkempt – same clothing worn every day of the week, looseor baggy clothing, clothing in poor state, hair unwashed, untrimmed nails, poorhygieneXX no dentures, hearing aids, mobility aids or glassesXX skin burns from urine being in contact with the skin for prolonged hours.
138 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSAbuseAbuse can be intentional or unintentional. Intentional abuse is when a persondeliberately causes harm to the other person by depriving and/or hurting the otherperson. Unintentional abuse can occur when another person doesn’t realise that,through ignorance or other reasons, their behaviour towards the person with careneeds is abusive. An example would be when a primary carer hasn’t had a break andis caring for someone with very high needs. If there is no one else the carer can callon, they can become very tired and resentful; not realising the impact their behaviouris having. This is still abuse and needs to be reported.Here are some other causes of abuse.
Causes of abuse
XX The primary carer being stressed at home or at work
XX A carer may being in debt and may steal from the person
XX Conflict, arguments and fights within the family
XX The person being isolated and alone, and the abuser thinking no-one will find outif they treat them badly
XX A carer using drugs or drinking too much alcohol and being unable to care forthe person properly
Indicators of abuseThe importance of observation and getting to know the person you are supporting canassist in identifying indicators of abuse. When you know someone well, you are morelikely to pick up on changes in their behaviour. Changes in behaviour can be a resultof other things, as well as being an indicator of abuse, so it is important to check yourassumptions before coming to the conclusion that the person is being abused.Here are some indicators of abuse.
Behaviour changes of person with care needs
XX A person may become withdrawn, depressed, anxious, or display signs of beingscared. They may become quite ambivalent or unresponsive.XX You might find the person is becoming disorientated or making contradictorystatements. This of course can be a sign of a range of illnesses, so should bethoroughly assessed before making an assumption that the person is beingabused.
Behavioural signs from the carer
XX You might encounter situations where the carer makes lots of excuses so youcannot gain access to the person with care needs.XX The carer might be overly affectionate and flirtatious with the person, whichmight indicate an inappropriate sexual relationship.XX You might find the carer is giving conflicting accounts of incidents or is hostiletowards the person with care needs.
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general indicators
XX Changes in the person’s health such as unexplained weight loss, bed sores, poorcolouration, sunken eyes and cheeks.XX The person with care needs has unexplained injuries or continual injuries.XX The individual’s personal care needs are not being met, which can be indicatedby dirty hair, dirty clothing, soiled bedding and unclean living conditions.XX Inappropriate use of medication, such as drugging the person so they sleep forlonger periods of the day and night.
Physical abusePhysical abuse can include physical assault, and can occur through physical acts ofviolence. Indicators might include physical pain or injuries. Physical acts of violenceinclude hitting, slapping, punching, pulling hair, spitting at the person, pinching, biting,twisting their arm or wrist, physical restraint such as being tied to a bed or chair,confinement to a room and using objects to hurt the person (throwing rocks, using astrap). This abuse needs to be reported.Indicators of physical abuse can include:XX bruises, cuts, scabs and scarsXX abrasions, welts, rashesXX swelling, burn blisters,XX loss of weight, agitation, coweringXX tenderness, pain, restricted movementXX broken or healing bonesXX drowsiness, unexplained weight loss, unexplained hair loss.Sexual abuseSexual abuse can include unwanted or uninvited sexual contact, language orexploitative behaviour by another person. Sexual abuse includes sexual harassment,indecent assault and rape. This abuse needs to be reported.Here are examples of indicators of sexual abuse.
Sexual abuse indicators
Withdrawal, disturbed sleep patterns, nightmares, agitation, fear
Unexplained difficulty sitting or walking
Bruising of genital areas or thighs
Unexplained sexually-transmitted diseases
Unexplained bleeding from the genital areas
140 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSFinancial abuseThis form of abuse is not always easy to spot. It can include a person’s money,property or assets being mishandled or taken and used without their consent. It canalso include situations where a person with impaired cognitive abilities has givenconsent without truly understanding what their consent means. This abuse needs tobe reported.Financial abuse includes the following:XX Embezzlement, fraud, forgery and stealingXX Withholding money from the person or not paying accounts or debtXX Forcing a person to change their willXX The enduring power of attorney refusing to provide enough money for the person tobe able to liveXX The enduring power of attorney refusing to provide money for the person to buyclothing or other required itemsXX Forcing a person to hand over their money or assetsPsychological and emotional abusePsychological and emotional abuse is an ongoing intimidating behaviour that isdesigned to disempower a person. This form of abuse can be both verbal andnonverbal. It can include belittling, threats and withdrawal of affection. This abuseneeds to be reported.Here are some indicators of psychological and emotional abuse.
Indicators of psychological and emotional abuse
1
Sense of hopelessnessFearfulness, helplessness, withdrawal, reluctance to make decisions
2
Behaviour swingsAnxiety, anger, moodiness, agitation, depression, passivity, low self-esteem
3
TirednessSleep deprivation, insomnia, confusion
4
Unexplained weight loss or gainChange in appetite, increased intake of alcohol
Social abuseSocial abuse occurs when another person behaves in ways to reduce or restrict aperson’s social contact with others. It can include stopping a person from beinginvolved in activities with others, and/or preventing contact with friends and family,resulting in social isolation. This abuse needs to be reported.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 141TopiC 4 COMPLETE REPORTING
indicators of social abuse
XX The person is withdrawn and sad.
XX The person is grieving the loss of family and friends.
XX The person exhibits low self-esteem and passive behaviour.
Follow policies and procedures when reportingIf you suspect abuse has occurred or you have witnessed abuse, you must act quicklyto ensure action is taken immediately to prevent further abuse from happening orescalating. When reporting, be guided by your organisation’s policies and procedures.Besides verbally reporting to your supervisor, you will be required to document thereport. This information may be recorded in case, continuation or file notes and in anincident report form.Here is an example of what to include in a report.
objective report
What you saw; for example, the size, location and type of bruising
When you saw it – date, time and day
What you did; for example, removed the person from the situation
What you said; for example, you explained to the person that you had to report theincident
The person’s response – what they said or did
Follow up action to be taken
Child abuse or neglectReasonable grounds for suspecting child abuse or neglect include the following.
reasonable grounds for making a report
XX A child disclosing that they have been abused or neglected
XX A child’s acquaintance, friend or relative advising that the child has been abusedor neglected
XX Behaviour being observed that indicates the child has been abused or neglected
XX Physical indications that the child has been abused or neglected
Mandatory reporting of suspected child abuse or neglectAll states and territories have mandatory reporting requirements, although the peoplemandated to report and the abuse types that are mandatory to report vary betweenstates and territories.142 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSYou need to be familiar with the mandatory reporting requirements in your state orterritory. As a community service worker, you may be mandated to report.Below are answers to some key questions about mandatory reporting legislation.
