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Towards a systematic identification of people with social complex needs: a pilot study on the use of the self-sufficiency matrix


Marta Ballester Santiago

Avedis Donabedian Research Institute - UAB, ES
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Integrated care has become a central part of policy initiatives to enhance the sustainability and affordability of their care system (1).  Within those efforts people with “complex cases”, are often the main focus. The identification of complexity in healthcare has been developed over the last decade. However, it remains much less developed within social services. We present the results of a pilot effort carried out in Catalonia (Spain) to build a systematic identification of complex cases in social services.


The hypothesis was that the identification of complexity could emerge from the self-sufficiency matrix, in its Catalan (SSM-CAT) and Spanish (SSM-ES) adaptations, an observational screening tool that provides a reliable assessment of the  self-sufficiency on thirteen life domains (4): Finance, Work & education, Housing, Domestic relations, Mental health, Physical health, Substance use, Activities of Daily Living, Social Network, Community participation and Law & order.

The pilot was carried out in Catalonia between November 2018 and January 2019, focused on identifying complexity of social care needs for people over 65 years old.

Sample selection: Professionals of 8 social care areas and 2 health care areas, based on purposive sample. The inclusion criteria for assessed persons were to be over 18 and a case known by professionals.

Assessment: Professionals’ assessment with SSM-CAT and on the complexity of social needs.

Analysis: SPSS statistics software for all analyses. The analysis was based on a binary logistic regression.


111 social care professionals participated assessing 912 people. 60% of assessed people were considered to have complex needs (including 17% very complex needs). By age, of those under 65 (425) 68.8% had very complex needs, compared to 51.5 % for those equal or over 65 (487).

We analysed the link between the profiles of self-sufficiency and professional perceived complexity among those people over 65 years old, building a predictive model, which had a positive predictive value of 76,6%.


Compared to other potential predictors of complexity, such as the summed total score of the SSM-CAT (a measure of overall self-sufficiency) or the number of SSM-CAT domains with a low score (a measure of multi-problem situation) the SSM-CAT predicted complexity model was a more accurate measure. This indicates that some life domains have more impact on the assessment of complexity than others.


SSM-CAT (and ES) score profiles are associated with perceived complexity of social care needs.

Lessons learned:

SSM-CAT has the potential to standardize professional assessment, support their decisions and improve communication across different care teams. Ultimately facilitating matching each person to the adequate care.


SSM-CAT was scored by the same professional that assessed complexity, scoring could have been influenced by this.

Suggestions for future research:

SSM has been proven useful to support social care professionals in their professional assessments in Catalonia and specific referral decisions in the Netherlands(5). It’s worth exploring further uses of SSM in decision support and as a communication tool across care teams.  SSM-CAT and its algorithms will be further developed in the upcoming years in Catalonia.

How to Cite: Ballester Santiago M. Towards a systematic identification of people with social complex needs: a pilot study on the use of the self-sufficiency matrix. International Journal of Integrated Care. 2021;21(S1):155. DOI:
Published on 01 Sep 2021.


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