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Wk8_NeedsAssessments.pdf

Needs Assessments

Leslie M. Tutty and Michael A. Rothery

N eeds assessments are a form of research conduclcd to gather information about the needs of a population or group in a community. One of the more practical types of research, needs assessments are used to develop new services or to evaluate the relevance of exist ing programs. They may also be used to establish a need to revise or create policy.

Th is chapter begins with a definition o[ needs assessment, how we define "needs:' and how we determine who to ask about needs. Common methodological approaches to needs assessments are described and evaluated using examples p rimarily from the social work literature. The benefits of triangulation, or using more than one source or method of gathering information, are presented, followed by a discussion of who shou ld digest and weigh inform at i.on about needs once the information is ga thered. Finally, we consider the importance of developing a plan to implement recommendations so that the work of assessing needs is used to clients' benefits, not relegated to the shelves occupied by other dusty and neglected reports.

What Is a Needs Assessment?

Needs assessments have not changed much over the years. In 1982, Kuh (cited in Stabb, 1995) listed five general purposes commonly served by needs assessment research that remain relevant today:

l. Monitoring stakeholders' perceptions of various issues, which can guide the devel- opment of new programs or policies

2. Justifying existing policies or programs

3. Assessing client satisfaction with services

4. Selecting the most desirable program or policy from several alternatives

5. Determining if needs have been met, a purpose closely akin to program evaluation

Two key questions are addressed when needs <1ssessments are undertaken: "Who?" and "IIow?" The "who" question requires the researcher to be dear about the membership of the group whose needs are to be assessed. Often, a study entails gathering information from a variety of respondents, from individuals who may never have been clients to those

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150 PART II • QUAII.TITATIVE APPROACHES: TYPES OF STUDIES

receiving multiple services. In almost every case, however, at least one set of respondents will be the individuals who are most immediately affected by gaps in services or supports, rather than relying solely on the opinions of service providers, academics, or funders.

The "how" question addresses the methods used to gather informa tion from the group whose needs are of interest. These are not unique; rather, needs assessments borrow familiar techniques such as surveys, interviews, and focus groups, all of which are high- lighted in other chapters in this book. Quantitative methods such as surveys or standard- ized measures may be used, as may qualitative methods such as in-depth individual interviews or focus groups. Combinations of both arc increasingly popular since each method has its advantages and limitations.

Defining Need When we invoke the concept of needs, we may easily assume that we share with others a common understanding of what it is we are talking about. However, it is worthwhile look- ing more closely at the definition of the term since useful characteristics and distinctions are highlighted when we do so.

The concept of need is not new: Researchers have been defining and redefining the term for decades. Stabb (1995) distinguishes between met and zmmet needs. "Met needs are necessary or desirable conditions that already exist in actuali ty. Unmet needs arise when there is a discrepancy between desirable conditions and current actuality" (p. 52). Both met and unmet needs could conceivably become the focus of needs assess- ment research, although unmet needs will be the main concern in the vast majority of cases.

A different distinction (perhaps more useful for our purposes) is provided by Witkin and Altschuld (1995), who define a need as "a discrepancy or gap between 'what is,' or the present state of affairs and \vhat should be; or a desi red state of affairs" (p. 4). In this analysis, needs equate with unmet needs, the most common focus fo r needs assessment research. Revere, Berkowitz, Carter, and Ferguson (1996) add the suggestion that need is defined by "community values, [and is) amenable to change" (p. 5).

From these perspectives (and with reference to considerations introduced earlier), a needs assessment gathers information about gaps between real and ideal conditions, the reasons that these gaps exist, and what can be done about them, all within the con text of t.he beliefs of the community and available resources for change.

Another distinction introduces the question of degree. Some needs are stronger or more important than others. f undamental needs with relevance to people's survival, safety, or basic comforts are not the same as "wants" or less compell ing needs. A social work professor's desire for a week in Mexico as a break from winter is qualitatively very different from a homeless person's need for food and shelter in the face of the same cold conditions. While it is often difficult to draw the line between relatively important needs and less important wants, it is still important to do so. Needs assessments are focused on needs that affect ind ividuals' abilities to function well in important areas of their lives. Wants associated with perceived quality of life (but not to the same extent with life's real essentials) are more lhe purview of market research.

