Measurement of Need for Care: A Trial of the Camberwell Assessment of Need and the Health of the Nation Outcome Scales

Objective: The accurate assessment of the individual needs of clients has been the focus of increasing discussion in mental health service delivery and evaluation. There is evidence to suggest that clinicians and clients differ in their perceptions of need and that staff assessments alone may not be sufficient for determining need for care. This study addresses these discrepancies in an Australian setting. Method: The Camberwell Assessment of Need (short version) and the Health of the Nation Outcome Scales (HoNOS) were completed on a sample of 78 clients of a mental health service in inner Sydney. Results: Clinicians identified a mean number of 7.3 needs per client (SD = 5.0) compared with 6.0 (SD = 2.4) identified by clients. The mean kappa coefficient for agreement between clinicians and clients in identification of the 22 need areas was 0.18 (range = 0–0.45), indicating poor to moderate agreement. Similarly, client ratings of need were only moderately correlated with clinician ratings of disability on the HoNOS (Pearson's r = 0.35). Clinician ratings of disability and unmet need were highly correlated (Pearson's r = 0.80), whereas ratings of disability and met need were moderately correlated (Pearson's r = 0.52). Conclusions: Individual needs assessments using the CAN are applicable in this Australian setting. Staff and clients differ in their assessment of need. It is important to consider both the role of the rater and the context in which they are making the ratings when applying need and disability assessments in clinical practice.