1 Review of current assessment instruments in Northern Ireland Introduction Aims/Objectives Methods –Instrument collection 11 Trusts –Instrument analysis 15 questions 9 domains Results –Instruments served there purpose –Wide variability in length, structure, content and comprehensiveness Discussion –The finding support the necessity for a single standardised assessment tool for N. Ireland

2 Introduction Assessment is the cornerstone of good quality community care Growth of N. Ireland assessment tools differs in different rates Wide variety of N. I. assessment tools

3 Aim/Objectives of the Project To review current assessment instruments in Northern Ireland –Objectives To examine instruments according to a set of questions based on guidelines set out in the NSF To compare the instrument coverage according to the nine domains outlined in the NSF for Older People

4 Methods All Health and Social Care Trusts invited to participate 11 Trusts provided instruments Instruments represented current care management documentation Specialist instruments excluded

5 Instrument Analysis (Part 1) 15 questions generated based on instrument validation guidelines Scored on a three point scale: Yes (1) To some extent (2) No (3)

6 Examples of questions Would the wording of the tool facilitate verbal and written communication with older people? Does the tool capture the source of information or the method of assessment used? Does the tool capture the older person’s strength and abilities? Are the effects of disability on the person’s quality of life captured explicitly?

7 Instrument Analysis (Part 2) 9 domains outlined in the NSF for Older People 40 sub domains Scored on a three point scale reflecting the domain coverage Low (1) Moderate (2) High (3)

8 Domains The user perspective Clinical background Disease prevention Personal care / Physical well-being Senses Mental Health Relationships Safety Environment and resources

9 Results Overview –All instruments served the purpose –Wide variability between the instruments Length Structure Content Comprehensiveness

10 Responses to the Fifteen Questions (%)

11 Six Question Categories Involvement of the individual in the assessment process A person-centred approach highlighting abilities, strengths and future wishes The effects of personal circumstances' on quality of life Usability of the assessment instrument Supporting integrated working and holistic assessment Application of consent guidance

12 Involvement of the individual in the assessment process

13 QUESTIONSTRUST ABCDEFGHIJK 1 Would the wording of the tool facilitate verbal and written communication with the older person? 2 Does the tool make the contribution of the older person to their assessment and care plan explicit? 3 Does the tool capture the source of information or the method of assessment used? Involvement of the individual in the assessment process = NO = TO SOME = YES

14 A person-centred approach

15 A person-centred approach QUESTIONSTRUST ABCDEFGHIJK 4 Does the tool capture the older person’s future wishes regarding their care? 5 Does the tool capture the older person’s strengths and abilities? = NO = TO SOME = YES

16 The effects of personal circumstances' on quality of life

17 The effects of personal circumstances' on quality of life QUESTIONSTRUST ABCDEFGHIJK 6 Are the effects of disability on the person’s quality of life captured explicitly? = NO = TO SOME = YES

18 Usability of the Assessment Instrument

19 QUESTIONSTRUST ABCDEFGHIJK 7 Does the tool contain a satisfactory balance of structured and unstructured questions to enable a reliable response from care managers? 8 Does the tool facilitate a clear link to identification of risk and care planning? 9 If all components of the tool were required, is material concise and non-complex to assist with clarity of information? 10 Is there no duplication of generic information across domains within components of the tool? 11 Does the tool enable referral to specialists and agencies? 12 Is a summary of specialist assessment available in a format easily understood by care managers?

20 Supporting integrated working / holistic assessment

21 Supporting integrated working / holistic assessment QUESTIONSTRUST ABCDEFGHIJK 13 Does the tool show balance in the detail of information gathered in all domains? 14 Is there an element of this tool designed for use by a wide range of health and social care professionals even if not in a care management role? = NO = TO SOME = YES

22 Application of consent guidance

23 Application of consent guidance QUESTIONSTRUST ABCDEFGHIJK 15 Is the older person’s consent to share information captured? = NO = TO SOME = YES

24 Results - Questions Instrument Strengths –Balance of structured/unstructured questions –Ease of referral to specialists from care managers –Ability to capture the individuals future plans

25 Results - Questions Instrument weakness –The effects of disability on quality of life –The inclusion of the older person in the assessment –Complexity/duplication of information gathered within the instruments

26 Low coverage Moderate coverage High coverage DOMAINSTRUSTTrust A Trust B Trust C Trust D Trust E Trust F Trust G Trust H Trust ITrust J Trust K User’s Perspective Clinical Background Disease Prevention Personal Care and Physical Well- being Senses Mental Health Relationships Safety Immediate Environment and Resources

27 Results - Domains 32% of the domains well covered 34% of the domains moderately covered Mental health and clinical background most comprehensively covered domains Disease prevention poorest covered (91% scored as low cover)

28 Conclusions All instrument gathered reflected good practice in relation to care management assessment Documentation reflects guidelines and policy in place prior to recent Departmental guidance

29 Conclusions There is considerable variability in the comprehensiveness of assessment coverage on all domains across the eleven trusts There is considerable variability in the level of coverage on all nine domains within different Trust documentation

30 Recommendations The findings support the necessity for to develop a standardized instrument; standardized on the level of assessment on each domain and standardized across all trusts