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Health Assessment
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Discusses the phenomenon of holistic health assessment. Focuses on problems of definition, psychometric accuracy, & legitimate application.... More...
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Paper Abstract:
Discusses the phenomenon of holistic health assessment. Focuses on problems of definition, psychometric accuracy, & legitimate application.
Paper Introduction:
ASSESSMENT
INTRODUCTION
Health assessment is a general topic related to many other health issues and practices. Health professionals in different fields use differing methods of assessment and must contend with a variety of issues specific to health assessment in their chosen field, but there are also certain general propositions to guide them in the assessment process. Holistic health assessment has been viewed with skepticism by some, to a degree justified by problems of definition, psychometric accuracy, and legitimate application (Dana and Hoffmann, 1987: p. 539). The application of holistic health assessment in schools, colleges, and community-based programs is promoted as sound public health policy. Dever
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Cost/utility approaches utilize theexpressed preference or utility of a treatment effect as the unit ofoutcome. As part of the larger community,the school is also a useful center for developing and implementing policiesfor public health on a broader scale, identifying problems and suggestingsolutions. The applicationof holistic health assessment in schools, colleges, and community-basedprograms is promoted as sound public health policy. 539). The role of the physical environment in the health and well-being of children. The parents bring with them certainbeliefs and practices that merge in marriage and produce a redefinedperspective on their culture or cultures. Health status assessment for elderly patients: Report of the Society of General Internal Medicine Task Force on Health Assessment. Health assessment becomes amore complex process when it must consider community-wide or population-wide factors and their relative importance in producing health outcomes. M. New Directions in health psychology assessment. Therefore, aknowledge of growth and development milestones serves as the basis ofhealth assessment of the child at various ages, providing criteria that canbe used to detect normal range and progression of physical growth anddevelopment in skill and capacity of functioning and by which to recognizeabnormalities. for optimumfunction. in Harold E. Pietrowski and Lubin (199 ) consider the health assessmentpractices of health psychologists, using a random sample of Division 38members and fellows who were also in the American Psychological AssociationDivision 12 or Division 29. ASSESSMENTINTRODUCTION Health assessment is a general topic related to many other healthissues and practices. Kaplan (1991) also discusses the multidimensional approach as opposedto the unidimensional process and sees that quality of life assessment cantake either of two approaches, defined as a psychometric approach and adecision theory approach. There is a difference, however, in that the analysis of thefindings is acutely attuned to the parameters of growth and development,both of which change rapidly in the early years of life. 149-15 ). BIBLIOGRAPHYDana, R.H., Hoffmann, T.A. Development of quality of life for setting priorities in health policy. The authors conclude that whatchildren need in their environment for overall good health is a settingthat is interesting, challenging, and malleable. 471-473). Assessment practices of health psychologists: Survey of APA Division 38 clinicians. Professional Psychology Research and Practice, pp. 99-1 6.Schroeder, H.E. (1989, June). The school can thus addressfamily assessment to a degree and can have an influence on changing familybehavior as related to health matters. 539-555.Dever, G.E.A. The health care that the child receives is also dependenton many cultural factors, and this needs to be analyzed. 6).DEVELOPMENT OF HEALTH ASSESSMENT Health assessment on a large scale has posed a particular problem forhealth psychologists, who initially failed to see the development of thisproblem. The authors call for giving special attention to children and adolescents,as well as for programs that do not talk down to the young person and thatmake the young person the primary focus. (1991). Holistic health assessment is a starting point and amethodology for accomplishing these tasks. New York: John Wiley & Sons.Kaplan, R. Dever (1991) also indicates an awareness of the complexity whennoting the need for an association of health status statistics withlifestyle, environment, education, socioeconomic status, and biology as away of assessing the effect of the health services (health system goals) onthe health and well-being (health status goals) of the population (p. (1991). Journal of the American Geriatrics Society, pp. Evans, Kliewer, and Martin (1991) note how the physical environmentcan influence the behavior of children and examine six underlyingdimensions of the physical environment that can have an effect on behaviorand health: pathogenic conditions, stimulation levels, functionalcomplexity, control, structure and predictability, and exploration. Holistichealth assessment approaches the whole human being and sees health in broadterms, including as it does here an understanding of social and educationalrequirements along with what would normally be seen as biological healthissues. The psychometric or profile approach tries toprovide separate measures for the many different dimensions of quality oflife, while the decision theory approach tries to weight the differentdimensions of health to gain a single unitary expression of health status.Kaplan notes another trend in assessment, cost/utility versus cost/benefit. . 