The idea of professional or organizational assessment is an inherent feature of contemporary practice in care services. Professional or organizational assessment represents the entry of an intentionally rational and systematic approach to the encounter between a homes Care manager, social worker, other professionals and people seeking help or services, who may be individuals, couples, families, groups or communities. The assessor’s role may be conceived as gate keeping, facilitating or empowering but, whichever is the case, the application of some form of assessment implies that a service does not operate entirely on-demand or that special expertise in defining problems or finding solutions exists or is needed. There is a further realm of assessment, namely user-led assessment that has emerged to modify aspects of the picture of assessment described. (Crisp et al, 2003, p iv), is supported in a number of quarters, as this guide will show. To summaries:
Government and agency policies and practices place great store in effective assessment the assessment process is significant for service users and carers in both conditioning their experience of the encounter with social care services and in shaping the service they receive, Assessment is widely portrayed in literature as fundamental to the safe practice of social care with some accounts defining it as a key part of intervention and others regarding it as the essence of intervention. In short, of all the skills that the homes care manager’s social workers and other professionals’ may aspire to, assessment seems the one most likely to achieve consensus among practitioners, managers, employers and service users as an essential skill. Assessment is widely agreed to be of great importance, Crisp and colleagues stated that assessment ‘involves collecting and analyzing information about people with the aim of understanding their situation and determining recommendations for any further professional intervention’ (2003, while some reviewed approaches to assessment fall very clearly into one or another of the types, other approaches overlap the types. Overlap is most likely to be found between process-focused and contingent types. Process-focused
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The process-focused group of definitions concentrates on assessment as an essential, practical function that must be carried out with professional sensitivity and competence. Of all the approaches, process-focused definitions are the nearest to an implicitly technical, even ‘scientific’, view of the assessment task as a set of methods to be learned and professionally applied. The concept of assessment itself is not thought to raise fundamental questions. Attention is directed to providing clear guidance on what to do, what questions to ask and procedures to follow, in making an assessment. Examples combine, in some form, the activities of information- gathering from service users and carers and other sources, exploring facts and feelings, analysis, understanding the situation, making judgments and determining action or recommendations. These activities may be found in the other types, including the critical social constructionist type, but there the very idea of assessment is treated as problematic and activities such as analysis and understanding the situation are used to question the process itself. Process-focused approaches vary on a number of dimensions.
They are: more or less oriented to judgments based on professional or organizational criteria and procedures – more or less oriented to need, eligibility, service user aspiration or resource availability – more or less oriented to care or control. The approaches also vary by their conception of assessment as: A distinct stage – a series of distinct stages – a fluid and dynamic process throughout the life of the ‘case’. Contingent: The contingent type has some similarities with the process approach but is contingent in the sense that the nature and direction of assessment is taken to differ according to particular independent factors. It is implied either that the approach to assessment is determined by a given independent factor, or variable, or that a given approach to assessment is particularly suited to that variable. Variables that are influential on assessment include: – the type of service for which assessment is being made – the goals of assessment – the conceptual framework or map chosen to make sense of assessment. Contestation-focused
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The contestation-focused type differs from process-oriented approaches in not viewing assessment procedurally, but shares with contingent approaches the recognition that other variables condition assessment. However, the focus is on the conflict or contestation between variables. Hence, the approach defines assessment as an area of contestation between different policies, perspectives and priorities represented, for instance, by: emphasis on need vs. eligibility – social worker idealism vs. realism – needs vs. risks vs. resources. Critical social constructionist
The critical social constructionist type proceeds from the view that the act of assessment involves the construction of meanings as distinct from the determination of objective facts and causes of problems. The understandings that constitute assessment are socially constructed by those involved, reflect their contexts and may be contradictory. The assessment made by the care manager social worker and other professionals represents his or her construction of a narrative or story about the situation in question and may, accordingly, reflect the perspective of the homes care manager social worker and other professionals more than of the client. In the process, particular people become defined as service users or carers and ‘client hood’ is constructed (Hall et al, 2003).
The critical aspects of the approach are found in the challenge to traditional, process- focused definitions of assessment and in the analysis of unequal power both in the assessment relationship and in the ideas and policies that influence those involved.
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Together with this critique, the approach envisages ways of thinking about and doing assessment that reflect on the narrative construction process and shape it in the interests of service users and carers. The critical social constructionist type shares aspects of its approach with the ‘exchange model’ of assessment, which recognizes that people are experts in their own problems and should be engaged by the homes care manager social worker and other professionals in a collaborative exchange to define and tackle issues (Smale et al, 1993 and 2000).
