Needs Assessments

Identifying barriers to care

At AccessHealth, our model for improving individual and community health outcomes is based on working with people to develop a plan for improving their health. We don’t develop plans for improving health FOR people. We develop plans WITH people.

This process starts with a Needs Assessment. After enrollment, every AccessHealth client is paired with a care navigator for the Needs Assessment. Our goal during this step is to learn not just more about each client’s health, but to identify and understand their barriers to living a healthy lifestyle. We can arrange an appointment with a doctor, but if, for example, that client does not have a place to live and/or transportation, having a doctor’s appointment is not going to improve their health.

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The Needs Assessment is about identifying a client’s social determinants of health. We want to know about every client’s housing, transportation, employment and social/family support situations, among other details. We want to identify if there are any behavioral health issues. In short, the Needs Assessment is essential to ensuring that the access we are providing to medical care is realized and benefited from fully. We need to go deeper than just identifying medical problems — we need to identify and then help address the barriers to living a healthy lifestyle.

Building trust and creating individual health plans

That information helps form an entire health plan. And at AccessHealth, we are very intentional about not saying we’re coming up with a plan FOR you, we come up with a plan WITH you. We can determine every client’s barriers with a Needs Assessment, but our idea about what someone should work on first may not be what they are interested in addressing initially. They know best their situation and their daily struggles and stressors. Therefore, our model is not to be prescriptive about what they should do first, it’s about working with them to determine what they are most interested in addressing first. This helps build trust and essential buy-in. We make sure each person knows their voice has been heard and respected. In the end, we are not doing something TO people, we are partnering WITH people to help manage their healthcare.

This approach includes questions that may be different than what you have typically been asked regarding your health or health care. For example, we ask our clients if they are a member of a church or spiritual community. We ask this because we are not just interested in what’s wrong and what needs to be “fixed.” We are interested in where the areas of strength are in their life, what their connections and assets are. Very often, people who are part of a church or spiritual community have someone who will give them a ride to an appointment or help them look for a job.

Another example is we ask our clients “What are you most proud of?” Again, this helps us look at what their strengths are. It helps us understand not only the difficulties of their story, but also the hope and strengths of their story and what they can build on. It also helps us build a relationship with them by identifying what is important to them. By gaining an understanding OF both a client’s barriers to good health and what good health looks like to them, the team at AccessHealth and our clients CAN create plans together that lead to better outcomes.

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