The Good Conversation (Disability Locality Teams and Transitions)
1. A Strengths Based Approach
Wherever possible, every conversation with an adult should be from a strengths perspective. This means that before you talk about service solutions to the presenting issue you must support the adult to explore whether there is:
- Anything within their own power that they can do to help themselves; or
- Anything within the power of their family, friends or community that they can use to help themselves.
A strengths based approach is empowering for the adult and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the Local Authority intervenes with support, but this decision will have been reached knowing that it is the most proportionate response available.
Adopting a strengths based approach involves:
- Taking a holistic view of the person or carers needs in the context of their wider support network;
- Helping the person to understand their strengths and capabilities within the context of their situation;
- Helping the person to understand and explore the support available to them in the community;
- Helping the person to understand and explore the support available to them through other networks or services (e.g. health);
- Exploring some of the less intrusive/intensive ways the Local Authority may be able to help (such as through prevention services or signposting).
SCIE have produced clear and practical guidance around how to use a strengths based approach in practice. It can be accessed here. Note: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.
2. Carers
Where the adult is known to have a carer the Care Act expects you to consult with them before making any decision regarding Care and Support for the person.
The purpose of doing so is:
- To gather further information about the needs and situation of the adult; and
- To understand the needs of the carer and fulfil the duty to meet them.
Where the adult with Care and Support needs has not consented to you consulting with their carer you must still do so for the purpose of understanding the needs of the carer. This will no doubt involve some discussion about the adult with Care and Support needs but the Local Authority has a duty to support the needs of any carer it identifies and the person they care for cannot override this duty.
When an adult has not consented to the carer being a part of the assessment you should:
- Advise the adult that you have a duty to involve the carer;
- Explain the benefits of the carer being involved; and
- Agree the most appropriate way to involve the carer (for example a separate meeting with the carer).
If the adult has requested particular information not relating to needs is withheld from the carer, and they have capacity to do so normal confidentiality rules apply unless doing so would put the person at risk of abuse or neglect.
Click here to access the local Data Protection policy.
3. A Whole Family Approach
What the Care Act says
Under the Care Act it is important that the adult's needs are considered within the context of their family network of support and not in isolation. This is what is meant by a whole family approach.
Taking a whole family approach enables the Local Authority to:
- Understand the impact of the adult's Care and Support needs on all family members, not just those that may be instantly recognisable as carers; and
- Identify and support carers (both these things are duties under the Care Act).
Taking a whole family approach also builds the resilience of families and increases the likelihood that a non-service led self-sustainable method of meeting needs will be identified.
The direct involvement of family member's in a needs assessment is subject to consent being provided by the person unless:
- They lack capacity to do so and a best interest decision is made to this effect; or
- The adult is under 18 and the family member has parental responsibility; or
- The family member is a carer under the Care Act (there is a duty to involve carers).
When taking a whole family approach you should consider involving the following people in the assessment:
- The adult's parents (where the parent has parental responsibility they must be involved if the adult is under 18);
- Other adult's living in the same household as the adult;
- Children living in the same household as the adult;
- Adults living elsewhere but who form part of the adult's support network;
- Children living elsewhere but who form part of the adult's support network.
Specifically you need to understand:
- The impact of the adult's needs on family members (both adult and children);
- Whether the role that adults or children in the family have constitutes a caring role under either the Care Act 2014 or the Children and Families Act 2014;
- Whether the support currently being provided to adults and children to manage the impact is appropriate (or whether a carer's/young carer's assessment should be offered); and
- Whether the support being provided is sustainable.
Where there is an appearance of need in a carer you have a duty to offer an assessment. Click here to access the carer's procedures, which include procedures for carrying out a carer's assessment, young carer's assessment and transitional carer's assessments.
Adult family members
Any conversations with adult family members must give regard to the duty to provide good information and advice about adult Care and Support. This could be in relation to the needs of the adult being assessed, in relation to their own apparent needs or in relation to another adult that they support or are concerned about.
You must also consider whether any prevention service would be of benefit to any adult family member you speak to, either to support them as a carer for the adult or in their own right. Where they appear to have a need for a prevention service themselves you should support them to access this service.
