Jill Hummell

Validity and Responsiveness of the Care and Needs Scale for Assessing Support Needs After Traumatic Brain Injury

OBJECTIVE To investigate the validity and responsiveness of the Care and Needs Scale (CANS), which was designed to assess support needs of people with traumatic brain injury (TBI). DESIGN Two samples of community clients (n=38, n=30) were recruited to examine concurrent, convergent/divergent, and discriminant validity. The ability of the CANS to detect change over a 6-month period from the time of inpatient rehabilitation discharge (predictive validity and responsiveness) was investigated in a third sample of 40 rehabilitation inpatients. SETTING Two Brain Injury Rehabilitation Units in Sydney, Australia. PARTICIPANTS People (N=108) aged between 16 and 70 years admitted for rehabilitation after TBI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The CANS, Supervision Rating Scale, FIM, Sydney Psychosocial Reintegration Scale, and Disability Rating Scale. RESULTS Evidence for concurrent validity was shown with fair to moderate correlation coefficients between the CANS and measures of supervision, functional independence, and psychosocial functioning (absolute value, r(s)=.43-.68; P<.01). Support for convergent and divergent validity was provided by correlation coefficients that were higher for measures tapping similar constructs (absolute value, r(s)=46; P<.01) but lower for measures of dissimilar constructs (absolute value, r(s)=.07-.26; not significant). In addition, the CANS discriminated between levels of injury severity, functional independence, and overall functioning (P<.01). In terms of predictive validity and responsiveness, CANS scores at inpatient rehabilitation discharge predicted the participants functioning 6 months later. CONCLUSIONS These results show the CANS is a valid and responsive tool and, together with its previously shown reliability, is suitable for routine application in clinical and research practice.

Health Practice Relationships

This book, and this chapter, explore health practice relationships. This chapter sets the scene for the book and privileges the humanity and diversity of social and practice relationships that this title evokes. In Chapter 2 we turn to the topic of professional practice, placing this book predominantly in the context of Western orthodox medicine today, and we place the clients, support people and healthcare providers at the centre of our discussion.

Healthcare Systems and Policies

Individuals and communities are experiencing increasingly complex health issues which vary widely in different local contexts (World Health Organization (WHO), 2010). Healthcare systems are accordingly highly complex, interconnected and constantly changing, with reforms regularly implemented. The increasing costs of healthcare result in governments and healthcare organisations focusing on public cost containment, often reducing the healthcare workforce and increasing client numbers.

Negotiating healthcare relationships through communication

Healthcare relationships are complex and multidimensional. Managing and negotiating such complexity and diversity presents challenges for all concerned. Meanwhile, positive health outcomes are contingent on the successful management of diverse healthcare relationships. In this chapter we draw on a social-ecological model of health promotion to scaffold the complexity of relationships within the healthcare context and then focus on communication as a critical way to link dimensions of those healthcare relationships at system and individual levels.