Social workers generally find Maslow's (1970) hierarchy of needs useful when consid- ering the needs and priorities of their clients. It is also a framework that can inform needs assessments. Maslow's five levels of need are physical and life-sustaining needs (such as air, water, food, warmth, and elimination of bodily wastes), physical safety (e.g., protec- tion from physical attack and disease), love and support, self-esteem and self-worth, and self- realization (e.g., needs to be productive and creative) . Maslow contended that these

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basic needs must be attended to before attempting to address higher level needs (or "wants"). Needs assessments can gather information relevant to any one or more of these five levels, but the hierarchy of priorities provides useful cr iteria fo r deciding on what to focus first in data collection and recorn mending changes.

Finally, some authors argue that once an "expressed need" is verbalized, it becomes a want or a demand (Stabb, 1995) . This is not the same as differentiating needs from wants on the basis of the strength of the potential impact on someone's well -being and is prob- ably less useful for our purposes. However, a related point is noteworthy: Verbal demands are not always the direct expression of need. Just because someone expresses a want does not mean that it represents a need. Thus, in needs assessments, it is important to gather information from members of a population beyond those publicly advocating for specific demands.

Who Do We Ask About Needs? The term stakeholders is often used to refer to clients or potential clients or the people who actually n-perience the need thal is being studied. However, Revere and colleagues (1996) suggest broadening the definition to refer to "service providers and management, com- munity members, certain politicians, the funding source, business/trade associations and the actual research •..vorkers" (p. 7) since each of these has a vested interest in the study and its outcomes. Th is flex[ble use of the term is helpful, suggesting a range of potential sources of data and recognizing that needs assessments have ramifications for people beyond those normally surveyed .

Needs assessments traditionally look to three groups as sources of data: the target group (i.e., clients or potential clients), key informants such as community leaders or service providers, or a sample of aJI members of the relevant comm unity. Each is described in more detail below.

The target group or populatio11 comprises the very individuals about whom we arc con- cerned and whose needs we wish to assess. Common sense suggests that these are the voices we most wish to listen to in our quest to gather the best and most current infor- mation. However, engaging with individuals to encourage them to share their needs and opinions is not always easy. Highly disadvantaged, socially m arginalized individuals and groups, the typical focus of social workers' interventions, are nol always accustomed to being asked their opinions and may not easily articulate their needs to a researcher when invited to do so. Furthermore, they may have understandable reasons for not trusting members of those who have more power in society, a group to which researchers belong. Consider the homeless as an example, especially the subpopulation that has been diag- nosed with psychiatric disorders. With any such group, the researcher cannot simply approach and invite them to enumerate Lheir needs. Strategies (and time) for building trust, rapport, and for encouraging engagement in the research process are prerequisites for successful data gathering.

McKillip (1998) defines another group serving as a common source of data, key infor- mants, as "opportunistically connected individuals with the knowledge and ability to report on community needs. Key info rmants arc lawyers, judges, physicians, ministers, minority group leaders, and service providers who are aware of the need and services per- ceived as important by a community" (pp. 272- 273). An advantage of gathering data from key informants is that they may have a broader knowledge of serv ices available in the community than the target population, and they may be better at articulating what needs must be effectively addressed. One disadvantage is that key informants sometimes have a vested interest in developing new services or preserving established resources even

152 PART II • Q UANTITAIIVE A PPROACHES: T YPES OF STUOIES

though they arc less than adequate (we all develop loyalties, and these can affect our judg- ment). McKfllip (1998) also notes that key informants may underesti1nate the willingness of members of the target population to participate in programs while overestimating the extent of the problems.

The third group, community members, comprises the entire citizen ry of a comm unity. This group encompasses members of the target population but also includes those not directly affected by these needs. Approaching community members for information has the advantage of identifying how broadly based the needs are, rather than assuming that they are restricted to the target population. lt also offers the opportunities to learn about how needs (and the strategies Lo ameliorate them) are perceived in the community at large and to think about how that v.rill affect efforts to implement changes. A disadvan- tage, though, is that community members m ay be relatively t111awarc of the needs of its more marginalized citizens.

In summary, each of these groups may be the focus of the needs assessmen t methods documented in the next several sections. The choice of whom to engage may be based on access to the group or limitations of tin1e and resources. If possible, representation from each of the target population, key community stakeholders, and members of the general public is worth considering as each provides valuable but somewhat different information.