What types of abuse must mandated reporters report?
XX In some jurisdictions it is mandatory to report suspicions of each of therecognised abuse types (physical abuse, emotional abuse, sexual abuse andneglect); while in other jurisdictions it is mandatory to report only some of theabuse types.
Is the identity of notifiers protected?
XX In most jurisdictions (all except Queensland), the identity of notifiers – whethermandated or not – is protected.
What age groups can you make reports about?
XX Legislation in all jurisdictions, except New South Wales, requires mandatoryreporting in relation to all young people up to the age of 18. In New South Wales,intervention covers young people up to 18 years of age, but it is not mandatoryto report suspicions of risk of harm in relation to young people aged 16 and 17.
What are the benefits of mandatory reporting?
XX Mandatory reporting aims to overcome the reluctance of some professionalsto become involved in suspected cases of child abuse. It also increases publicawareness of child abuse among professionals and in the community.
Does person confidentiality apply?
XX In the context of mandatory reporting of child abuse or neglect, the right toperson confidentiality of information legislated under the Privacy Act 1988 (Cth)does not apply.XX Access information about your state or territory’s requirements at:http://aspirelr.link/mandatory-reporting-child-abuse
Child protection authoritiesThe following lists the child protection authority in each jurisdiction, which should becontacted if child abuse or neglect is suspected.
Australian Capital Territory
Child and Youth Protection Services:http://aspirelr.link/child-protection-services-act
New South Wales
Department of Family and Community Services:http://aspirelr.link/report-child-abuse-nsw
Northern Territory
Department of Children and Families:http://aspirelr.link/report-child-abuse-nt
Queensland
Department of Communities, Child Safety andDisability Services: http://aspirelr.link/report-childabuse-qld
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South Australia
Department for Child Protection: http://aspirelr.link/report-child-abuse-sa
Tasmania
Department of Health and Human Services:http://aspirelr.link/dep-health-human-services
Victoria
Department of Health and Human Services:http://aspirelr.link/report-child-abuse-vic
Western Australia
Department for Child Protection and Family Support:http://aspirelr.link/child-protection-wa
Follow organisational policies and procedures forreferring to protective servicesIf you suspect a child is being abused or neglected, follow your organisation’s policiesand procedures for reporting. If you are not clear on the policies and procedures,consult with your supervisor.Procedures generally include the following.
reporting requirements
Your organisation’s procedure for reporting child abuse or neglect should specify:XX which authority to report toXX how and when the report should be madeXX who you should inform about making the notificationXX the procedure for reviewing the child’s case while notification is being processed.If you believe a child is in immediate danger or is in a life-threatening situation, callemergency 000.
reporting details
If known, provide:XX the child’s name, age and addressXX the parents’ names and addressesXX siblings’ names and agesXX the language spoken by the familyXX whether the family knows the report is being madeXX whether the worker knows if any other agencies are involvedXX the reasons for concernXX the worker’s relationship to the child.
Reporting WHS risksFollow organisational guidelines for reporting risks and hazards. This may involvecompleting a standard form or writing a report. If you are unclear about your reportingrequirements, consult your supervisor and/or your organisation’s procedures manual.144 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSAssess according to policies and proceduresOrganisational guidelines outline how the assessment should be conducted andanalysed based on workplace requirements, legal obligations, industry standards, andcodes of ethics or conduct. To comply with relevant guidelines, you need to familiariseyourself with your organisation’s policies and procedures. If in doubt about theseguidelines, consult your supervisor.Each organisation will have specific procedures for the assessment process andmaking decisions about appropriate services to meet people’s needs.Guidelines are necessary to help workers achieve the following:XX Meet the organisation’s specific objectivesXX Conduct assessments in a standardised and consistent wayXX Work within their own job role and level of responsibilityXX Comply with legal and ethical requirements and current standards of practice
Example
Document outcomes of assessmentHere is an example of a report. An organisation’s report form may include theguidance supplied by form fields that prompt the support worker to supply specificinformation.Complex assessment report: Disability Support ServiceReport prepared by: MirabellaWattsPosition: Complex needs assessor, disabilitysupport serviceName: Nina BlackGender: Female DOB: 1/11/2007Contact: (03) 66 272 272Address: 16 Parish Drive, Ashtonville 2006Guardian/next of kin (relationship): Belinda Black (mother)Guardian contact: 66 272 272Guardian address: 16 Parish Drive, Ashtonville 2006Referral information: Referred for assessment by Dr Collins, GP, to Dr Wallis, ChildPsychologist. Presented with indications of ADHD and autism spectrum, as well asdepression. Assessment confirmed ADHD, autism spectrum disorder and childhooddepression. Referred to Disability Services for further assessment, seeking fundingand additional support.Note: Dr Wallis has made a notification to child protection services for suspectedchild neglect under mandatory reportingHealth history: No previous medical history or operations. No prescribedmedication.
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Home environment: Nina lives with her mother, who is a single mother on apension. They live in a one-bedroom apartment. Her mother has recently beenconvicted for illicit drug dealing. She served one month in prison, at which timeNina stayed with her grandmother, Hyacinth Black, in regional NSW. Nina reportshaving been hit on many occasions by her mother, to the point of bruising. She alsohas reported being left unattended during the evening several nights a week. Ninadoes not appear undernourished, and reports to eating meals every morning andevening. She either catches a bus to school or walks.Developmental assessmentDemonstrates ability to:XX play independentlyXX maintain eye contactXX follow simple oral instructions such as ‘Please sit down’XX imitate simple tasks like washing dishes.Does not demonstrate ability to:XX sit for more than five minutesXX read at Grade 1 levelXX writeXX control impulses; for example, she yelled at the assessorXX follow complex instructions; for example, she was not able to follow theinstruction, ‘Please sit and read this book for five minutes before the assessorreturns to the room’.Physical assessmentDemonstrates ability to:XX perform normal physical tasks like walking, running or sitting.Does not demonstrate ability to:XX control impulses like salivating.CommunicationDemonstrates ability to:XX speak clearlyXX hearXX maintain eye contactXX follow simple oral instructions such as, ‘Please sit down’.Does not demonstrate ability to:XX speak slowlyXX be polite and courteous towards othersXX demonstrate empathy.