The contestation and critical social constructionist approaches treat the idea of assessment as problematic. They provide critical perspectives on: – the social and political contexts of assessment – other assessment approaches that take social and political contexts for granted. Neglect of social and political contexts may stem from the professional’s preoccupation with the skilled conduct of the assessment process. Yet a process dimension is inescapable for home care managers social workers and other professionals. In some form, a repertoire of technically and professionally proficient steps of the kind described in some textbooks and practice guides (Nicholls, 2006), is indispensable if assessments practice is to take place. But it is also important for the home care manager social worker and other professionals to be able to submit the process to critical review and revision.
Lead, Contribute and manage assessments. 01.2 02.2 02.4 03.1 03.2
Describe the process used in your workplace to support this active participation of the individual in shaping the assessment process and how you deliver a care support plan that meets there needs. Explain your role in this process. 0.1.2
All care agencies need to work together so that assessment and the resultant care plan is effective and coordinated. The Single Assessment Process was introduced in the National Service Framework for Older People 2001. Assessments are shaped by policies to protect vulnerable children and adults, to integrate people who are socially excluded and to prolong or improve independence and the ability to work. These care-focused social objectives connect with other, control-oriented goals that are also part of the influence on assessment and condition its purpose, especially in the statutory sector and among the agencies the sector commissions: for instance, control of abusers, management and reform of offenders, rationing of demand and containment of public sector costs.
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Assessment becomes not only multi-faceted but also multi-layered. Individual assessments may be made on the basis of ‘professional judgment’ or a set of independent, agency criteria, but both are carriers of judgments and priorities formulated outside the assessment situation. It is clear that assessment does not have a purpose but purposes. The way to explore the picture further is to ask, ‘for whom or what is assessment being undertaken?’ and to concentrate on where the main emphasis is found. This approach embodies the idea that assessment takes place in the service of particular interests and, far from being a singular and fixed entity, will shift as those interests pull it in different directions. Five kinds of purpose are distinguished in Fig. 1. Each ‘purpose’ is represented by the assessor acting as agent of a set of interests or goals and being cast in a corresponding role.
Fig. 1 Five purposes of assessment
Purpose: interests or goals for which the assessor is agent
Individual and public protection
Service user and carer needs
Service user and carer representation
Agency function, policy and priorities
Other professions or agencies
Communications are fundamental to practice and to assessment in particular. In some instances assessment begins at first contact, sometimes in response to a crisis, and is relatively short. Assessment may precede intervention or represent a service in its own right, for instance, for a court or where the assessor’s role is solely to assess for separately commissioned services. In other cases, there may be several assessment-focused contacts with service users and carers over an extended period the ongoing approach acknowledges that the needs of clients change over time, especially following a critical event. Service users and carers are regarded increasingly as key participants in the assessment process, an expectation that service user and carer interests need to be made clear. Service users are a key part of the assessment process. No single form of self-assessment is suitable for all service users or types of need. Some service users and carers may prefer an autonomous self-assessment; others seek professionally supported self-assessment or assessment led by professionals.
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In working with partners to deliver care there is always the potential for repetition of work and overlap of delivery. Sap aims to ensure that the individual’s needs are assessed thoroughly and accurately without duplication by different agencies. By sharing the information appropriately between all relevant agencies SAP coordinates the assessment and ensures effective delivery of care. Joint working necessitates the effective sharing of information; there is a range of approaches’ to implement electronic SAP. The Health and Social Care Integration Programme, an NHS Connecting for Health project is working to enable the sharing of electronic records between the NHS and social care systems, this is subject to individuals consent. 0.2.1 0.2.2
The reason behind the need for an assessment would determine the level of urgency. In the case of a person with memory loss or signs of a stroke the need for an early assessment would be of major importance to enable planning for the future or if treatment is to be given this would enable its institution at an early stage. In the case of a stroke the quicker the condition is assessed the sooner the person can assess treatment and the possibility of full recovery. In these cases early assessment is crucial to enable a better outcome. In all other cases of need the assessment process should be initiated immediately or as soon as the care requirements of the person changes. Early assessment would enable the care plan to be implemented with speed and meet the needs of the person. In some cases there may be need for urgency due to homelessness or a break down in family relationships in this case the assessment would also need to be done with a matter of urgency. There would be a need with minimal information available to quickly set up a strong line of communication with other professionals’ if possible family members external agencies maybe the judicial system.