Where you take action to support another adult in the adult's family via a whole family approach you should make sure that you make appropriate and proportionate recordings for the action you have taken or the information and advice you have provided.
Child family members
The Duty to safeguard children
Children are protected under different legislation to adults. You must know your statutory responsibilities in relation to protecting children so that you can respond appropriately.
Things that you must consider in relation to all children living in the household:
- Whether the child is taking part in any caring activities that may be inappropriate for their age, gender or that cause them physical difficulty or emotional distress;
- Whether the adult being assessed for adult Care and Support presents with behaviours that place the child at risk of harm or abuse;
- Whether the child is at risk of neglect because the adult being assessed for adult Care and Support has caring responsibilities towards them that they cannot adequately meet as a result of their own needs;
- Whether the child is at risk of neglect because a carer has caring responsibilities towards them that they cannot adequately meet as a result of caring for the adult being assessed;
- Whether the home environment or any caring role is having a negative impact on the child's well-being, education or development.
If you are concerned about the safety of a child, or that they are at risk of abuse and neglect you must take action to protect them.
For more information about Safeguarding Children visit the Croydon Safeguarding Children Board website by clicking here.
If you are concerned that a child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialling 999.
Responsibilities to young carers
The legal definition of a young carer under the Children and Families Act is;
“a person under 18 who provides or intends to provide care for another person (of any age, except where that care is provided for payment, pursuant to a contract or as voluntary work)”.
There is a duty to meet the needs of young carers under the Children and Families Act in the same way as there is a duty to meet the needs of adult carers under the Care Act. This means that if you become aware that a child or other adult under the age of 18 is providing care you must take steps to ensure they are appropriately supported.
The first thing you should do is liaise with children's services to establish whether the child or other adult is already being supported as a young carer.
If support is in place you should provide children's services with any new information you may have about the impact that the needs of the adult being assessed has upon the child, but you will not need to provide any further support to the child.
If the young carer is not already being supported by children's services you should discuss and agree with your line manager and children's services who is best placed to assess them.
Option 1
If the young carer is not approaching the age of transition any assessment and subsequent support they receive will be provided under the Children Act 1989. The practitioner carrying out a young carer's assessment under the Children Act must be suitably skilled, knowledgeable and competent to do so.
Option 2
If the young carer is approaching the age of transition (or is at a time of their life when it would be of significant benefit for transition to begin) a young carer's assessment under the Children and Families Act or Care Act may be more appropriate. This will involve the development of a transition plan that will support the young carer through the transition to adult Care and Support (when they become 18).
There is a legal duty to ensure that transition planning and the whole transition experience is positive for the young carer. To this end an element of joint work will likely be required to ensure the young carer receives the support they need both now and into adulthood.
Click here to access the procedures for carrying out a carer's assessment for a young carer going through transition.4. Talking about Individual Wellbeing
Why you must talk about Wellbeing
Wellbeing is the single most important concept of the Care Act. The duty to promote individual wellbeing applies at all times; in every single process, conversation or decision that is made and you must be able to demonstrate that you have done so.
It is vital that you understand your duties in relation to promoting individual Wellbeing. Click here if you are unclear or require further information.
What you must establish about Wellbeing
In order to promote individual Wellbeing you must first understand what Wellbeing means to the adult. The Care Act sets out 9 domains of Wellbeing that you must consider. Click here to see the domains.
As part of any process to establish needs you must understand:
- Which areas of Wellbeing are most important to the adult at that moment in time;
- Which areas of Wellbeing are least important at that time;
- Whether there are other areas of the adult's life important to them but not listed as a domain (the domains under the Act are not definitive as Wellbeing is personal);
- Which areas of Wellbeing are causing the adult concern or worry;
- What impact any concern or worry is having (or could have) across the Wellbeing domains (is there a destabilising effect?); and
- How the adult thinks any Care and Support needs interact and impact on Wellbeing.
It is important to remember that under the Care Act the Wellbeing domains are all as important as each other. Any hierarchy can only be determined or described by the adult whose Wellbeing it is.
