Bradshaw's Taxonomy: Comparing Definitions and Measures of Need As a Basis for Equitable Voices and Distribution of Resources for Substance Use Disorders

Purpose: Needs assessment planning for substance use disorders (SUD) is dominated by what experts perceive to be important and further by universalist theorists who defend objective expertise. Relativist theorists, on the other hand, promote client interests in needs assessment. Adding to these theoretical tensions is the discussion over the concept of need and its practical applications in prioritizing services or allocating resources. Studies about how to define need and measure SUD and how they influence decision-making about treatment are lacking. This study contributes to knowledge about the options for measuring needs and demonstrates how certain methodologies impact the definition of need with specific attention to the equity of voices and distribution of resources. While meeting the needs for SUD treatment has been the subject of increased policy interest, Bradshaw’s taxonomy of need has not been used in this context. In an era of changes in health care, integrated care models, and reductions in funding, policy makers will need better evidence to justify their plans for the changes that are expected in this decade.  The aim of the study is to arrive at a clearer framework for needs assessment that can be used in addressing SUD. The study questions include:

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.