Academic journal article British Journal of Occupational Therapy

An Evaluation of the Use of Self-Assessment for the Provision of Community Equipment and Adaptations in English Local Authorities

Academic journal article British Journal of Occupational Therapy

An Evaluation of the Use of Self-Assessment for the Provision of Community Equipment and Adaptations in English Local Authorities

Article excerpt


National policy has voiced high aspirations for the future of adult social care. The vision is of a more personalised approach to service provision, with service users given greater choice and control, a new emphasis on early intervention and prevention, and the delivery of services closer to home (Department of Health [DH] 2005, 2006a, Her Majesty's Government 2007). The introduction of a new Common Assessment Framework, which challenges organisations to redesign local systems around people's needs and, wherever possible, enable them to self-assess, is central to these ambitions (DH 2008). The pace at which this agenda can be delivered, however, is likely to depend, at least in part, on occupational therapists' enthusiasm for such initiatives, for despite representing just 2% of the social care workforce, occupational therapy staff manage around 35% of all referrals to local authority social services departments (Department of Health and College of Occupational Therapists [DH and COT] 2008). Furthermore, although the expectation is that self-assessment will provide faster, easier access to services, freeing professional staff to work with complex cases (DH 2005, 2006a, 2006b, 2008), any change to service delivery models should be evidence based (Bannigan et al 2008), and knowledge about virtually every aspect of self-assessment--its very definition, application, scope and effectiveness--is undeveloped.

Against this background, in August 2006 the Government in England announced details of 13 local authority projects that would pilot the development of self-assessment in social care (DH 2006b). The intention was to determine if self-assessment was feasible in this sector and, to this end, a multisite evaluation was commissioned. This aimed to:

1. Classify and describe the different approaches taken to self-assessment

2. Gauge service users' experience of self-assessment

3. Evaluate the cost-effectiveness of self-assessment

4. Appraise the implementation and sustainability of new assessment practices (Challis et al 2008).

The work described in this paper formed part of this evaluation and draws on a subset of the data collected in eight projects concerned with the provision of community equipment and adaptations. It addresses the following key questions:

* How has self-assessment been used?

* Who undertakes self-assessment?

* What services do people receive following self-assessment?

* Is self-assessment associated with more timely service delivery?

Literature review

A critical appraisal of the relevant literature relating to the use of self-assessment in social care was undertaken, drawing on a wide range of sources including government and professional bodies' policies and statements, academic journal articles and reports. In comparison with the situation in health care, where self-completed screening questionnaires have long been used to identify individuals requiring further professional assessment or advice (for example, Tulloch and Moore 1979, Bowns et al 1991), the use of self-assessment in social care is a relatively new phenomenon. The emerging literature, which contains a disparate mix of descriptive and evaluative reports, is still, therefore, quite limited, while the self-assessment tools themselves range from the locally developed to the rigorously tested. Indeed, the concept of self-assessment in social care has not yet been clearly defined and, as Griffiths et al (2005) have noted, at its broadest this term has been used to refer to any situation in which professionals take account of service users' views of their needs or respond to evaluative questions about their health. In contrast, the definition of self-assessment offered by Qureshi (2006) stresses the potential for individuals themselves to use information about their goals, circumstances and environment as a basis for decision making. …

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