Methods of Needs Assessment

As mentioned previously, one ca n conduct needs assessments u sing a variety of strategies. We will d£scuss methods in lwo broad categories, quantitative and qualitative. Quantitative methods gather data that are translated into numerical form and described using statistics. Using such methods, it is possible, for example, to conclude that in a sam- ple of 102 shelter residents, 70.5% of these women abused by intimate partners were abused themselves as children and described 73.7% of their par tners as also having been abused (Tutty & Rothery, 2002). Such high proportions may be interpreted as suggesting the need for early in tervention with children in shelters in the hope of preventing the cycle of violence from affecting a new generation.

Providing statistics about the extent of a need can be a powerful method of raising awareness of the severity of gaps in services. The section on quantilative needs assessment will describe three such methods: surveys, s tandardized needs assessment measures, and using existing statistical databases.

In cont rast, qualitative needs assessments ask questions that are more open-ended and allow the research info rmant to describe in detail the complexities of the issues at hand. for example, a qualital ive needs assessment conducting in terviews with another group of ,63 abused women residing in a shelter noted that providing for their basic needs such as safety and food was of great importance (Tutty, Weaver, & Rothery, 1999) . However, some women expressed concerns about the fact that a few residents were difficult to live with, and some mothers did not m anage lhcir children's aggressive behavior or ignored them. These results suggest a somewhat different focus for intervention by crisis counselors and the need to provide parenting programs for some residents.

Results from qualitative needs assessments often lack s tatistical dat a that could convey the extent of the problem, but they tend to be rich in detail that conveys the complexities and uniqueness of the experiences of different individuals. The quali tative needs assess- ments methods described in the chapter include interviews (either face-to-face or by tele-

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CHAPTER 9 • NEEDS ASSESSMENTS 153

Quantitative Methods of Needs Assessment Surveys Allhough surveys may ask open-ended qualitative questions, the great majority are devel- oped for quantitative data analysis. Quantitatively oriented surveys, particularly those employing questionnaires, are the most frequent method of assessing needs. The tasks involved in developing a survey to assess needs are identical to those undertaken when surveys arc developed for other purposes, so they will not be detailed here. The major steps involve

1. Deciding who Lo survey (e.g., target groups, key informants)

2. Selecting a method of sampling (e.g., random or systematic sample)

3. Determining the content of items (through reviewing the literature or holding focus groups with key informants, as only two examples)

4. Choosing what type of question to use (e.g., open-ended, multiple choice, or scaled with respect to the extent of agreement)

5. Selecting a method of distribution (e.g., the Internet, mail, or telephone)

The advantages of surveys include the ease and flexibility with which they can be administered compared to other methods and the relative lack of expense to collect a con- siderable amount of data. Disadvantages include the extent to which a set questionnaire can predetermine the issues that respondents address and the consequent danger of not hearing about needs that would emerge in a more open-ended process.

With such risks in mind, Witkin and Altschuld (1995) recommend being cautious about assuming that a written questionnaire is the most appropriate tool when considering con- ducting a needs assessment. While a questionnaire can be an important tool, they suggest that it should not be used until after more exploratory methods have been employed to ensure that the factors measured by questionnaire items are as well chosen as possible.

Furthermore, some cultural groups find surveys strange or difficult (especially if English is not one's first language) and respond negatively to them. Weaver (1997), for example, described a questionnaire developed to assess the needs of an off-reservation Native American community in an urban area. A large number of questionnaires were mailed out, with virtually no returns. The alternative of a qualitative approach including focus groups and individual interviews was adopted with considerably greater success.

An example of a needs assessment that employed survey methods more appropriately is Brennan Homiak and Singletary's (2007) study that surveyed Christian clergy members from 15 denominations in central Texas with respect Lo their perceptions of the number in their congregation experiencing intimate partner violence and what clergy needed to better address this serious concern. Of the 100 surveys mailed, 44 were returned, a some- what low but not unusual return rate for mailed surveys.

The clergy members estimated that less than IOo/o of their congregation members experienced partner violence--low when compared to incidence studies in Texas that cited lifetime rates of 47%. Only about one third of the clergy had received domestic violence-specific training; they were more likely to have resource materials in their churches and were familiar with local agencies and shelters for abused women. While a small proportion of the clergy considered themselves very equipped to counsel victims of domestic violence or make referrals, the majority did not. The authors recommend that social workers take the lead in offering training to assist the clergy in promoting violence- free congregations.