In cases were there is no matter of urgency when the assessment takes place it is preferable to follow a more structured process of assessment which would enable the clients needs to be the central figure in the negotiation this is recognized in legislation as being the optimum process for care planning. The NHS and Community Care Act 1990 and The Carer Recognition Act 1995 led the way in this type of care planning. The care professionals knows best way of operating takes away choice and limits the clients ability to make their own decisions and should therefore be a thing of the past. Any care plan that is developed without the client is meaningless since it is the client who experiences the discomfort of their condition and has the expert opinion of what they need. To aid and give a greater clarity to the assessment process the best way to proceed is to direct the questions to the client, ask the questions in a way that makes the client feel fully involved in the process ask the questions what do you want, what do you believe you need, in what areas do you feel you need support in, is there specific times during the day that you would wish the support that you need to be provided, intermittently check with the client during the process that they are feeling ok and that they are comfortable with the process.
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The client is potentially going to be discussing areas of their life that are of great importance to them and that they feel are very personal to them. The way this information is gained needs to be done in a sensitive and as least intrusive way as possible. By actively encouraging the client to voice there needs concerns and wants with respect to their care a good rapport is developed and the client will feel actively involved in all decisions. On occasions their may be clients that are not able to engage with the process of assessment due to various conditions that prevent understanding or sensory impairments which may make the process difficult. In cases like this an advocate or IMPCA needs to be called in to attend the assessment to act on behalf of the client and to ensure hat they are fully represented.
Case Study Client A: A Social Worker made contact with the supported living unit that I manage enquiring if there were any vacancies as they needed to urgently find accommodation for Client A. Client A had been given notice to move out of the home they were residing in due to incidents that happened within the home. A brief history was given over the phone of the Client A to determine if they could be suitably supported, once this had been determined the referral was then taken to the next stage. The Social Worker e-mailed Client, A’s support plan to the homes secure e-mail. A return call was then made to the social worker to arrange a date, time and suitable location for an assessment to take place, this is usually arrange under theses circumstances as quickly as is practicable for all concerned. The date was set for 48 hours later.
The assessment was conducted with Client A his Social Worker the Homes Manager Client A’s key worker, the units operational manager and myself. After introductions were made a brief description of the unit I manage was given to Client A to ascertain if this was the kind of support he was looking for. Once Client A had a clearer understanding of the support that was available to him Client A’s social worker asked Client A if he had any concerns regarding the sharing of his personal information to those present. Client A expressed that he had no concerns regarding this. He informed his social worker that when it came to giving others information about his past he would prefer it if he did this himself. It was then explained to others the stage that he was currently at and what had lead to the need for the move. Once Clients A, social worker had finished talking Client A give a brief explanation of his past experiences to everyone. Client A was then asked if he could give some clarity as to what he believes he needs support with and were he would like to be in the future.
Client A then asked some questions about the accommodation he would be staying in and the area that the unit was in. How assessable it would be for him to visit his friends and family. Once theses concerns were answered the homes manager explained that although there had been some problems within the home that Client A was living in he had been working for a long time to achieve a more independent lifestyle. After all exchanges had been made it was then decided to set a date for Client A to come and visit the unit with the Social Worker the following day. Once the visit had been completed and it was decided that it would be suitable and that suitable support could be provided a moving in date was set. Client A was asked if he would give consent for all his notes and information to be shared with the operations manager and myself. The homes manager were Client A was living was contacted to find out if it would be possible for the information to be made ready and if they would be able to support Client A with the move.
The commission for Social Care Inspection in their National Minimum Standards publishes standards and as such Managers should make themselves and their staffs aware of the regulations for assessment and the updating of clients care plans. Standard 6.9 states that: The service user is made aware of the respective rules and responsibilities of the care manager, CPA, care co-coordinator, key worker and or advocate and knows how to contact them. The client needs to be fully aware of the roles of each person involved in their care and the manager must ensure that it is explained to them what a managers role is. A manager must make sure that as far as possible the needs of the client are being met. – Any information obtained from the client is relevant to meet their needs. – The information that the manager provides is coherent and meets the individual’s needs. There may be times when a client needs to be referred to another care professional and at times this can mean a delay in treatment or service delivery.
