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205YW Understanding the Health Needs of Adolescents and Chil

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Sian Ponting

on 15 November 2016

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Transcript of 205YW Understanding the Health Needs of Adolescents and Chil

Name the 4 models of health

What do you remember about them?

A quick re-cap
205YW Understanding the Health Needs of Adolescents and Children

Health needs understood in terms of person-level dimensions (e.g., neurology, biology, and psychological).
Bio-medical model: Neuro-biology and physiology.
Psy-medical model: Psychological systems (e.g., cognition, emotions, and actions).

Early identification and intervention (diagnose and treat) are considered necessary to avoid long-term negative outcomes (Fuchs & Fuchs, 2007).

Medical Model
The social model shifts the focus from person-level impairments to the effects of socio-environmental forces (Norwich 2002).
Idealist stance:
Health entirely socially constructed
emphasise the social and environmental factors which create barriers, deny opportunities, and “dis-able” people (Murray & Osborne, 2009).
Materialist stance:
Social-relational model (Reindal 2008)
recognizes social factors (e.g., barriers and opportunities) and the material reality of impairment.
Social Model
Is strengths-based (not deficits-based)
Believes every person and environment has strengths and resources.
Strengths are identified (assessment) and utilized, in order to intervener or prevent problems and promote positive development, wellbeing, and resiliency (Seligman, 2003).
Strengths-based model
Why is it important to measure health?

How can you measure health?

Measuring Health
In order to measure something, you need to be able to define what you are measuring
Measuring Health
Reliance of negative definition of health provides little information on the majority of the population
Positive Health
Social sciences - mostly self-reporting tools such as questionnaires
Measurement tools
Week 2: Assessing Health Needs of Adolescents and Children
Learning Outcomes
By the end of this session, students should be able to:
Identify ways in which health is measured
Describe 2 levels of assessing health needs: the individual and the community
Understand the CAF process
Describe how different methods of assessment relate to different models of health
Individual Model (Preistly, 1998)
Is solution-focused (not problem-focused)
Stop trying to “fix” problems and start “finding” solutions.
People are all inherently solution-focused, so they have expertise about themselves and what is needed for positive changes.
Solutions and mutually agreed goals established are constructed “collaboratively” (i.e., voice)
(de Shazer, 1984; Lopez & Snyder, 2009; Reeves, 2012; Saleebey, 2006)
Based on Systems Theory (von Bertalanffy 1968)
Psychosocial adaptation, development, and health is determined by a range of factors; such as biological, psychological, socio-cultural, socio-political, and environmental factors (Bronfenbrenner 2005).
Bio-psychological and socio-environmental factors are recognized as exerting bi-directional influences.
Relationship between the Person and their Socio-environmental context across time
Bio-psychosocial Model
The individual model identifies innate impairments, which require treatment.

The social model emphasises the removal to problematic socio-cultural forces.

The strengths-based approach emphasises personal strengths and socio-environmental factors, which must be mobilized to prevent problems or support coping.

The biopsychosocial model considers a complex array of problematic and facilitative factors; which implicates a range of personal attributes (e.g., strengths and deficits), socio-environmental (e.g., people and objects), socio-cultural (e.g., social expectations) and contexts (e.g., home and school).
Consider the following concepts:how might you measure them?
Health & Disease
Ill health as indicated by morbidity & mortality
survival/ death
pain/ discomfort
change in functioning and feeling
Indicators of Health
Mortality & Morbidity
Judges the value or efficacy of interventions based on survival and/ or symptoms
This ignores individuals own perception of health
Does not take into account other factors relating to health socio-economics,
Subjective health indicators
Studies based on either patient or physician surveys
Dorn (1955) health spectrum (Perfect health - death)
Merrell & Reed (1949) wellbeing
Such scales as 'crude' and representing underdeveloped measure sof health outcome
Service utilisation
Access to health care sevices eg hospital admissions
Reflects people's illness behaviour - perception of and response to illness
Functional Ability
Peoples' ability to perform daily tasks
More meaningful than bio-chemical measures
Measures the impact and effects of the dieseas
Social Health:
Individual well-being distinct from physical and mental dimensions and includes interpersonal interactions (Donald et al 1978)
Socially healthy people are more able to cope with challenges (Lerner 1973)

Quality of Life
Individual's achievement of a satisfactory social situation within the limits of perceived physical capacity (Mendola & Pelligrini 1979)
Individual responses to the physical, mental and social effects of illness on a daily living which influence the extent to which personal satisifaction with life circumstances can be acheived.
How do you measure these concepts?

Who should measure them?
Stevin et al (1988) found big differences in how physicians and patients assessed quality of life
Optimal measurement: use different approaches to measure the same thing
Bowling 1997
Assessing Health Needs
What does it mean to assess health needs?

Why is it important?

Assessing Individual Needs
Needs assessment is a process, not a task.
A tool to develop a needs-led approach to health care
The process of exploring the relationship between health problems in a community and the resources available to address those problems in order to achieve the desired outcome

Health Needs Assessment
Pickin & Selwyn 1993
Different organisations will assess health needs in different ways and using different methods, and tools

What might be the difficulties/ limitations to this?
The Common Assessment Framework
Identifying children and populations who are in need
Planning appropriate supportive services for them
Publicise those services
Equip practitioners with knowledge, skills and tools for accurate assessments (Ward, 2002)
Theoretical Framework of the CAF
Pays attention to the interaction between CYP, family and environment.

Ecosystems approach, along with a strengths perspective. Child protection through supporting families as the best safeguard from harm (Siporin, 1975, Garbarino, 1982)

Attachment theory (Bowlby, 1988): attachment is as important as food and shelter. Children learn, explore, self-regulate and socialise accordingly (Masten and Coatsworth, 1998). Secure attachments predict good development. 'Prototype' for future relationships.
Do these domains interact or are they independent of each other?
The Common Assessment Framework is a shared assessment and planning framework for use across all children's services and local areas.

Its purpose is the early identification of additional needs. It also aims to enhance coordinated service provision to meet those needs.

It consists of:
A pre-assessment checklist
A process to enable undertaking a common assessment
A standard form to record the assessment
A delivery plan and review form
'Request for services' and not 'referral' process.
When a practitioner is concerned about a CYP's progress (health, development, welfare, behaviour, progress in learning)
When a CYP/parent/carer raises a concern with a practitioner
When CYP's needs are unclear
CAF: Four Steps
Assessment Triangle
Interaction is not always straightforward. Remember to:
Gather information precisely and record it systematically
Check information and discuss it with CYP and parents
Record clearly possible differences in views and reflect on them
Assess and understand strengths and difficulties
Investigate vulnerabilites and protective factors
Identify the impact of what is happening (Department of Health et al, 2000)
Child-centred. Awareness of child development.
Equality of opportunity
Inter-agency working
Continuing process, not single event
Evidence-based knowledge and critical judgement
Direct work with children and families to build on strenghts and recognise difficulties
Consideration of particular vulnerabilities

Core Principles
Continuum of Needs
Assessing Community Needs
Identify needs & resources
A strategic process
Time consuming
Needs groups
(eg. specific diseases or clients): groups may overlap; excludes majority of population; focus on service users rather
Locality Needs
- geographical: allows health to be assessed related to social variables; health resources located geographically; still need to divide into different groups
Life Cycle Framework
- age and gender as main determinants of health and use of health services; explains rather than describes health needs; easily accommodates other determinants of health
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