154 PART II • Q uANTilATIVE A PPROACHES: TYPES OF STUDIE~

As mentioned previously, surveys may usc both check-lis t type, predetermined responses and open-ended questions that allow for m ore context ual detai led responses and arc analyzed using qualitat ivc methods. A recent example of using open-ended ques- tions is a survey with 206 agency-based social work field instructors, querying their initial awareness, personal and professional needs, and field issues that arose in response to the World Trade Center disaster of September lith, 2001. The field instructors had clearly been weary but retained sensitivity to studen t and client needs. The results suggest the importance of developing an integrated crisis plan to better link the school, students, and field instructors in the event of future disasters.

Standardized Needs Assessment Measures A relatively new needs assessme11t methodology entails developing stand ardized measures to assess the needs of a specific population group. For example, Wancata and colleagues (2006) initially used focus groups and in depth individual interviews to develop a mea- sure comprising 18 common problems experienced by caregivers of adults diagnosed with schizophrenia. The difficulties were translated into items such as "not enough infor- mation on the illness, its symptoms and course," "fear of stigmatization and discrimina- t ion," and "burnout or illness of the carer."

Using such a measure in other needs assessment research has the advantage of building on the work that has gone into identifying and conceptualizing potentially important n eeds and of using a measure for whi ch reliabil ity and validity will often have been estab- lished. A possible disadvantage is that needs proven relevant to caregivers of adults diag- nosed \'l'ith schizophrenia in one location may not have the same importance in others. Conversely, items about other needs tha t are important in a new loca le may be m issing from the standardized measure.

Using Existing Statistical Information Another quantitative method of conducting needs assessments is using data that have been previously collected. Existing data may be available in agency fi les or governmen t data banks, for example. Such secondary analyses have the advantage of sparing researchers the time and expense of gathering new data. A d isadvantage is that one is lim ited to data that someone else considered worth gathering, and potentially important variables may be absent or may need to be inferred indirectly from the data that were recorded.

Reviewing case fil es can be challenging. As a follow-up to a previously completed study on the outcomes of a specialized domestic violence court (Tutty, McNichol, & Christensen, 2008), we are using district attorney files to collect a number of variables, including the demographic characteristics of tbe accused and the victim, whether the victims testified or provided a victims impact statement to the court, and hov,, the trial was resolved.

In contested cases, the files can be very large, literally inches thick! The fi les are created for the criminal justice system, not researchers, so there is no consistent organization. As such, collecting data from one file can take several hours. Considerable information may not be recorded. Lawyers are not necessarily as interested in demographic characteristics such as ethnicity or age as most researchers are, and so lit tle of this can be found in the files. Despite these challenges, if we are to evaluate the specialized courts, paper flle reviews are our only option to assess whether the courts are meeting Lhe needs of both the victims and the accused.

The following needs assessment used case records to assess whether the needs of abused and neglected children were adequately addressed by the child welfare intervention. Tracy,

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Green, and Bremseth (1993) reviewed case records of supportive services for abused and neglected children in one U.S. state. Five hundred child welfare cases were sampled to explore facto rs associated with decisions to offer one of two services, family preservation if children at risk were still at horne, or reunification fo r families with children who had been placed. The authors collected information on demographic variables, presenting problems, service history, service needs, services planned and provided, service characteristics, and service outcomes. This enterprise, the aLlthors noted, consumed thousands of hours.

The analysis uncovered significant stresses affect ing the children sampled, parental substance abuse, economic difficulties, and poor living conditions, which were infre- quen tly addressed in case plans, whi ch emphasized indications of child abuse. The authors conclutled that "there was little one-to-one d irect correspondence between the service need and the service offered" (Tracy eL al., L993, p. 26), raising serious questions about the quality of service planning (and the training of child welfare workers).

Qualitative Methods of Needs Assessment Qualitative needs assessment research may be conducted via individual interviews, small group discussions, or even large town hall meetings, each of which allow for more open exploration of issues than the quantitative methods previously outlined. Such studies tend to involve a greater t ime commitment from respondents but offer much more opportunity to identify and discuss issues in depth.

Individual Interviews

Face- to-face and telephone interviews are one method of gathering in-depth information about the needs of particular groups. Preparation involves thinking through the purpose of the interview, constructing an interview schedule, and train ing interviewers (\Vitkin & Ahschuld, J 995). When a good rapport develops between interviewer and respondent, the result can be disclosure of information and ideas about sensitive issues that would not emerge when more formal, structured approaches are used. Also, in a more open-ended process, respondents may identify needs that no one had anticipated.