It is that the service required has a waiting list or it may be that the way in which the referral system works is cumbersome or confusing for the client. Clients often are told that a referral to another service will be made only to realize they have little or no influence over the process or any knowledge about who they will be referred to or how long they can expect to wait this increasingly leads to dissatisfaction with the care being given and a manager is likely to end up with a very unhappy client. As a manager this can be pre – empted by implementing referral agreements.
In the events that referrals need to be made between the partners delivering the clients care a manager can to agree that: the partnership group should work together to draw up a set of guidelines that outlines the conditions best managed by the setting and the conditions that need to be referred. With each group undertaking, this work there will be information about local practice habits previous patterns of referral and availability of specialist, as well as current information on how each condition should be managed. Any referral to other services should be discussed with the client in advance and the clients consent obtained to disclosing information. A manager then needs to ensure that the recipient of the referral is able to provide the required service and that confidential information disclosed will be protected.
If a client requires support that does not fall within the scope of our organization, there may a need to investigate other options and refer them to another service provider. There are a number of important issues to consider when you choose to refer a client to another agency, or to another member of your team, be it an emergency referral or part of treatment planning. The most important consideration should be: Is this the best possible service provider to refer this client to? Will they be able to adequately meet the needs of this client? Are there specific protocols (cultural and/or otherwise) that must be followed to ensure effective referral processes? To do this, you need a good understanding of the services and requirements of the agency that you are providing referrals to, and of the skills and expertise of other members of your own team. Service providers are workers in agencies who can offer our clients a service, resource or program to meet their needs. They could be government, private or community-based agencies.
They could specialize in meeting particular needs, such as drug and alcohol support services, or they could offer general support to our client, such as counselors’ or foster and respite care. When we think about identifying other service providers for our client, we consider: existing service providers. Do our clients already have workers and agencies involved in their life? Is there a need for a new service provider? What services/assistance do our clients agree they need and who can provide it? We make sure we are fully aware of the service options available to our client. We may need to locate a resource file that lists service provider details, such as telephone numbers. We need to understand the referral protocols for various services/agencies in our area. If we decide that our organization cannot help the client, we consult them about other options they would be willing to investigate or give them a choice about alternative services.
We will negotiate with another service directly or on behalf of a client to make sure that the referral is agreed upon and the roles and expectations of the service provider and client are clear. Within this process caution needs to be taken: Service providers only need to know as much personal information about the client as will directly help them deliver their particular service. It would not be necessary, for instance, to reveal personal details about the client’s family history to the worker helping them with job training skills. We would obtain the client’s consent to discuss their needs with service providers and assure them that some information remains confidential. Most agencies that our organization deal with have a form outlining ‘Consent to Release of Information’ which clients sign; this identifies the type of information they consent to being shared and the names of agencies with whom this information can be shared. As a manager I need to be familiar with any policies or procedures that exist in our agency for exploring other options and referring to other services.
The urgency of referral will be determined by several factors: level of risk involved – wishes of the clients -immediate nature of the demands for service (that is, response to crisis v. response to long-standing needs) – ability of organization or service to meet all or some of the client’s needs – wishes of other relevant stakeholders, e.g. family, friends and other members of the treating team. After the initial assessment, there is usually a reasonably good understanding of the above factors and a decision would be made relating to the need for referral. There may be no need for referral at all.
This would occur, for example, when our organization is able to meet all of the client’s immediate needs. If our organization is unable to meet the immediate needs of the client and, in particular, if there is a high level of risk involved (for either self-harm or harm to others), the urgency of referral will be high. We would make a quick decision about what to do and where to refer the client. In order to do this effectively, all involved need to have a good knowledge of what emergency procedures may be required and what other services or agencies are available within the community. 03.1 03.2
The involvement of the individual in his or her treatment and care is a significant cornerstone of the Mental Health Act, 2001. Actively working with the service user to complete his/her care plan is a logical and meaningful means of ensuring the involvement of the service user. An individual care plan, as defined by the regulations, is: a documented set of goals developed, regularly reviewed and updated by the resident’s multi-disciplinary team, so far as practicable in consultation with each resident. The individual care plan shall specify the treatment and care required which shall be in accordance with best practice, shall identify necessary resources and shall specify appropriate goals for the resident.
