Bradshaw's Taxonomy: Comparing Definitions and Measures of Need As a Basis for Equitable Voices and Distribution of Resources for Substance Use Disorders
1) What kind of evidence for SUD can be used in applying Bradshaw’s taxonomy of need?
2) Who knows best about need? Does one approach in the taxonomy give privilege of voice over others?
3) How do we operationalize Bradshaw’s taxonomy in a policy and service context?
4) How can Bradshaw’s framework be expanded to amalgamate all of the information and balance perspectives and desired outcomes for needs assessment?
Methods: This paper uses a case study of a two-year comprehensive needs assessment project for SUD. Primary data from interviews, focus groups, web-surveys and secondary sources (e.g., mortality, morbidity) were used as indicators of normative, perceived, expressed, and relative need. Next, case study analytic techniques were applied to assess the framework’s propositions (indicators of need) and to compare how methods and measures impacted the representation of client views and distribution of resources.
Results: Prevalence of substance use and mortality data represent normative need; perceived need was captured through interviews with consumers, informants, and residents; SUD related hospital discharge and treatment admissions show an expressed need; and treatment admissions and morbidity demonstrate comparative need across jurisdictions. Although consumer voice in deciding need is growing, results demonstrate that 3 out of the 4 perspectives show preference of expert views over consumer voice. Relative and normative needs were central to making a case for changes in the location and access to services. Adaptations to the framework were identified including additional criteria that can be applied when defining and measuring need for SUD.
Implications: Needs assessment approaches can be selected based on the value placed on participation, expectations for addressing inequities in service delivery, allocation of resources and other outcomes important in social work. This study adds to four decades of work based on Bradshaw’s taxonomy with new updates and application to the context of SUD.