Friday, 19 September 2008

More on telecare assessments

What is a telecare assessment?
Is it a method, a process or a determination?
If it is a method then it is something people can learn and be taught, it is measurable and quantifiable.
If it is a process then it is a set of procedures and protocols, but the user is not necessary to the outcome.
If it is a determination then the user is central and it is qualitative and quantitative. Measuring the determination of an assessment is difficult.

So how could one determine if an assessment is good?
1) measure lots of processes and procedures to ensure that all the paperwork leading to and from the assessment are taken care of, so all bases are covered.
2) Send an "expert" to shadow an assessor and see if their is a congruence of opinion between them on specific cases.
3) lay down strict guidance and procedures saying that an assessment must contain x, y and z in it.

If we take option 3 - then we can easily make a self assessment or a computer programme that prompts assessors for the next question or area to investigate. This of course will be limited by the narrowness of the available options and will not be able to take the whole person's needs into account or crucial aspects of their specific domestic environment. So it is likely to be useful only in simple interventions and even then have limited efficacy.

If we take option 1 we have a clear audit trail and are covered legally as ticking all the boxes. But the problem might be that ticking the boxes is often to the exclusion of providing a real assessment or a bespoke service to meet the needs of the person.

If we take option 2 we should get good quality of assessments with the person at the centre of the assessment and their needs being met by technological interventions if appropriate.

So which is best, which option should we go with?

This is the $64,000 question.

To me, we need something that covers all of the aspects. To omit one is to make judgment of an assessment useless or invalid.

If we always start with the person and build our assessment criteria around meeting their real needs, we should find that we naturally develop an auditable trail with clear signposts to good practice and person-centred planning. We would be able to help some people who need no interventions to meet one off needs through bespoke telecare solutions, whilst other people would require more complex interventions and assessments.

So what is the problem with using this interactionist approach?
Simplicity and cost-efficiency, I suspect will be the response. To undertake alll these methods would be prohibitively expensive.
I suspect this is anathema and a white- elephant.
Good practice save money in the long term. Short term high costs for long term gain.
Similarly with telecare if we use it in a preventative manner to meet needs before they escalate we are often stopping the need from being unmanageable by the person.

So if we are to make assessments overly good practice they must contain all three parts. The next big question is how can we accredit the qualitative aspects effectievely and who is qualified to do this?

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