For a resident who is a child, his or her individual care plan shall include education requirements. The individual care plan shall be recorded in the one composite set of documentation.” Article 15 of the regulations states: “The registered proprietor shall ensure that each resident has an individual care plan.” Article 16 of the regulations states: “The registered proprietor shall ensure that each resident has access to an appropriate range of therapeutic services and programme in accordance with his or her individual care plan.” “The registered proprietor shall ensure that programs and services provided shall be directed towards restoring and maintaining optimal levels of physical and psychosocial functioning of a resident.” When endeavoring to ensure that Articles 15 and 16 of the regulations are met, it is necessary to understand fully the care planning process. The Individual Care Plan Components include:
A documented set of goals
Regular review and update of the plan by the resident’s multidisciplinary team Consultation with each resident in so far as is practicable
Specification of treatment and care required in accordance with best practice Identification of the necessary resources
Specification of appropriate goals
Records being kept in one composite set of documentation
Consideration of education requirements in the case of a child. If each of the above components are fulfilled the mental health service provider will be fully compliant with Article 15 of the Mental Health Act 2001, (Approved Centers) Regulations 2006. Government policy ‘A Vision for Change’ (Department of Health & Children, 2006) advocates the need for consultation with users and carers, in order to construct a comprehensive care plan. It further adds that care plans should be written and agreed between all parties, and includes a time frame, goals and aims of the user, the strategies and resources to achieve these outcomes and clear criteria for assessing outcome and user satisfaction. “Each service user has an individual care and treatment plan that describes the levels of support and treatment required in line with his/her needs and is coordinated by a designated member of the multi-disciplinary team, i.e. a key-worker”.
The Inspector of Mental Health Services suggests ten reasons to implement care planning, as follows: Respect for the patient – Good practice – Better patient co-operation – Good communication with the family, helping to involve them in the patient’s care – Enhancing communication between the multi-disciplinary team and different shifts – Medico-legal defense – Improves measurement of progress towards all goals – Clearer identification and analysis of problems – Easier to audit care and treatment provided – It is legally required to do so. In summary, a best practice perspective nationally and internationally requires that each user of mental health services should have an individualized care plan. The Mental Health Act 2001, (Approved Centers) Regulations 2006, also places a statutory obligation on services to ensure that residents within approved centers have an individual care plan.
The regulations require that the multi-disciplinary team in consultation with the service user complete an individualized composite document. The care plan exists for each service user to assist with recovery and to facilitate the service user, the providers of services, the family member or advocate, to work towards the desired outcome. Criterion 1.1.3 of the Quality Framework (2007) advocates that the care and treatment plan should reflect the assessed needs of the service user, not from any one professional group but from the perspective of the multidisciplinary team. Care and treatment should be developed, implemented and reviewed in a timely manner, signed by the multidisciplinary team member who is the allocated key-worker and the service user, (if the service user chooses not to sign the care plan a note should be made of this refusal), and a copy of the care plan kept by the service user unless there is a documented reason for not doing so (Mental Health Commission, 2007).
This criterion also reflects the ambition of “A Vision for Change” (Department of Health & Children, 2006), which proposes a person centered treatment approach, through an integrated care plan, evolved and agreed upon with service users and carers. Contemporary views would require that for the care plan to be a dynamic, positive document the concept of “Recovery” should form the basis of its construct. Since the 1980s, momentum has been given to the concept of recovery oriented mental health services. It is acknowledged that the person’s journey through mental illness is not always destined to result in on-going deterioration and loss of skills but that the person can recover and have a meaningful life (Higgins, 2008).
There is now internationally a real desire to embed the concept of recovery into all aspects of mental health service delivery and to place recovery at “the heart of all that we do”, (Devon Recovery Group, 2008).