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SocialNina has difficulty relating to peers. She has minimal engagement with otherstudents her age, and spends most play times alone. She hits and bites otherchildren when she gets frustrated. She can follow simple instructions from adultsbut becomes frustrated quickly, and acts out by shouting.EmotionalNina reports to crying frequently, and having difficulty going to sleep and getting outof bed in the morning. She reports having unstable moods throughout the day.RecommendationsAssessment finds that Nina requires support for:XX educational outcomes such as reading and writingXX behaviour managementXX communication stylesXX social engagement.Priority should be given to Nina’s current home state. It appears that Nina isneglected and child support intervention should occur. A report has been madeto child protection services. We will communicate with child protection services todetermine the best outcome and next stage of the process.Signed: Mirabella Watts Date: 16/4/2017
Practice task 161. In the case of mandatory reporting for suspected child abuse, how does theperson’s right to confidentiality apply?2. Which authority should you report suspected child abuse to?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 147TopiC 4 COMPLETE REPORTING3. What information should be included in a mandatory report for child abuse?Click to complete Practice task 16148 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS4B Maintain and store the person’s informationCommonwealth and State privacy, healthrecords and information legislation outline theobligation of community services providers totake reasonable security safeguards to protectthe security of a person’s personal information.Community service providers are required tounderstand and adhere to legal and ethicalobligations to ensure a person’s privacy andconfidentiality are maintained when handling andstoring a person’s information.To read more about Commonwealth, state andterritory privacy, health records and informationregulations go to the following website:http://aspirelr.link/alrc-national-consistency-health-information.Store informationInformation must be stored and managed securely to avoid the risks of privacybreaches, both intentional and unintentional.Here is some more information about storing information.
physical safeguards
XX Physical safeguards include:– locking filing cabinets and unattended storage areas– physically securing areas where information is stored– not storing information in public areas– positioning computer terminals and fax machines so they cannot be seen oraccessed by unauthorised people or members of the public.
Technical safeguards
XX Technical safeguards include:– using passwords to restrict computer access, and regularly changingpasswords– establishing different access levels so not all staff can view all information– ensuring information is transferred securely; for example, not transmittinginformation via non-secure email– using electronic audit trails– installing virus protections and firewalls.
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Administrative safeguards
XX Administrative safeguards include:– policies and procedures to address information security– training staff on policies and procedures.
ConfidentialityWhen discussing a person’s situation, always be aware of maintaining their privacy.You must protect confidential details. You always need the person’s consent if you wishto talk about their situation. Often people are happy to give their consent because theyknow you want to help.Maintaining confidentiality is part of respecting a person’s privacy and individualrights. In practice, confidentiality means not discussing an individual’s personalinformation unless they have given their consent for this to happen. There areexceptional circumstances that do enable you to disclose private information but thisis generally only when you become aware that someone may be harmed.You can read more about privacy, confidentiality and disclosure at the following site:XX http://aspirelr.link/law-handbook-privacy-confidentialityConfirm confidentialityConfirm person confidentiality prior to the assessment’s commencement. Relevantprofessionals can review the person’s results, but only with the person’s knowledgeand written consent. This right to confidentiality is legislated under the Privacy Act1988 (Cth).Here are some points to follow to confirm confidentiality.
How to confirm confidentiality
It is your responsibility to encourage the person to ask questions to confirm theyunderstand their right to confidentiality.
If the person trusts that their information will be used only for purposes relevant tothe assessment, they will have more confidence to disclose accurate information.
A person being assessed for drug use, for example, may have difficulty disclosinginformation about their drug use if they believe the assessor will report to the police.
Always follow organisational procedures to maintain confidentiality, such as onlyconducting an assessment in a room where others cannot hear the discussion.
Ensure assessment documentation is stored securely.
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Example
Maintain and store informationThere are 13 Australian Privacy Principles that apply to the collection, use and storageof people’s information. Here is further information about how to handle personalinformation.Collection, use and storage of personal information1Open and transparent management of personal informationEnsures that organisations manage personal information in an open andtransparent way.2Anonymity and pseudonymityRequires organisations to give individuals the option of not identifyingthemselves, or of using a pseudonym. Some exceptions apply.3Collection of solicited personal informationOutlines when an organisation can collect personal information thatis solicited. It applies higher standards to the collection of ‘sensitive’information.4Dealing with unsolicited personal informationOutlines how organisations must deal with unsolicited personalinformation.5Notification of the collection of personal informationOutlines when and in what circumstances an organisation that collectspersonal information must notify an individual of certain matters.6Use or disclosure of personal informationOutlines the circumstances in which an organisation may use or disclosepersonal information that it holds.7Direct marketingAn organisation may only use or disclose personal information for directmarketing purposes if certain conditions are met.8Cross-border disclosure of personal informationOutlines the steps an organisation must take to protect personalinformation before it is disclosed overseas.9Adoption, use or disclosure of government-related identifiersOutlines the limited circumstances when an organisation may adopt agovernment-related identifier of an individual as its own identifier, or use ordisclose a government-related identifier of an individual.10Quality of personal informationAn organisation must take reasonable steps to ensure the personalinformation it collects is accurate, up to date and complete.11Security of personal informationAn organisation must take reasonable steps to protect personalinformation it holds from misuse, interference and loss, and fromunauthorised access, modification or disclosure. An entity has obligationsto destroy or de-identify personal information in certain circumstances.
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12Access to personal informationOutlines an organisation’s obligations when an individual requests to begiven access to personal information held about them by the organisation.13Correction of personal informationOutlines an organisation’s obligations in relation to correcting the personalinformation it holds about individuals.
Practice task 171. When maintaining and storing a person’s information, what safeguards should beimplemented to ensure the person’s confidentiality is maintained?152 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2. List and explain five of the Australian Privacy Principles that apply to collecting,storing and using a person’s personal information.3. When confirming confidentiality, what points must be considered?Click to complete Practice task 17UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 153TopiC 4 COMPLETE REPORTING4C Provide the person’s information to other servicesA person’s right to privacy and confidentiality, and their right to refusal must be upheld.The support worker is required to provide information about information sharing andthe consequences for both sharing and not sharing information to other services. Theperson should be allowed the opportunity to make an informed decision free from biasor duress. The process for obtaining consent and sharing information to a third party isguided by organisational policy and procedures.Follow processes for accessing servicesOrganisational guidelines apply when accessing services from within and outside ofyour organisation.
guidelines for accessing services
Use the appropriate method of communication with services about person referral.
Communicate with necessary parties about referral; for example, notify the personabout referral, the person’s advocate or the person’s family members as required.
Communicate with the service on behalf of the person or facilitating the person tocontact the service themselves.
Complete requisite documentation when making contact with a service or network.
File communication documentation appropriately.