Important rules when talking about Wellbeing
- A sense of Wellbeing is extremely personal and will be different for every adult;
- Never make assumptions about what is important and what is not important to an adult;
- The adult is the expert in relation to their own Wellbeing;
- If an adult tells you they have no worries in a particular area this does not mean the area is not important to them; and
- Conversations about Wellbeing should be 'genuine' person centred conversations, not process led.
Preparing to talk about Wellbeing
Often the key to an effective conversation about Wellbeing is preparation and you should take whatever steps are available to ensure that the adult is as prepared as possible for the conversation:
- Provide information that will support the adult to understand the concept of Wellbeing and why it is important;
- Offer advice about the things that an adult may want to think about before having a conversation about Wellbeing;
- Make sure that anybody who will be supporting the adult understands Wellbeing and is confident and appropriate to support the adult to prepare for and have the conversation; and
- Consider whether any tools may be helpful to support the adult to think about Wellbeing.
Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.
Click here to access the range of tools that are available and practice guidance around the use of tools.
Talking about Wellbeing
A conversation about Wellbeing can be a very difficult conversation for an adult to have. Not everyone will feel happy, confident or able to share with you how they are feeling about the different areas of their life. For many young people, this will be the first time they have been asked or given an opportunity to think about their own Wellbeing in this way, and they may also be doing so whilst adapting to significant change in their life.
Any questions that are used to support an adult to think about Wellbeing must:
- Be proportionate to the level of information required;
- Be appropriate, taking into account the adult's specific needs around communication and their specific circumstances;
- Be realistic in respect of the adult's mental capacity and ability to be able to answer the question; and
- Be asked in a manner that is accessible to the adult.
Powerful questions
A powerful question is a specific type of open question that:
- Encourages a person to reflect;
- Is thought-provoking;
- Supports an exploration of options; and
- Helps the person to gain a greater insight into their situation.
Powerful questions should be framed in a positive way to promote engagement of the person and promote a strengths based approach.
Powerful Question | Open Question (not powerful) |
Why do you think that means so much to you? | What do you think that for? |
What works well about the support you have? | Who does that for you? |
Why do you think that didn't quite go as expected? | Why didn't that work out? |
What made you decide to take that approach? | Why did you do that? |
Appreciative Enquiry
An appreciative enquiry is a conversation that is led by the adult and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.
The listener should invite the adult to:
- Talk about a time or times when something has been working well in their life;
- Explore what it was that worked well and supported them at that time;
- Think about how that experience could support them now in making a plan for the future.
Some key questions to support an appreciative enquiry approach include:
- Tell me about a time when things were going well for you?
- What did you learn about your strengths at that time?
- If you had a magic wand what would the future look like?
- What is it that you value most in your life now?
- What small changes would make the most difference?
The use of tools
A tool can be helpful to shape and focus a conversation about Wellbeing, making sure that you consider everything that needs to be considered from a statutory perspective. Tools are also useful because they:
- Can be completed with the adult as part of any conversation you have with them; or
- The adult can complete them in their own time as part of their preparation for the conversation.
Click here to access the range of tools that are available and practice guidance around the use of tools.
Wellbeing and Capacity
Some young people will lack capacity to have a conversation or communicate how they feel about their own Wellbeing at a particular moment in time (verbally or through another means). For example, they may be too unwell to do so or have a significant learning disability. Where this is the case the duty to ensure their involvement still applies.
There are a range of ways that you can ensure the involvement of an adult who lacks capacity, including but not limited to:
- The involvement of the adult's parents (unless there is a reason not to a best interest decision should normally be made to involve the adult's parents when they lack capacity; additionally if the adult is under 18 you are required to do so at all times when the parent has parental responsibility);
- An appropriate other person or independent advocate to support the adult to engage and ensure that they are represented;
- Spending time with the adult can show you what they enjoy about life and what may be most important to them (this could be a person, a place or something they do with their time);
- Consulting with a range of people who know the adult before reaching a judgement about Wellbeing. Speaking to a family member, a health professional, a paid carer, a college tutor and a day services manager will give a much better picture of what appears to matter most to the adult than relying on the views of one person;
- Use other available evidence to support you to understand Wellbeing (for example ABC charts and other records that show behaviour changes clearly linked to an event, person or place).