The Mental Health Commission, 2007, identified in the Quality Framework (Standard 3.5), the need for a recovery-focused approach to the treatment and care of service users. Care plans are a crucial part of supporting and helping the process of recovery. They should not be distinct from the daily provision of care. They are a key mechanism by which a person’s individual care and treatment can be developed, documented and shared with all those who are involved. Care plans provide a participatory framework for agreeing and reviewing the benefits of a given programme of treatment and care with an individual in the context of his or her recovery. A good care plan requires the care planning process to be an evolving process facilitating adaptation and change. It must include a pre-scheduled evaluation of the plan in collaboration with the service user. Any adjustments to the care plan should be agreed and documented and signed by a member of the MDT and the service user. Unscheduled evaluation of a care plan may also be required at times. The benefits of a care plan include:
The identification of problems and setting of realistic goals that can then be worked towards and achieved Service user and providers become more focused on the individual’s needs. Service users become more involved in the care planning process, thus fostering a sense of commitment and responsibility in achieving their personal health gain and social gain Continuity of care among the relevant disciplines becomes more streamlined. The care plan should reflect the service user’s needs and wishes, and is about both the more immediate concerns of care and safety and support with progress towards recovery. According to the Mental Welfare Commission of Scotland (2009) best practice points with regard to care planning include:
– The person being involved from the beginning – An understanding of the person’s communication style/needs – Using advance statements if they exist (encouraging the development of such statements if they don’t exist) – Involvement of the advocate/carer – Ensuring the person understands the care planning process and the care planning discussion -Recording the person’s views including his or her met and unmet needs – Availability of the care plan in a format that is meaningful to the person – The person having a copy of his or her care plan, or knowing where it is kept and having access to it – The language used being easy to understand – The care plan containing up to date contact details for all involved, including telephone numbers – The proposed treatments and services being available to the person (in a timely fashion) – If there are unmet needs these are recorded and proposals to remedy them documented – The plan clearly identifying those elements that are to be provided on a compulsory basis (when applicable) and those with the consent of the person
– Any recorded matters are clearly identified and the actions required clearly timetabled – Clearly identified timescales for review and evidence of this occurring – Evidence that outcomes are monitored and care and treatment adjusted accordingly – Changes are documented and a system is in place to ensure that the most up to date care plan is available to the care team and to the person themselves – Risk assessments and risk management plans regularly reviewed and updated – Crisis plans, or out of hours contact arrangements, clearly documented – The care plan makes reference to social, recreational and spiritual needs as well as to treatment and community care needs – Physical health care needs documented where appropriate – Named persons/carers/independent advocates and others, as well as professionals, that have been involved in the preparation of the care plan – Evidence of the issues that are important to the individual being taken into account.
The Mental Health Commission document “Teamwork within Mental Health Services” (2010) details the role of the service user within the mental health team and refers to Slade (2009) when emphasizing the need for service users to be recognized as experts in taking an active involvement in their own care. If mental health services are to ensure that the needs of the service user are paramount then being true partners in the mental health team is essential. This self-advocacy will increase the opportunities for engagement and decision-making. The service user acting as a self-advocate must be facilitated to work in partnership with the key-worker to develop his/her care plan. If self-advocacy is not possible then independent peer advocacy should be sought. The responsibility for organizing a care planning meeting with/or for the client may lie with the manager of the care setting, therefore the manager will need to have gathered all the information for the meeting to take place. This would need to be done in advance of the actual meeting to enable people to read about and understand the services that may be on offer.
Only then can informed choices be made. Prior to the meeting the manager would need to ensure that contact is made to all who would attend and the manager would also need to be aware of the professionals with whom they would be working with in order to support the client. For the client the meeting may be quite a daunting process. They may lack the confidence to be part of the meeting where there are other professionals like GPs, health visitors, housing officers, involved if this is the case they may not fully participate. If this were the case it would be good practice to meet with the client and the family before the meeting to help them through the process and to discuss what will happen and who will be there.
The manager might also be able to help them to prepare what they wish to say and perhaps make notes to help them. A manager may need to act as an advocate for the client or they may enlist the help of and independent person to do this job, particularly if the manager is chairing the meeting. This is a difficult situation since it is quite easy to make suggestions as to what you or the advocate thinks is best for the client and yet may be far from what they actually want and would be the best outcome for them. Care must be about listening to what the client is saying and to put forward their views.
The Social Care Institute for Excellence on assessments states: Although assessment has been recognized as a core skill in social work interventions, there is no singular theory or understanding as to what the purpose of assessment is and what the process should entail. SCIE 2004.With no theory to support it the process of assessment became a huge subject, one which potentially might differ with each service in a partnership group. This situation could lead to fragmentation of a clients care with many differing approaches to assessing their needs being used at the same time. It becomes imperative then to determine how we as care providers will assess the client and to simplify the process. The care planning process is a good place to start. In any assessment of a client the following basic helping cycle as suggested by, Taylor and Devine 1993 is useful. Assess. – Plan. – Implement.- Review. In this basic cycle, the client and care professional work together to assess the needs of a client.
