Auditing need

This section of the toolkit is about different ways of auditing need. It draws on methods used by those with experience of doing needs assessments in community and secure settings.

This aspect of health and well-being needs assessment (HWBNA) work can be the most time consuming. It will benefit from input from colleagues in public health. It is likely to generate ideas for future data collection and service planning as well as helping you get an overall picture of current needs.

There is some overlap with the section on Consultation because the information you get from interviews, questionnaires and focus groups is likely to include information about needs as well as services.

The section includes:

Analysis of data held on systems and files

There is routine activity data that can be aggregated and analysed in order to build up a picture of needs overall. For instance, for a secure setting HWBNA, you could take a six- or twelve-month period and review the information that is held on:

  • Nationally available data, about issues relating to youth justice, for the local authority areas where the young people normally reside. Some of this data has been made available by ChiMat in a simple report – Youth Justice for local authorities new. The report includes the prevalence rate for some needs experienced by young people, for England as a whole and for each local authority.
  • The electronic case management information system (SystmOne is now live in young offender institutions (YOIs)
  • Nurse recording sheets, used for logging contacts and for recording young people’s needs
  • Recording forms for medical examination and screening at reception
  • Information recorded about discharge arrangements
  • Service information from each part of healthcare – about the number of contacts and salient information about the young people seen, such as age, ethnicity, diagnosis and treatment.

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Using data collected via standardised tools

There is also data you can draw on from standardised instruments.

The Comprehensive Health Assessment Tool (CHAT), which is currently being embedded into work in all secure settings, will ease and improve the collection and aggregation of information about needs in the youth justice system. There are also other standardised tools to draw information from.

Asset and Onset
There will be information from Asset and Onset forms (and from the SQIFA and SIFA screening and assessment tools used in conjunction with them). If you do use Asset and Onset forms it is worth scrutinising and analysing the whole form, rather than the score sections only, because you will find that information about particular needs is likely to be included under various headings. An Excel spreadsheet can be useful for logging and analysing your findings in this sort of exercise.

Find out more about Asset, Onset, SIFA and SQUIFA, on the Assessment page of the Ministy of Justice website.

CAF and eCAF
In community settings, an important source of information will be the Common Assessment Framework (CAF or eCAF).

Although there is no requirement to use the CAF tool, and there is flexibility about its format and content, most local authority areas use it as an agreed assessment form and process – across all agencies – for the early identification of needs of children and families.

It is, therefore, relevant for work with children and young people likely to come into contact with the youth justice system (YJS), and the CAF guide for managers includes specific information for youth offending team (YOT) managers.

For relevant guidance about integrated working, using CAF, and about lead professionals, see the Team Around the Child (TAC) page of the Department for Education website.

Other instruments
Information from other standardised instruments that might be used in your Unit, or by services in the community, can help you compile baseline information about the range and complexity of needs of young people.

The one used most commonly is the Strengths and Difficulties Questionnaire (SDQ). Information about, and links to, this and other instruments (including CAF) are available in the screening tools section of the Youth Justice Liaison and Diversion section of this site.

A community service that used two standardised instruments to conduct a health needs assessment was able to make the case about the greater complexity of need in young people serving a community youth justice sentence compared with other young people in the area (Engage website). The instruments were the Trauma symptom checklist for children and the Youth self report.

If you are able to allocate more resources to your needs assessment work, you might want to do a larger research project, with help from academics or others. Such an exercise would probably include the use of standardised instruments. For example, a study comparing the health and well-being needs of young people in custodial settings with the needs of the general population used part of the SF36 Health survey, a self-administered measure of health-related quality of life outcomes (Health needs assessment of children in secure settings in the East Midlands, University of Lincoln, 2009).

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Developing and using other tools

You might want to develop your own tools for collecting information about need. For example:

  • In Hackney, as part of work to explore ways of providing for young people’s holistic health care needs, an advanced nurse practitioner audited the needs of the young people referred to the youth offending team (YOT) over one year, using a questionnaire that had been adapted from work in Australia to assess the health-risk behaviours of young people.

  • In Surrey, the primary care trust (PCT) public heath lead, with advice from communication specialists, developed an easy-read questionnaire for gaining health needs information from young people in contact with the local youth justice service. The form was adapted from earlier work doing a health needs assessment for adult prisons in the area. A similar questionnaire was developed for canvassing staff views about both young people’s health needs and staff perspectives on the link between health and offending behaviour.

  • In Norfolk, a prevalence screening tool was developed by those conducting the YOT health needs assessment. The tool combined sections from various other instruments developed to identify health and health-related needs. See p173-178 of Norfolk youth offending team (NYOT): health needs assessment (NYOT and NHS Norfolk, 2009).

  • In Suffolk, an interviewer-administered questionnaire was developed, as part of the latest health needs assessment, to audit the health needs and health and health-related behaviour of young people held in the local young offender institution (YOI). See Appendix 2, p80-87 of HMYOI Warren Hill: health needs assessment (HMYOI Warren Hill and NHS Suffolk, 2011).

There are other resources to draw on, too.

You might have developed consultation materials – such as questionnaires, surveys, focus group questions, case study vignettes – as a way of collecting information for your HWBNA. This material might have been designed for consultation about services and service delivery, but it is likely to pick up some information about needs, too. Examples of this sort of material are included in the Consultation section of the toolkit.

You might be able to collect information about needs through existing mechanisms for routinely gaining feedback from young people, parents and professionals, such as those used by YOTs and secure establishments. Some of these, too, are in the Consultation section.

There might be other mechanisms to consider using to get a handle on the needs of children and young people. For example, you could use the qualitative information on Asset forms to analyse the pressing need of each child and then aggregate that information into a set of 'need groups' for the sample overall, to help you understand the range and severity of needs of children and young people in your sample, before moving on to consider services gaps and solutions. A suitable methodology for that sort of exercise (Matching needs with services) is described in Matching needs and services: an audit of the needs of 268 children attending Pupil Referral Units in 4 local authority areas (Brown E, National Children's Bureau (NCB), 2011).

You might find it helpful to check your emerging data about the prevalence of needs against findings in similar settings. This can help you gauge what you might be missing or it could highlight possible discrepancies to reflect on with colleagues. For instance, your group of children and young people might be different from others in some important respects, or your screening procedures might need reviewing, or both factors might be at play. Those preparing HWBNAs recently have found it helpful to check their findings against the data reported in other community or secure setting HWBNAs. Others have checked against national need prevalence data: for secure settings there is information in the Toolkit for health care needs assessment in prisons (Department of Public Health & Epidemiology, University of Birmingham, 2000), and for all settings there is summary information in the Evidence of needs paper (Ryan M and Tunnard J, 2012).

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Lessons from auditing need

Auditing need for HWBNA purposes might alert you to policy and practice issues for the future.

For example, it might lead to suggestions about how to extract more or different data about need, or more detailed data, for future needs assessment work. Service providers are likely to want this information, too. They are also likely to have ideas about what they will find helpful to record, and to see the value of service level agreements setting out agreed variables to use for collecting data.

Similarly, the work of auditing need might highlight the need for service specifications to include a requirement about demonstrating user involvement in service review, and about regular feedback about service satisfaction. This need not be onerous. There are simple but effective ways of canvassing views, including occasional short feedback surveys and standard questions at the end of meetings to ask ‘how was that for you?’.

You will find more about ideas in the Consultation section of this toolkit.

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