Seek the person’s consent to release information before information is released,using the appropriate consent form.
Process for accessing servicesThe process for accessing a service may vary between organisations. For example, asocial worker is required to send an email to the coordinator of an internal service,advising them that they would like to arrange an interview between the coordinatorand the person. The social worker schedules the interview and notifies the person andcoordinator of the time and place. The social worker ensures the person is eligible forthe service, and that the service has the capacity to meet the person’s needs. Withthe person’s consent, she sends all the necessary referral information to the servicecoordinator.154 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSThe following is a process for accessing services.
1
Send an introductory email to the service in question.
2
Arrange a meeting between the service coordinator and the person.
3
Gain the person’s consent to share their personal information with theservice.
4
Compile and deliver the necessary person information, including anassessment report.
5
Processes for assisting the person to access external service, on the otherhand, may include completing an organisational referral form.
6
Obtain the person’s consent to share information.
7
Arrange a meeting with the person and the service coordinator.
8
Arrange a follow-up review of the service to ensure it meets the person’sneeds.
Consent to share personal informationAs well as explaining the assessment process, it isimportant to clearly explain the dissemination ofresults. The person must be given the opportunityto consent to how assessment results are usedbefore assessment is conducted. For example,if an older person is being assessed for herability to live independently in the community,the assessment team must clearly explain theassessment process, and that they will send acopy of the results to the person’s GP (with theperson’s permission). A follow-up visit will bearranged with ACAT to discuss what the resultsindicate and the support options available.Discuss the implication and possible outcomes of the assessment. Where possible,remain positive and encouraging in your language, using statements such as, ‘Thisassessment will enable you to access more suitable services’.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 155TopiC 4 COMPLETE REPORTINGGain consent and document for referralYou must gain the person’s consent when information is being shared for a referral.This consent should be carefully and accurately documented before information isshared.Your organisation has policies and procedures that outline when you must obtain aperson’s consent to share their information. These policies and procedures will bebased on Commonwealth and state/territory privacy legislation.
Legislation relating to consent
XX Privacy Act 1988 (Cth)
XX Privacy and Personal Information Protection Act 1998 (NSW)
XX Information Privacy Act 2009 (Qld)
Person consent requirementsOne of your roles when working with a person on an individual basis is to givethe person information about privacy and consent requirements and ensure theyunderstand this information. Your organisation’s privacy policy and procedures usuallycontain this information.
right to consent
XX Advise persons that they have the right not to consent to share their informationwith other service providers. The only exceptions to this are when you needto disclose a person’s personal information because there is a risk that theywill harm themselves or others, or a court orders access to the information.If a person is unable to provide consent, you should obtain it from their legalguardian, carer or next of kin.
Document consent
XX Most organisations have forms that the person can sign to give consent to sharetheir personal information with another service provider.
inform of consequences
XX If persons do not consent to share information, you need to make sure theyunderstand the consequences of this. This may include them not receivingneeded services or treatment, or it being more difficult for other agencies orprofessionals to provide services because they do not have information aboutthe person.
right to refuse
XX Persons should not be coerced or pushed into providing consent. Providethem with the necessary information about the targeted service, check theyunderstand the information and then respect their right to make their owndecision.
156 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSDocument for referralWhen documenting a referral, it is useful to ask yourself if you would be comfortableif the person read what you have written. This will help you to write in a way that isrespectful and preserves the dignity of the person you are writing about. Rememberthat, under freedom of information legislation, persons can request to see their files.Consider the following when making referrals.
Meet requirements
Ensure you follow the organisation’s guidelines, such as:XX using the standard referral form, and signing and dating all documentationXX complying with confidentiality protocolsXX completing documentation within your scope of practice and work role; do notcomplete sections you are not authorised to completeXX remaining objective and not including your opinionXX being concise and ensuring information is accurate and factualXX citing the source of the information; for example, ‘Fiona’s guardian stated that …’
provide information
Collate the appropriate documentation to forward to the service provider. You needto find out exactly what information the provider requires. As part of the referralprocess, you may need to provide:XX copies of the individual’s service delivery plans and recordsXX contact details of the person’s next of kinXX assessment results relevant to the service; for example, if the service providessports activities, they should have access to information pertaining to theperson’s health/physical assessmentXX medication the person is currently takingXX relevant first-aid information; for example, if the person requires an inhaler.
Accuracy of documentationDocumentation sent to the agency you arereferring the person to must be accurate. Ifmistakes are made during the referral process,the person’s safety may be put at risk. Doublecheck all referral information before handing itover.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 157TopiC 4 COMPLETE REPORTING
Example
provide person’s information to other servicesThe following are examples of information collected on forms dealing with consent.Hilltop Community Support Service – Consent to disclose personal informationI have given my consent for Hilltop Community Support Service staff to provide mypersonal information to meet my support and care needs.Name: Mavis HigginsSigned: Mavis HigginsDate: 21/10/17Westbank Welfare Agency – Referral formPerson Details Date: 7/5/2017Last name: Langveld First Name:FredTitle: MrDate of birth: 12/03/1971 Address: c/o Westbank Welfare Agency,26 Kalinga Rd, North BellalongConsent to release informationCompleted:  Yes  No Filed:  Yes  NoCopy attached:  Yes  NoReferred to: Dr Tanya Sutherland – PsychologistReason for referral: Fred Langveld has expressed a need to deal with the issuesarising from his experiences being physically abused as a young boy. He would alsolike to learn strategies to deal with anger constructively and be able to strengthenhis relationship with his partner Cheryl.Relevant history: Fred Langveld is a survivor of physical abuse. He has disclosedthat he hits his partner Cheryl when he has consumed excess alcohol.Name: Jane Robb Signature: J RobbPosition: Welfare Worker Contact phone: 0452 228 545
158 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 181. Outline the process for accessing services.2. What information should be provided when documenting for referral?3. Outline the support worker’s role in confirming consent to share a person’sinformation.Click to complete Practice task 18UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 159TopiC 4 COMPLETE REPORTINGSummary1. Requirements for format and content of reports will be outlined in organisationalguidelines.2. Professional language and excellent written language skills are critical for writingan effective report.3. Gain the consent of a person before sharing personal information with a service,including assessment results.4. Follow organisational policy and procedure when obtaining consent to sharepersonal information, documenting assessment reports and referring to otherservices.5. Follow organisational privacy and confidentiality policies when collecting, storingand using a person’s personal information.6. Follow the ten national privacy principles when collecting, storing and using aperson’s personal information7. Implement safeguard strategies to maintain confidentiality when accessing, storingand using a person’s personal information.8. If you suspect a child is being abused or neglected, and mandatory reportinglegislation applies, you must report to your state or territory child protectionauthority. Follow your organisation’s policy and procedures for reporting childabuse or neglect.160 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSLearning checkpoint 4Complete reportingThis learning checkpoint allows you to review your skills and knowledge in completingreports.Part A1. Explain the exceptions to gaining informed consent from a person with supportneeds and what you should do in these exceptional situations.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 161TopiC 4 COMPLETE REPORTING2. A person is accessing support from a government AOD agency in South Australia.The person has reported that their six-year-old daughter is currently at home,unsupervised. They tell you they often leave the child at home unsupervised forextended periods of time. Explain how you should respond and why.3. What information should be included in the contents of a summary report?4. What is the purpose of a summary report?162 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS5. When documenting an objective report of suspected abuse, what should beincluded in the report?Part BRead the scenario, then answer the questions that follow.