The disadvantages of this approach include the fact that it is notoriously labor intensive. Interviews arc time-consuming to conduct, often lasting one to two hours, especially if asking individuals to reveal their personal stories. As a result, often only a relatively small sample of individuals may or can realistically be interviewed. Training the interviewers also takes time, and the job of transcribing and analyzing interviews is normally a lengthy, com- plex task. The following needs assessment is an example of using face-to-face interviews.

In the past 30 years, intimate partner violence has become an issue of significant soci- etal concern, resulting in specialized justice and physical and mental health shifts to more adequately safeguard the women and children who are the primary vict ims. Yet certain ethnocultural groups, including immigrants and refugees, are underrepresented among those seeking assistance from formal supports such as the police and emergency shelters.

With respect to the question of what would constitute culturally appropriate responses to domestic violence, Pan ct al. (2006) conducted 120 face- to-face interviews with members of three ethnic communities in San Diego: Somali, Vielnamese, and Latino. The interviews were provided in the appropriate language, and within each cultural group, 10 women, 10 men, 10 boys, and 10 girls participated.

Because of tl1e sensitive nature of the issue, the topic of domestic violence was intro- duced using vignettes, rather than asking interviewees whether they had personally been abused. This allowed the respondents to speak about abuse in their culture in more gen- eral terms and to suggest possible resolutions to the problem.

156 PART II • QUANTITI\TIVE APPROACHES: TYPES OF STUDIES

The analysis of the interviews highlighted six core issues, including "varying defmi- tions of violence, specific definitions of family harmony, strict gender roles, varying con- flict resolution strategies, cultural identity and spirituality" (Pan et al., 2006, p. 42) . The differing perspectives from the three ethnic communities suggested the need to develop diverse culture-specific services.

Focu s Groups

Focus groups are relatively unstructured small group experiences, typically with about 8 to 12 participants. The group composition is usually homogeneous in that members share a particular experience or interest, like the members of what we described earlier as the target population. Focus group interviews typically take from one and a half to two and a half hours, and a number may be conducted for a given study.

Witkin and Altschuld ( 1995) summarize the process of a typical focus group. Initially, members hear a general statement of the purpose of the session and are given a question related to this purpose designed to elicit perceptions about important needs. Often, par- ticipants are asked to write down the ideas that the question stimulates and then to share them with the group. The leader typically writes ideas as they are shared, summarizing them and making sure th at there is agreement among members with what is being recorded. This process is then repeated with other predetermined questions.

Leadership is important to a focus group's success, especially since there is no highly structured agenda (except for the posing and answering questions aspect). According to Witkin and Altschuld (1995), "The leader must be nonjudgmental, create a supportive group atmosphere, be able to keep the interview process going, be a good listener, and be alert to sense when a group is deviati ng from the prescribed question route in meaningful and non-meaningful directions" (pp. 172-173). These are by no means easy demands.

One advantage of group approaches over individual interviews can also be a disadvan- tage. Whi le participants do not have the same opportunity to explore their own perceptions or experiences in depth as in individual interviews, a group approach can elicit information that would not emerge without the stimulus of i nterC~cting with others and reacting to their ideas. When group discussions detour in innovative ways, this may lead to original and cre- ative ideas. Brainstorming, or encouraging members to present any solution to a problem without prejudging it, is one way to encourage such innovation. Alternatively, without effec- tive facilitation, the groups may pmsue unproductive tangents, and there is a heightened risk of interpersonal conflict detracting from the effectiveness with which research goals are pursued. The following study used focus group methodology.

A relatively new role for sociaJ work graduates is working with seniors and their ramilies to assist these clients in a number of ways. Yet, how readily are social workers per- ceived as resources to this population? Naito-Chan, Damron-Rodriguez, and Simmons (2004) used focus groups to explore what skills social work practitioners need to ade- q uately address the Heeds of older persons and their families. The four focus groups included older adults and caregivers of older adults (consumers) as well as providers of care and recent social work graduates, both working in gerontology settings.

Notably, the analysis highlighted that a number of the consumers had little under- standing of how social workers could assist them. Key among the consumer needs was resource finding, which the consumers did understt~nd as a social worker role. However, other social work competencies such as assessments and case management were not men- tioned by the consumers. The results suggested the need for public education abo ut the roles of social workers in the field of aging.

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Nom i nal Groups

An alternate group approach to needs …