The care to meet those needs is then planned and put in to action at the third stage and finally evaluated or reviewed starting the cycle again. In 2005 Thompson described what he called the ASIRT model of care planning. AS – Assessment phase which is the start of the process and the first part of an action plan leading onto the, I – Intervention stage when aims and objectives for the intervention are selected. R – Review when the evaluation of what has happened takes place before finally. T – Termination when the intervention is no longer needed and can be stopped. The care planning process however we approach it is just one part of the assessment. Three different models of assessment have been suggested in research by Smale et al. 1993. The Questioning Model – in which the care worker leads the process and questions and listens before processing the information. This means that the process is service led. The Procedural Model – in which information is gathered by the care professional who the makes a judgment as to best fit for the service.
This is criterion based and a range of checklists is used to determine which service is best for the client. The Exchange Model – in which the care workers view the clients as the expert in their own needs and is really the most person centered approach of the three. This model seems to describe the most holistic form of assessment with the care professional managing a more client – centered approach. The types of assessment carried out will differ according to the setting. Or according to the types of needs that the person has. If the person living in their own home is having difficulty with their personal care, they might consider getting support by having a community care assessment of their needs. These assessments are carried out by social services in order that services can be provided by the local social services department of a local authority. The assessment considers what type of services are needed by the person being assessed and can vary, depending on the particular needs of the person who needs to help.
People with mental health problems: Assessments for people in need of mental health services are carried out under the Care Programme Approach, which assesses: risk and safety – psychiatric symptoms and experiences – psychological thoughts and behaviors. Mental health issues require the help of mental healthcare professionals and the community care assessment entitles the individual to a care plan that is regularly reviewed by the professional. If the person has a range of needs and is considered to have severe mental health problems, their care may be coordinated under a Care Programme Approach and a CPA care coordinator will be appointed to coordinate the assessment and planning process. The coordinator is usually a nurse social worker or occupational therapist. People with learning disabilities: For each client with learning disabilities assessment is governed by the principles set out by the Valuing People plain which aims to improve services for people with learning disabilities by treating them all as individuals.
This person – centered approach considers the clients ability to exercise choice and control over their lives. There is a thorough referral and assessment process, working with individuals and their advocates to plan a bespoke transition programme for anyone moving to our organization. Referrals come to us from a wide variety of backgrounds, Hospital Social Work Teams, Social Care Providers, Community Social Work Teams including placement breakdowns, and individuals looking to leave the family home. The catchment area is Bristol, however we welcome referrals from throughout the UK. In each case, we assess the needs, abilities and personality of the individual in detail, to determine their suitability. The purpose of our assessment is also to ensure that we are offering a home in which the individual will be able to achieve positive outcomes with regards to their own aspiration’s.
Referrals can be made by a social worker, care manager, families/advocates, although the care manager acting on behalf of the service user must be consulted before an assessment can take place. During the referrals process, the service user, their family, friends and/or advocates and the care manager/social worker are offered the opportunity to visit the organization for them selves, allowing them the opportunity to meet the other service users and staff. Where it is not possible or appropriate for the service user to visit in person, it is important to have guidance from someone who knows the individual well and can make recommendations on their behalf. Should all parties, including the service user themselves, agree that the placement is appropriate, the care manager will apply for funding. If, and when, funding is agreed, a transition plan can then be devised, which will be specifically tailored to the individual’s needs, in order to provide as much support as possible during the move.
This process is designed to help the service user, and all those supporting them, to feel as confident as possible that the placement will be a success. 04.2. 04.3 The main aim of any assessment is to improve the quality of life of the client unfortunately care workers often focus merely on the needs of the client and fail to recognize their strengths. If staff’s continually focus on what the client is unable to do we negate the fact that they have strengths in certain areas and they miss out on optimizing their well – being. In helping others in the care process to understand this, a reminder can be made as to the positive and negative definitions of health. If we have a negative view of health, then we subscribe to the notion that health is the absence of disease’. WHO 1946. A more positive way to look at health is to focus on what the individual can do, irrespective of any condition they have. In this respect, the focus is more on optimizing the health of the client and recognizing the fact that despite having an illness and needs, they can still live an independent and full life.
Within our organization when there were concerns raised regarding the level of contribution needed in the development of a robust assessment process the decision was taken to take decisive action to address the concerns. Initial resistance from management indicated that a series of presentations and a training course would be helpful. It was agreed that training would be conducted separately for both frontline staff and managers of front line staff. Fears about the workload needed addressing, but the impending Supporting People programme had convinced most that changes were coming and more evidential work was required. The training sessions were very practical and the action learning set approach included an exercise in filling in a plan. This was initially very challenging but became funny when some took the role-play as an opportunity to turn into Victor Meldrew!