Scenario
You work in disability services and are coordinating an assessment of a personwith complex issues. The person, Stefan, is on the autism spectrum and has anintellectual and mobile disability. He also has AOD issues, which affect his abilityto live safely on his own and impact on his mental health. An assessment is beingconducted to determine which services will best meet his needs.At the time of assessment, Stefan is living with his sister and her family, but hissister has requested support because she can no longer afford to support Stefan.She also finds it difficult to manage his dramatic mood swings. She reports that attimes, Stefan’s behaviour is aggressive, bordering on violent.Stefan was injured in a car accident when he was 17, sustaining back and neckinjuries, and losing the use of his legs. He uses a wheelchair. Stefan currently takesmedication to manage chronic pain. He is not currently receiving medical supportother than occasional visits to the GP to collect prescriptions. He is unable to liveindependently, as he cannot manage his own hygiene or food preparation. He alsohas difficulty accessing transport and integrating into the community.Stefan is eligible to access two disability organisations that currently havevacancies in residences. One service has a share residence available, where Stefanwould be living with one other person with disabilities. The other service offers anapartment on the second floor, where Stefan would live independently.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 163TopiC 4 COMPLETE REPORTING1. What safeguards should the service provider implement to ensure that Stefan’spersonal information is stored and managed securely to avoid a breach of hisprivacy?2. List three strategies that you could use to maintain Stefan’s right to privacy andconfidentiality when collecting, using or storing his personal information?164 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS3. What process would you follow to share Stefan’s information for referral to anotherservice to ensure Stefan’s confidentiality is maintained?UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 165Topic 5In this topic you will learnhow to:5A Seek feedback aboutassessment processes5B Monitor processes andtheir outcomes5C Routinely seek feedback5D Use feedback to improveprocessesEvaluate assessment andreferral processesYour relationship with the person you are assessing doesnot end once service delivery has commenced. You needto regularly monitor the allocation of services to ensurethey continue to meet the person’s needs. Progressreports and person feedback are an important meansof evaluating the service’s adequacy and performance.They are also a means of monitoring whether anychanges have occurred in the person’s circumstancesor the services being provided. It is also important toseek feedback from colleagues and people you areproviding support to about your own performance. Thiscan be used to improve your ability to conduct complexassessments and referrals in the future.166 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS5A Seek feedback about assessment processesActively seek opportunities to obtain feedback onyour performance from colleagues and the peopleyou support. This feedback can be used to improveand further develop your skills in conducting complexassessments and referrals.Seek out colleagues who will give you honest andconstructive feedback. Also keep in mind that there isno point in asking others for feedback unless you arewilling to consider what they have said.Seek feedback from networksThe quality improvement process involves gathering feedback on service delivery fromall stakeholders. Networks are a valuable resource for providing feedback to informthe quality improvement process. The community services sector is dynamic due tochanges to funding, service delivery models, capacity of networks and services, andprocesses. These changes can impact upon your organisations service delivery; this iswhy it is essential to keep abreast of changes to other services and networks.Feedback may be sought about:XX the capacity of the service network to effectively deliver services to meet the needsof the communityXX the referral processes between agenciesXX the roles of agenciesXX how agencies in the network support each other in their rolesXX whether services are extensive and comprehensive enough to meet the needs inthe communityXX funding arrangements and changes to fundingXX best practice models and changes in best practice.Accept feedback non-defensivelyWhen you request feedback, make clear the area of practice you want to receivefeedback on. For example, you may request feedback from a person you support aboutyour management of their referral to a service. If you feel yourself reacting stronglyto feedback, think about why this may be. Is it because you know what is being saidis true, or is it because the feedback has been given in an unfair way? Seeking outand accepting feedback non-defensively shows that you respect the opinions of yourco-workers and other people, and are willing to learn from them. Here is some furtherguidance on accepting and responding to feedback.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 167TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSES
Accepting feedback
To accept feedback in a non-defensive way, try the following:XX Listen carefully to what is said.XX Be polite and courteous to the person providing the feedback.XX Accept the feedback without interruptions or protests.XX Ask for clarification or examples if you are not sure what the person is saying.XX Think about how you can apply the feedback you have been given.XX Discuss possible strategies to improve your work practices.
responding to feedback
You may appear defensive and hostile if you respond to feedback by:XX becoming angry with and insulting the feedback providerXX interrupting and arguing with the feedback providerXX denying that the feedback applies to you and refusing to take personalresponsibilityXX failing to consider or act on feedback.
Give and receive feedbackLearning the guidelines for giving and receiving feedback should help you feelconfident about giving feedback and accepting it from others. The way you providefeedback affects the way others receive it. It is most beneficial when given in arespectful, sincere and courteous manner. Always try to convey that you appreciateand value the person you are giving feedback to and that you want to support and helpthem. Accept feedback from others in the same spirit and try to learn from it.Here is some further guidance on giving and receiving feedback.
Be specific
Make sure the feedback you give is specific. For example, ‘I appreciate that youalways write your case notes promptly, but sometimes you don’t explain what youmean. If you say you have noticed behavioural changes in a person, I need you toprovide details of the types of behaviour changes you have noticed’. This tells therecipient what they need to do and offers positive feedback at the same time.If a colleague gives you feedback and you are unsure what they are saying, ask themto clarify what they mean or to provide specific examples of the performance, actionsor behaviour they are commenting on.
Be constructive
Avoid purely critical or negative comments, and never offer feedback as a way ofhumiliating or belittling your co-workers. Try to make positive comments beforeproviding feedback about what they need to improve.Constructive feedback allows the recipient to feel supported and respected. Always tryto convey that you respect and value the person and are sensitive to their goals andneeds. If a co-worker makes comments that are personal, you have the right to tellthem that you will only accept feedback that focuses on your skills and performanceand if it is given in a respectful manner.
