The current LEAF-7 questionnaire is the result of work started by Age UK Wakefield District in 2009 to develop an effective assessment and outcomes measurement tool. The questionnaire has been through several iterations in the intervening years following advice first from Leeds Beckett University and more recently Sheffield Hallam University. During this time the main priority has been to develop a way of assessing a person’s quality of life that is easy to understand and use, facilitating a productive discussion between client and support worker, even when someone has some impaired comprehension, is feeling depressed or is not coping well.
At the same time, the questionnaire needs to be sufficiently reliable and accurate to be accepted by statutory bodies wanting to understand the impact that can be associated with the services they fund.
A version similar in format to the 2016 questionnaire was first introduced at the start of 2015 and since then more than 3000 assessments have been performed with it.
The 2016 LEAF-7
The questionnaire and the assessment
The 2016 questionnaire has seven questions which ask about a person’s quality of life. The seven questions ask the person to rate how able they are to:
Manage their daily living and manage their health, have the social contact they want, do the things they value and the things they enjoy, feel safe and secure and live their life in the way that they choose. Each question has the same four options for rating their situation: completely, mostly, little and hardly at all.
In an assessment, the support worker will focus particularly on the lower ratings selected and try to determine from the person the reasons why the ratings were low and what kinds of actions and support might improve them.
In outcomes measurement terms, we can look at a person’s or a group of people’s ratings and compare these with ratings before and after support and, between different groups. We can also look at ratings on total scores and benchmark individuals and groups against typical mean averages.
Sheffield Hallam University undertook a validation exercise of the 2016 LEAF questionnaire. The resulting report (September 2016) showed that LEAF performed favourably in all the tested areas – face validity, internal reliability, factor structure, concurrent and test-retest validity. A summary of the findings is available here and the full report is available on request.
Life Satisfaction question
The LEAF-7 questionnaire was tested alongside a version of the ONS Life Satisfaction (LS) question (How satisfied are you with your life nowadays?) with a shortened scale. The analyses showed that the internal reliability and factor structure of LEAF-7 were equally robust regardless as to whether the LS question was incorporated into the tool or not. Therefore organisations are free to decide whether to use the LS question alongside LEAF-7, or not. The advantage of using the LS question is that it provides results that are easy to communicate about changes in a fairly graspable concept – life satisfaction. The main disadvantages are that the numerical scale can be challenging for some clients and the idea of a life satisfaction rating can be counterproductive where someone has recently experienced bereavement or received a terminal diagnosis.
LEAF-7 comprises a 6-page paper assessment form and accompanying user manual. The assessment form has a customisable header page for recording personal information about the person undertaking the assessment.
Subsequent pages hold the seven self-assessment questions and provide boxes where the support worker marks the ratings selected and can add key points relating to each. There are text boxes for summarising the person’s situation at the first interview and setting out the action plan. There are also boxes for noting points arising in review meetings, further actions and any key points (such as the nature of any ongoing support) when closing the referral.
The questionnaire also assesses whether a person is able to manage financially.
Sample LEAF question:
It is important to recognise that the tool works effectively because the questions are embedded within a standard framework for supporting a person – assessment, action planning and review. As the questions are indivisible from the framework, the support process as a whole becomes more consistent, systematic and easier to quality assure.
We have found that the form works best when it is completed by being hand-written. Our pilots have shown that tablets or netbooks are slow and fiddly and likely to provide a distraction for both support worker and the client from the assessment and subsequent conversations.
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