512). Other populations have been treated similarly, with health assessmentsurveys used to determine the needs of the population as a preliminary todesigning programs to serve that population. (1987, April 23-26). It is also noted that these changes during childhood arechallenging to the adolescent, parents, relatives, teachers, and neighbors. Clinical Psychology Review, pp. A report from the New YorkCity Department of Health (1984) indicates how such an assessment may servethe interests of the school population as the school uses the data as thebasis for a major reorganization of school health services. Health assessment domains: Credibility and legitimization. The same sorts of connections are made for other populations,essentially comparing the results acquired through direct analysis of datawith the norm for the given population. (1988). This has become a valuable tool indesigning programs and settings for education. Rubenstein, Calkins,Greenfield, and Jette (1989) report on such a survey of the elderlypopulation to determine functional status, quality of life, and healthstatus. Further, it demands that skills and/or deficiencies be evaluated together,in transaction, connected to each other through the goals, values, andregularities contained within the social units, psychologicalconstructions, and the nervous system of the child and adolescent" (p. This leads to the question of what methods are used in holistichealth assessment today. At first, standard methods of behaviorchanged seemed to be fairly effective in individual cases, but in time itbecame evident that some of these behaviors were resistant to change andthat improvement in national health status was a complicated goal. One problem with cost/effectivenessmethodologies is that they do not allow for comparison across verydifferent treatment interventions. 127-128). (1991). Boston: Jones and Bartlett.Karoly, P. Among the dimensions that are important to note are family health andhistory, diet, habits, sleep patterns, home and neighborhood conditions,recreation and hobbies, occupation and socioeconomic level for the familymembers, previous experience with immunization and illness, mental status,affect, knowledge and its application, and so on. (1991). Gaithersburg, Maryland: AspenPublications.Evans, G.W., Kliewer, W., & Martin, J. Preschoolers and elementarychildren require increasingly complex, responsive focal features in theirenvironments, and the authors believe that the availability of functionallycomplex objects along with the freedom to explore the immediate environmentpromotes healthy development in young children (pp. He notes that these terms are used inconsistently in the medicalliterature. Fisher (1987) discusses preliminary data froma study of the relationship of three family systems dimensions to threemeasures of adolescent health extracted from the RAND Health AssessmentQuestionnaire: the Health Index, General Well-Being, and Symptom Checklist. The goals of health are known to add years to life and to addlife to years, and health care is designed to make people live longer andto live a higher quality of life. A systematicsurvey determined the health status of the New York City school population,and this survey covered 6,282 pupils attending 12 public and non-publicschools. Functional status includes the dimensions of physical, mental, andsocial functioning in daily life. 562-569.Pietrowski, C., & Lubin, B. New York: Hemisphere Publising.New York City Department of Health. To a degree, the methods are determined by thepopulation surveyed. 7-8).PRACTITIONERS AND ASSESSMENT Grime and Burns (1992) provide an overview of health assessment ofthe child and the adolescent by nursing practitioners and find that thenurse applies many of the same basic principles of interpersonalrelationships and communication used in collecting data from the adultclient. Cost/utility approaches have gained greater acceptance in recentyears as methods for comparing many diverse options in health care (pp. A subset of the larger populationcan thus be analyzed for its place on a continuum (and this includes thesmallest subset, the individual). Over thirty percent of the pupils were found to have conditionsrequiring referral for further diagnosis or treatment. The authors provide different types of assessment that need to beundertaken in addressing the needs and progress of the child and theadolescent. Dever (1991) states:"It is impossible to develop responsible and realistic objectives withoutanalyzing the community's population groups and the health servicespresently available to them" (p. (1987). General health assessment, neuropsychologicalassessment, and the assessment of depression were major areas of focus forthese clinicians, but the majority of testing was performed with a limitednumber of instruments, usually traditional techniques of assessment.Health evaluation of the aged was not a major area of concentration. Karoly (1988) offers a good definition of"assessment," differentiating it from "diagnosis": ". & Burns, E. (199 , April). The data can then indicate what sorts ofbehavior changes are needed and can suggest the types of programs to beundertaken to effect those changes. Health assessment: In nursing practice. Report of the school health assessment, planning, and evaluation project. Health status includesphysical, mental, and social health. It was noted that thetargets of intervention were no longer obvious as psychologists look atvarious social systems such as the family or work and find that complexfactors interact to produce health outcomes. They find different needs atdifferent age levels. Schroeder, New Directions in Health Psychology Assessment. Cultural assessment recognizes that children are stronglyinfluenced by cultural patterns. In economics, cost/benefit analysis measures both program costand treatment outcomes in dollar units. Aknowledge of these underlying dimensions can help in designing anenvironment that will be optimal for the health of this population. What Karoly seeks is a multidisciplinary assessmentthat integrates the elements of a biopsychosocial worldview, and for thisbroadly trained analysts are required. Holistic health assessment also focuses on the methods of thepractitioner to determine the most effective approaches and also areaswhere the practitioner might benefit from better health assessmentprocedures. (1991). . Karoly (1988) examines child health assessment as abiopsychosocial