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ensure feedback is timely
Try to give feedback as soon as possible following the time the behaviour or workpractice you are discussing occurred. It is not helpful to say, ‘Mrs Jones told me lastmonth that you never follow up and get back to her about other services that she iseligible for. It’s too late now because she has left.’It is always better to point out problems or oversights at the time they occur so thefeedback recipient can correct the issue themselves or make sure they do not repeatthe same mistake.
Be clear and direct
Some people are uncomfortable giving feedback, so they ‘beat around the bush’and do not state exactly what they mean. This can be very confusing for everyone.Work out what you want to say before you say it and give your feedback in a clear andconcise way so the recipient can easily understand what you mean.If you are not sure what someone means when they are giving you feedback, askquestions until you do understand. Seek clarification and examples of the behaviouror practice so you know what areas you need to improve.
focus on behaviours and actions rather than personalities
Never make personal criticisms of a co-worker. If you need to provide feedback, focuson behaviours or actions, rather than making personal remarks or attacking on thebasis of a personal characteristic.For example, avoid saying ‘You’re so full of yourself. You think you have a right to talkover everyone else all the time’. Instead, you could suggest that while it is importantto make contributions, it is also important to listen to others.
Be fair
Always ensure you give feedback that is fair and balanced. For example, do not givefeedback if you do not know all the facts of a situation, as you could blame someonefor something that was beyond their control.Always ensure you take into consideration other factors that may have influencedwork performance. For example, a worker may not have been able to do everythingthey were supposed to do on a particular day because a number of colleagues calledin sick that day.
encourage open, two-way communication
Communication is based on sending, receiving and interpreting messages. Manyof us have been in situations where something we have said was interpreted in acompletely different way from what we intended.When giving feedback, choose your words carefully and give the feedback recipient anopportunity to respond to what you have said. If the recipient does not have a chanceto talk about or clarify feedback, they may become resentful and feel they have beenunfairly criticised.
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Example
feedback formThe following is an example of a feedback form.Feedback formName: Date:My feedback is a: Compliment  Complaint  Comment/suggestion Name of service:What would you like to tell us about the service?What would you like to see happen?How should wecontact you?Phone  Email  Letter Signed:
170 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPractice task 191. What information should be sought from networks to contribute to qualityimprovement?2. When receiving feedback, what should you do to ensure that you accept it in anon-defensive way?3. If you receive feedback that you do not understand what should you do?Click to complete Practice task 19UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 171TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSES5B Monitor processes and their outcomesIn addition to consulting service providers toobtain review information, it is important to seekfeedback from the person using the service abouttheir level of satisfaction with the assessmentand referral process and services provided andwhether their needs are being met. This is akey criterion for judging whether a process andoutcome is satisfactory.Continuous improvement in the organisation’sservice delivery also involves ongoing monitoringand evaluation of processes and their outcomes.These processes and outcomes are measuredagainst service standards and key performance indicators to identify the need forimprovements to service delivery.Monitor service delivery at the organisational levelUsing routinely-collected data, you can obtain general information about yourorganisation’s processes and outcomes and how well they meet the needs of serviceusers.
Strategies for monitoring processes
XX Internal audits
XX Satisfaction surveys or questionnaires for service users, staff and otherstakeholders
XX Monitoring of organisation key performance indicators
XX Review of risk management plans
XX Collating information such as feedback forms and incident and hazard reports
XX Review of policies and procedures in relation to current practices
Monitor processes for feedbackQuality improvement processes are set out by organisational guidelines. Theseguidelines are based on industry standards and should outline the processes forfeedback and the procedures for monitoring processes. The way the organisationseeks, collects and responds to feedback should be clearly outlined in the guidelines.Consider the following when monitoring the feedback processes:XX Is the feedback, complaints and appeals process fair, accessible and accountable?XX Has feedback, complaints and appeals processes been effectively communicatedto relevant people?172 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSXX Have the relevant people been informed of support for feedback, complaints orappeals?XX Have the relevant people been informed of how to access this support?XX Have feedback, complaints and appeals processes lead to improvements withinthe service?XX Have outcomes been communicated to relevant stakeholders?XX Has adequate opportunity been provided to stakeholders to provide feedback?Assess impact of setting on the processWhen conducting a review of processes, it is important to consider the impact ofthe setting on the process. In the instance of feedback processes, it is of particularimportance to ensure that the person providing feedback has adequate access toinformation about the process, access to feedback mechanisms and the freedomto express feedback without the risk of negative consequences, such as unfairtreatment or intimidation. In order to elicit the most accurate, unbiased and reliableinformation from the feedback process, it is important to conduct an assessment ofhow the setting may impact on the reliability of feedback. Careful consideration mustbe made to identify the most appropriate setting for seeking feedback and proceduresimplemented to ensure that variables do not impact upon the reliability of thefeedback.Here is information about these variables.
privacy
XX A person may not feel comfortable providing honest or accurate feedback in thepresence of others for fear of ridicule, judgement or recrimination.
Accessibility
XX Important feedback may not be provided due to lack of access to feedbackmechanisms, lack of information about feedback processes or lack of adequatesupport to provide feedback.
Data collection
XX Methods of data collection must be user friendly and able to be adapted toaccommodate a diverse range of users in order to provide an inclusive andaccurate representation of service users.
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Example
Continuous improvement guidelinesThe following is an example of an organisation’s continuous improvement guidelines.Continuous improvement principlesXX All management and staff have a role to play in the management anddevelopment of the continuous improvement process.XX Ongoing feedback and consultation should be sought from service users,management, staff, volunteers, the community, suppliers and other relevantstakeholders.XX Complaints, compliments and other feedback should be recorded, reviewed,investigated, evaluated and acted on.XX Mechanisms for feedback must be; explained to stakeholders, accessible,user-friendly and free from influence or bias.XX The person providing feedback should be informed of the actions taken.XX The outcome of the feedback must be evaluated.XX Improvement plans and records of improvements should be maintained todemonstrate what has been achieved over time.XX Feedback should be provided to inform service users, management, staff,volunteers and other stakeholders about implemented improvements.XX Management and staff must have knowledge of the organisation’scontinuous improvement processes and their role in the process.XX Policies and procedures should be documented to guide practices andprocesses.