Staff grew to see the Support Plan as an opportunity to evidence their good practice and their professionalism. It empowered both frontline and management to engage with each other about practical problems solving and future priorities. Clients have appreciated the time and thoroughness of the staff who were capturing their views and helping them to agree some goals. They expressed appreciation of the client-centered approach that helped them spend time thinking about what they could realistically expect and help them understand which services could be available to them in due course. Some initial resistance from people who did not want to be bothered would need time and patience. The trainer was able to report that where one service has been using this system for about two years, there had been a marked quarterly reduction in the need to write unilateral plans and that clients showed greater understanding of the role of the frontline staff. 05.1 05.2
Can assessment be effective? People with chronic mental illness have complex needs and strengths across multiple health and social domains. Assessment of social care needs is a complicated task, involving the individual patient at the centre of the process, and their family, carers and multi professional care team. Assessment provides an opportunity to explore in a dialogue with the individual (and those who are important to them) how they see their life, their strengths and their difficulties. Putting the person at the centre of the process can promote collaboration, engagement and empowerment. Assessment should point to appropriate or evidence-based interventions to meet identified need. Once the care plan is in place and being implemented, it is important to monitor its effectiveness and to make changes as and when it is necessary. At the onset of the assessment it will have been agreed the following.
The frequency of monitoring the plan. What methods are used to monitor the plan? Who will be expected to contribute to the evaluation? How often? This largely will depend upon the complexity of the plan and the needs of the client. If the client has severe needs to be met then changes are likely to happen with more regularity. In this case a weekly meeting may need to be planned to monitor how the plan is working. If the client needs very little support the need to monitor the plan may become necessary only when a change occurs. Methods? This can be in written form or at a case meeting but whatever method is used it is wise to document what has been said so a verbal report would not be best practice since there would be no record. Who? The more people involved in the care of the client, the more evidence there will be to check the outcomes.
There is danger that to much information may be forthcoming so it may limit the evaluation to key people. It is also not good practice to overload a carer with forms to fill out on a regular basis since they may already feel overwhelmed with the care they are giving. The sort of things that may become evident from monitoring may be: Deterioration of the client’s physical condition. – Deterioration of the client’s mental condition. – Changes in support from neighbor’s friends, or family. – Changes in housing. – Changes in finances. – Change in local services offered. – Changes in staff being offered. Whatever changes have been noted for the client need to be recorded and then acted upon. The information about the changes must be shared with all involved in the care and action as to how the changes will impact on the care and the client. When reviewing the process there should be a planned meeting in order for all involved in the process to be present to discuss the changes and how they can be dealt with. As the care manager it is likely they will be responsible for organizing the meeting and drawing up an agenda or a checklist of things that need to be discussed.
At the end of a review meeting there will be a need to ensure that the care plan is revised and updated with respect to the changes that have been discussed. The client needs to be able to understand how the changes will impact on their care and the significance of the changes. Revisions to the plan could be: Outcome achieved In this case, the clients condition has changed and they no longer require an intervention to help. Perhaps they have been suffering from depression which necessitated additional care being put into place. Their recovery means their care is no longer needed. Reduction in support – This would link with the first outcome and as the client became more independent, they may need a reduced level of support and this can then be planned for. Increase in support – on occasions the client may require more care in certain areas it may be that they have just come out of hospital or had a change in family circumstances they may need additional support with their personal hygiene if they have had an operation or they may need to have additional help with shopping if a family member who help them to do this has moved away.
Increase in the type of support needed – If a client has become more disorientated or forgetful, then they may need to have a different type of service put in to place. This may also be the case when there is the onset of a physical disability. Change in the method of support – Occasionally a service provider may go out of business or be unable to provide the service due to resource limitations. In this case a new service provider would need to be sourced to enable the changes noted in the action plan to be implemented. The care planning process is an important one and every step of the way needs to be documented, reviewed and accurately recorded. Good practice demands that confidentiality is respected and that records are maintained in good order. Written reports must be included in the care package. Minutes of meetings with staff in attendance must also be kept and a record of the pre-review meeting should also be available to show how the client was prepared for the meeting. Changes to the package should be identified clearly and the revised plan made available to all involved in the care to be delivered.