NAMI NC -System Reform- Technical Assistance Bulletin #5:
Gap Analysis

What this information is...and is not
Summary and observations
How to use this information
The chart 

The local business planning process requires that Consumer and Family Advisory Committees be involved in the needs assessment or "gap analysis" process. A needs assessment is an analysis that looks at:

• what services are needed for the individuals to be served
• how much of those services are needed
• what services are currently provided
• how many people can served by those services (capacity)
• what additional services are needed and how much of those services are needed

In previous Technical Assistance Bulletins NAMI North Carolina has advocated that "what" type of services are needed are those considered best practice for adults with severe and persistent mental illness . These include ACT teams that follow the PACT model, supported employment, family psycho-education, social skills training, illness management, and dual diagnosis treatment.

NAMI North Carolina decided to survey all Area Programs on the availability of best practice services and the capacity of those services in order to provide information for individuals participating in or reviewing the local needs assessment. Included is a summary chart of the results as well as observations and ways in which you can use this information.

Area Programs were surveyed during the month of July by students at the UNC School of Social Work in Chapel Hill. Additional follow-up calls were made during the first three weeks of September to programs that had not responded. Twenty-seven out of 39 Area Programs provided information. Here are some things you should know about the data:

• The survey looked at the capacity to provide the service, not the number of people actually receiving the service. In some cases, particularly where a service was not fully staffed, the capacity may be greater than what is actually being offered.

• The survey could not look at "unduplicated" numbers. For example, there was no way to tell whether the 20 individuals who were receiving social skills training were the same 20 individuals identified as receiving illness management. Since many services were identified as being offered through Clubhouse programs this duplication probably occurred in some cases.

• The survey did not look at whether programs were offering services in compliance with best practice standards. It simply asked whether a service was being offered and described to the respondent the elements of a best practice service.

• The survey did not look whether or how services were coordinated and integrated, an important part of developing a system of best practice services.

• The numbers reported should not be considered absolute or precise. They do, however, give a good general sense of what services are being offered and how many individuals can be served at any one time (capacity).

• Given the numbers of adults in North Carolina with serious mental illness, the capacity of best practice services is far below what is needed.

• There is significant variability in how Area Programs define and provide the services that were surveyed. Many of the services that are offered contain components or elements of services considered best practice but few appeared to be offering services consistent with an identified model of best practice. Very few programs seemed to be comparing their service to published models of best practice.

• The variability in services is due to a several factors: 1) the state has not identified the services and models of best practice it expects Area Programs to implement, and 2) the state does not pay for best practice services. Service definitions do not reflect best practice. Area Programs are forced to cobble together services that are paid for in order to try to offer a best practice service that isn’t paid for. This is a major barrier to implementing best practice services in North Carolina.

• There is a critical need across the system for training in best practice services.

• Many services are offered through Clubhouse programs, especially employment, social skills training, and illness management. This would suggest that Clubhouse programs are an effective and efficient way to provide these services and should be expanded.

• Area Programs were very aware of the reform efforts and the need to offer new services and/or expand existing ones.

• Four Area Programs reported that they were about to initiate ACT teams, had secured funding and were hiring staff. These programs were Crossroads, Duplin-Sampson, Lenior, and Mecklenburg.

• A number of Area Programs reported that they offered Family Psycho-education via referral to the NAMI Family-to-Family program. There did not appear to be any formal or contractual arrangement to this referral and was difficult to determine how many individuals were actually taking advantage of the program.

• Some Area Programs were unable to report specific numbers of people receiving services or the capacity of those services, suggesting the need to develop better data systems in order to get this information and use it for planning purposes.

The information provided in the chart should be used to start a dialog with your Area Program, Consumer Family Advisory Committee, and your County Commissioners.

Questions to be asked include:

• Are the reported services and capacity consistent with our actual experience?
• If our community does not have a particular service, should we develop it and how many people should it serve?
• If our community offers a particular service, is there sufficient capacity and accessibility to that service?
• Do the services we offer comply with standards of best practice for that service?
• What can we do to support the development and expansion of best practice services in our community?

The Council of Community Programs has developed a Needs Assessment Template to assist communities in conducting a "gap analysis". Most Area Programs have requested a copy of this Template. If your program has not received a copy or if you would like your own copy, contact Michael Owen at the Council of Community Programs (919-327-1500).

We are very grateful to the individuals at the Area Programs for their willingness to participate in the survey. We also thank Anna Scheyett and her students at the UNC School of Social and Caroline Rickless of Raleigh for their willingness to conduct the phone surveys.

If you have any questions or would like additional information please contact Beth Melcher at bmelcher@naminc.org or 919-788-0801.

The Chart

Click here to see the summary chart