Practice task 201. List five strategies that can be used to monitor processes.174 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2. What should be considered when monitoring feedback processes in terms ofmeeting the person’s needs?3. Explain how the setting can impact upon the reliability of feedback.Click to complete Practice task 20UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 175TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSES5C Routinely seek feedbackIn addition to consulting service providers toobtain review information, it is important to seekfeedback from the person about their level ofsatisfaction with the service provided and whetherthe service is meeting their needs. Meeting withthe people you provide support services to givesyou an opportunity to gauge this. As well as askingdirect questions, you can observe nonverbaland other behavioural cues about the person’sexperience.Consult your supervisor and organisationalpolicies and procedures to determine whichprocesses to use to collect their feedback about the adequacy of service delivery.This feedback can be collected formally or informally. You may also need to engageadvocacy services and/or an interpreter to enable effective review of the services.Processes for collecting feedbackFeedback forms or surveys are used to obtain feedback from people about theservices they are receiving. Follow organisational procedures for how often feedback isobtained and which forms to use.Survey forms can be used to assess:XX what the person is and is not happy withXX whether the person would like to make a complaintXX whether the person has any suggestions to improve the service.Formal and informal feedbackWhen identifying the extent to which the person is satisfied with the services provided,always probe to find out the reasons they are satisfied or dissatisfied. If the personhas made or wants to make a formal complaint about the service, or refuse deliveryof a service, assist them by providing them with information for how to do this. Followorganisational procedures for recording their feedback. This may involve writing areport, adjusting service delivery plans or making notations in the person’s file.Here is more information about gaining feedback formally and informally.
Questions to ask the person
XX Was the cost appropriate?XX Were staff easy to get along with?XX Was it easy enough to get to the service?XX Did you receive an appropriate level of support?XX Did you see the relevance of the services and support offered?
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observe nonverbal cues
XX As well as asking direct questions, you can observe nonverbal and otherbehavioural cues about the person’s experience. These cues may include:– not turning up for appointments– consistently being late to appointments– evading questions about the service– using defensive body language when discussing the service, such as turningaway or avoiding eye contact.
Determine reasons for dissatisfaction
XX If you maintain open communication and a trusting relationship with theperson, they will be more likely to express when they are dissatisfied with aservice. However, a person may provide contradictory information. They maytell you everything is fine, but nonverbal cues suggest otherwise. Use probingquestions to get to the bottom of the issue such as, ‘You tell me you are happywith the service, yet you do not attend the majority of meetings. Can you help meunderstand why this might be?’
Practice task 21Read the case study, then complete the questions that follow.
Case study
Azmin has started a new job at a home and community care service. Her role is toconduct assessments of people with complex issues and facilitate service delivery.She has previously only worked in aged care and she is nervous about her ability towork with people who have disabilities and mental health concerns.Azmin consults the organisation’s policies and procedures, and speaks tocolleagues and supervisors before conducting her first person assessment andarranging service delivery.The first person she works with is Ross, who has an intellectual disability and AODissues. Azmin collects relevant information during the assessment and uses arange of assessment procedures, including interview, observation and compilingmedical records. She presents a range of services to Ross that are intended tomeet his needs. Internal services include housing, skill development and a dayprogram. External services include drug and alcohol rehabilitation and counselling.With Azmin’s assistance, Ross selects and accesses appropriate services. After amonth, Azmin’s supervisor, Belinda, asks her how Ross is progressing and whetherthe services match his needs. Azmin says she’s not sure.Belinda queries Azmin’s review strategies. She suggests that Azmin becomes moreinvolved with service delivery to ensure the services meet Ross’s needs. Azminlistens carefully to this feedback . Belinda suggests Azmin work closely with anothercolleague in a similar role, and that she ask for help and feedback as she goes.Azmin is thankful for the feedback, although she feels embarrassed that she hasnot followed organisational procedures adequately.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 177TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSES1. What does Azmin do correctly in the early stage of her new role?2. Identify two opportunities for obtaining feedback that Azmin does not recogniseand use.3. How has Azmin responded to the feedback she has received and how could she bemore proactive?Click to complete Practice task 21178 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS5D Use feedback to improve processesFeedback is a critical component of the quality improvementprocess, and the information obtained from feedbackprovides valuable insight about performance, systems andprocesses. By evaluating the lessons learned from feedbackwe are able to identify what is working well and what we needto improve or change to achieve optimal service delivery.Review strategiesStrategies that can be used to review services, changes in circumstances,environmental factors and urgency of person needs are presented here.
Meetings
Meetings are a good way for stakeholders to share insights about what is and is notworking and to develop better ways of working together. These meetings may beformal or informal.As a follow-up to the meeting, check whether any agreed changes have made theservices and supports more effective.
Case notes
Case notes can help identify whether the service being delivered remains effective.They can reveal day-to-day issues, such as growing dissatisfaction with serviceproviders. Absences or missed appointments can also point to person dissatisfaction.
Discussions with the person
In most cases, people will tell you if they have any issues or concerns if you give themthe opportunity. Allow the person time to speak. Ask open questions such as, ‘Whatwould you like improved?’, rather than closed questions such as, ‘Are you happy withthe services you’re receiving?’
family discussions
Family members may be frustrated with the services provided or the person’sprogress. Because they are outside the system, they are not always aware of whoto speak with. They will generally be pleased to discuss any issues or concernsproviding you give them the opportunity.
Worker discussions
Providing you have informed, written consent, ask other workers and healthcareprofessionals about whether the person is engaging with the services or supports,and whether they believe additional or different supports and services are needed.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 179TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSES
nonverbal cues
Be observant. Do the person’s, family member’s or worker’s spoken language andbody language match? If they are telling you they are happy but their body languagesuggests otherwise, use appropriate probing questions.
observation
Take time to get to know the person within the scope of your practice and job roleboundaries. Do their issues seem to be getting better, are they getting worse or arethey staying the same?
formal assessments
Use formal assessments from healthcare professionals or specialist service providersto assess whether the support measures are helping the person to achieve theirgoals and to meet their identified needs.
progress reports
Individual progress reports may be prepared by the service provider to give details ofthe person’s progress towards target actions and goals. Recommendations may alsobe made about changes to the service/program to better meet the person’s needs.
Surveys
A review form or survey is a set of written questions used to invite feedback about allaspects of service provision. The results of surveys can be used to help individualsand to make changes across the board for the benefit of all persons.
Document revisions to service deliveryA person’s feedback regarding service delivery should be documented. If the personis dissatisfied with the service, or their needs have changed or not been met, you mayneed to terminate the service, organise variations to the service, refer to a new serviceor help the person make a formal complaint.Here are guidelines to consider when making revisions.
new service inclusion
The following should be undertaken upon new service inclusion:XX Provide the service with person contact details and relevant information.XX Provide the person with service contact details and relevant information.XX Obtain person consent before sharing information.XX Change the service details in the service delivery plan and complete the referralforms.