assessment and discerns various levels of pediatricassessment, and he presents different theorists on each of these levels.There are also specialized foci of assessment noted, such as children'sperceptions of illness, questions of pain, and the adjustment of childrento the effects of hospitalization, dental treatment, surgery, and othermedical interventions. Data is collected and analyzed and can then becompared with other regions, schools, and even populations, and the schoolsare also in a position to design and implement programs to change behaviorboth for the child and for his or her parents. This information can also be used toanalyze and evaluate existing programs for their effectiveness and theirvalue based on expenditures against benefits.CONCLUSION Health assessment for children often centers quite naturally on theschools as a place where the childhood population can be found and whereproblems can best be ascertained and addressed across a broad populationfor public health benefits. The studyfound that perceived family organization, perceived family privacy, andfamily problem solving ability differentially predicted health scores.This again indicates the complex ways in which health is related to socialinteraction and environmental issues. The mother, father, and childgenerally assume their assigned roles and positions within the family, andthe character of interactions among family members derive from the samecultural roots. The authors notethat with small children especially it is necessary to obtain thehistorical information about the child from the parents, but interviewingthe child is also important and must be undertaken with the proper care inasking questions, interacting with the child, and analyzing the answers(pp. The assessment of these dimensionsdemonstrates public health needs to serve this population as well as areaswhere this population is particularly lacking in acceptable performance orservice.OTHER APPLICATIONS Another specific population, though obviously much broader in scope,is the family in the community, and the family has been addressed as a unitin holistic health assessment programs, information from which is oftenused in determining child development programs and in service of schoolgoals for health promotion. in Schroeder, Harold E., New Directions in Health Psychology Assessment. Community health analysis: Global awareness at the local level. 195). This analysis also shows how holistic health assessment can be usedby institutions to design better environments for serving specificpopulations, notably school children. New York: Hemisphere Publishing.----------------------- 1 Health status assessment can beaddressed on a community-wide basis or geared to a specific populationwithin the community, such as young people, the elderly, or people at riskfor specific health problems. New York: Hemisphere Publishing.Fisher, L. Cost/utility studies use outcomemeasures that combine mortality outcomes with measures of quality of life,and the utilities are the expressed preferences for observable states offunction on a continuum bounded by zero for death to 1. The survey alsoprovided data that allowed for comparison with pupils in other parts of thecountry, information that could be helpful in designing other public healthprograms and systems. Theauthors believe that the quality of the physical environment has a greatereffect on children than it does on adults, though it does have an effect onthe adult population as well (pp. Health professionals in different fields usediffering methods of assessment and must contend with a variety of issuesspecific to health assessment in their chosen field, but there are alsocertain general propositions to guide them in the assessment process.Holistic health assessment has been viewed with skepticism by some, to adegree justified by problems of definition, psychometric accuracy, andlegitimate application (Dana and Hoffmann, 1987: p. (1984). Dana and Hoffmann (1987) approach the issue by trying to provide a moreuseful definition of holistic health assessment, one that permitsdistinctions to be made among health assessment domains such as healthhazard appraisal, health status, holistic health, well-being, and wellness. Paper presented at the Biennial Meeting of the Society for Research in Child Development, Baltimore, Maryland.Grimes, J. The author finds that the data demonstrates the complex relationshipsbetween family and health scores and that it is important to be aware ofthe differential impact of parental perceptions on children. The authors note thatthe health assessment of the child and adolescent utilizes developmentalparameters for each age level as a basis for evaluation of the differentfactors examined (p. Quality of life issues includesocioeconomic or environmental factors such as financial security,availability of food, and quality of housing. They note that childrenalso require a range of social opportunities, from solitude to broadcontact with groups of heterogeneous people. Inanswer to this perception, new issues in assessment arose. Handbook of child health assessment. Someapproaches emphasize simple, treatment-specific outcomes, while others mayoffer more complex answers. New York: New York City Department of Health.Rubenstein, L.V., Calkins, D.R., Greenfield, S., & Jette, A.M. Cost/effectiveness is an alternateapproach in which the unit of outcome is a reflection of treatment effect,and this has gained considerable attention in recent years. They note that infants in particular cannot acceptlarge or sudden changes in stimulation, and that stimulation levels for allchildren should be kept moderately low. in systems terms,it implies diverse levels of evaluation capable of indexing not onlyproblem precipitants, but also personal, social, and familial competencies. Schroeder(1991) indicates some of these issues and offers reports on them from aconference held at Kent State University in 1987. National health assessment indicated certain risk factorsinvolving lifestyle behaviors or personality variables, and these seemed tobe obvious targets for intervention. 195). Family influences on adolescent health.
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