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Service revisions
If a service is terminated or adjusted:XX adjust the person service delivery planXX make notations on person recordsXX contact relevant parties to inform them of the changeXX update any other relevant organisational documentation.
Use own evaluation to improve processSelf-evaluation is an effective way of improvingprocesses. By reflecting upon your ownpractice, identifying your strengths and areasfor improvement in your work, you are able tocontribute to improving process. For example, byreflecting on your own practice you may identifya need to gain further knowledge and skills in acertain area of your work. This may lead to yourengagement in professional development, theoutcome being the improvement in your abilityto undertake a process more efficiently or yourcontribution to making changes to processes thatare outdated or not working. Your own evaluationshould be ongoing, and the focus of your evaluation should be clearly identified. TheQuality Framework Cycle can be used to conduct your own evaluation to improveprocess, as it is simple and easy to use.Use feedback to improve processesA quality framework cycle can be represented in many ways, including the plan-docheck-act (PDCA) cycle. There are four stages that revolve around a central point.In the quality framework cycle, it may be a system or a policy in the centre. Qualitysystems must be continuous.Here is some more information about a system for continuous improvement.planCheckDoActAfter you have a plan, you then implementit. You may decide to test the plan or pilotthe plan first.The next step is tocheck the new system.Is it working as youexpected? Did it have agood or a bad effect? If itis not working, you may needto go back to the plan stage andstart again until you get it right.If all is working well,you act; that is, fullyimplement the changedsystem.The first step in the cycle is to plan. Thisinvolves looking at data on the presentsystem and working out whatneeds changing and why. Youneed to look at what youexpect to happen, if it ischanged and whetherit will improve thesystem.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 181TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSESPractice task 22Read the case study, then answer the questions that follow.
Case study
Barry is a man with mental health issues and an intellectual disability. He iscurrently receiving services offered by a disability agency. Services include a dayprogram that includes socialising and physical activities, skill-building and housing.He also accesses weekly appointments with a psychologist and monthlyappointments with a speech pathologist.Barry is not happy with the skill-building program. He does not like the facilitator,John, because he is not open to listening to his questions. Barry decides tocomplete a feedback form to submit to Wendy, his case manager. Upon Barry’srequest, a support worker is asked to assist Barry to complete the form.
1. Create and complete a feedback form for Barry. You will need to includehypothetical information.182 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2. Based on the information provided in the feedback form, what revisions, if any,would you recommend be made to the service delivery arrangements?3. What methods are used to collect feedback, either in your own organisation ora community services organisation near you? Write a brief report explaining themethods used.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 183TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSESSummary1. Actively seek opportunities to obtain feedback on your performance fromcolleagues and the people you support. This feedback can be used to improve andfurther develop your skills in conducting complex assessments and referrals.2. Quality improvement processes are set out by organisational guidelines. Theseguidelines are based on industry standards and should outline the processes forfeedback and the procedures for monitoring processes.3. Routinely seek feedback from service providers and the person using the serviceto obtain review information. Seek feedback from the person about their level ofsatisfaction with the service provided and whether the service is meeting theirneeds.4. By evaluating the lessons learned from feedback we are able to identify what isworking well and what we need to improve or change to achieve optimal servicedelivery.Click to complete Practice task 22184 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSLearning checkpoint 5Evaluate assessment and referralprocessesThis learning checkpoint allows you to review your skills and knowledge in evaluatingassessment and referral processes.Part A1. List and explain three methods that can be used to seek feedback when reviewingservice.2. List five strategies that can be used to monitor processes and their outcomes.UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 185TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSES3. List five principles of continuous improvement.4. Why is it important to collect feedback from clients about their experiences withthe service? Use examples from your own work experience or case studies in thisunit to illustrate your answer.5. How can feedback from your supervisor, colleagues or clients be beneficial toyour practice? Where possible, use examples from your own work experience todemonstrate the benefits of receiving feedback.186 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDSPart BRead the case study, then answer the questions that follow.
Case study
Sarah Brown is 16 and has cerebral palsy and epilepsy. She has been referred to anoccupational therapist for weekly speech therapy and fine and gross motor skill training.She has had eight sessions with the therapist. The therapist provides a report aboutSarah’s progress to a disability organisation where Shaun works. In the report, theoccupational therapist states the following:XX Sarah experiences severe articulation problems, which make it difficult for her tospeak clearly. There has been no improvement in speech articulation over the eightweek period.XX Sarah requires a walking frame for assistance. She cannot walk without the frame.Sarah is making progress, however, by standing for up to a minute confidently withoutthe frame.XX Sarah cannot hold a pen to write, or hold cutlery. She cannot grip tightly on objects.There has been no recognisable change during treatment.XX Sarah has had three aggressive outbursts during occupational therapy sessions,which has made it difficult to continue with treatment. One session ended early dueto Sarah’s behaviour.Shaun has an appointment with Sarah and her mother, Rebecca. He needs to discussthe current service plan and the question of whether adjustments should be made.During the meeting, Shaun asks for Sarah and Rebecca’s feedback about the currentservice. Rebecca tells him she is unhappy with the therapist, as she feels she bossesher daughter around and expects too much from her. She also believes the fundingcan be better used elsewhere. Her suggestion is that Sarah be allocated one-on-onesupport when in school to support Sarah with all school activities, rather than seeing anoccupational therapist weekly, which appears to have no results.Shaun asks Sarah to complete the client feedback form about the existing service withher mother’s assistance.At the end of the meeting, Rebecca tells Shaun she is very frustrated by how slowlyeverything is moving, and how there has been no noticeable improvement in Sarah’sfunctioning. She says that the services have failed to meet Sarah’s emotional, social andpsychological needs. For instance, Sarah has been given no support to improve her abilityto form friendships at school. Greater attention should be given to all Sarah’s needs,rather than just her physical needs.Rebecca tells Shaun that unless quality of service and speed of progress improves, shewill move Sarah to another organisation, which can provide faster and more effectiveservice delivery.
UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTING 187TopiC 5 EVALUATE ASSESSMENT AND REFERRAL PROCESSES1. Create and complete a client feedback form from the perspective of Sarah and hermother.188 UNIT RELEASE 2 (ASPIRE VERSION 1.4) © ASPIRE TRAINING & CONSULTINGCHCCCS004 ASSESS CO-EXISTING NEEDS2. How should Shaun respond to Sarah and her mother when they share how theyfeel about the existing service?3. How could the service delivery plan be adjusted to incorporate the feedback?Provide at least three suggested changes.4. Explain how Shaun should respond to the individual feedback given about hisperformance during the meeting.

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