All information gathering and sharing should be carried out with regard to the Caldicott Principles and local information sharing policies.
Use the tri.x Resources tab to access further information about the Caldicott Principles in the glossary.
Click here to access the local Data Protection policy.
Exploring and Managing different views about Wellbeing
Because Wellbeing is extremely personal different people are likely to have different perspectives about the same domains. The adult themselves is more likely to have a subjective view about their Wellbeing which may be dominated by worries or concerns they have about their presenting situation (for example if they are going to be leaving school), whereas someone who is emotionally removed from may see things more objectively.
It is important that you recognise when an adult's views about their Wellbeing may not be holistic and take steps to try and support them to gain insight or broaden their thinking. One way of doing this is to seek the views of family members and others involved in their life. This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support. You can seek the views of others:
- When the adult consents to this; or
- When the adult is under 18 and the views are to be sought from a person with parental responsibility; or
- When the adult lacks capacity, a best interest decision is made to this effect.
Even with the involvement and perspective of others certain factors effecting Wellbeing may still be difficult for people to recognise, acknowledge or explore. If it is your view that these things are having an impact on Wellbeing then you must raise them for the purposes of:
- Supporting the adult to gain insight into their situation;
- Developing the adult's resilience through talking about difficult situations and exploring options to find a solution;
- Providing information and advice;
- Preventing, reducing or delaying the need for Care and Support.
You may also find the tool 'Six Tips to Help You Have Difficult Conversations' useful. This can be accessed from the tri.x Resources by clicking here.
You should also make effective use of supervision to explore and develop skills that will support you to have difficult and sensitive conversations with people in a positive way.
Talking about Wellbeing in a Crisis
An adult's wellbeing is always affected by what is happening in their life at that time. It changes as their situation changes, and sometimes the changes in Wellbeing that take place can be quite dramatic. It is therefore important to understand an adult's Wellbeing in the context of their current situation, but to monitor and review Wellbeing as things change.
Promoting Wellbeing
When you have understood an adult's individual Wellbeing you have a duty to promote it. To do this you must understand:
- The things that they want to achieve;
- The things they want to change; and
- The things that they want to stay the same.
These things are known as the adult's outcomes. In order to promote Wellbeing you should explore with the adult during the assessment the steps that they can take to achieve their outcomes, as the two things are intrinsically linked.
Click here to access an NHS Choices resource that summarises 5 simple steps to promoting individual Wellbeing. These steps can form the basis of an effective strengths based conversation with an adult and their parents/family.
If, following assessment the Local Authority meets any eligible needs that the adult has you will need to explore not only what steps the adult can take to achieve their outcomes, but also how the support/services provided can help them do so too.
Balancing the Wellbeing of others against the Wellbeing of the adult
You have a duty to promote an adult's individual Wellbeing but this is not a duty at the detriment of others. The Wellbeing of others must be taken into account and may determine the action that you then do or do not take to promote an adult's Wellbeing.
For example, if promoting one person's Wellbeing will put another vulnerable adult or a child at risk then you must not do so unless risks can be mitigated. The duty to protect people from abuse or neglect overrides the duty to promote individual Wellbeing.5. Talking about Needs
Why you must talk about needs
The Local Authority has a duty to meet eligible needs, and it cannot fulfil this duty unless it establishes whether the needs that an adult appears to have are eligible.
An adult's needs also often directly impact on their Wellbeing, which you have a duty to promote. Therefore understanding needs will also support you to fulfil the duty to promote Wellbeing.
The areas of need described in the Care Act
The Care Act sets out 10 areas of need that must be assessed whenever it appears that they exist;
- Manage and maintain nutrition;
- Maintain personal hygiene;
- Manage toilet need;
- Being appropriately clothed;
- Be able to make use of their home safely;
- Maintain a habitable home environment;
- Develop/maintain family and other personal relationships;
- Access/engage in work, training, education or volunteering;
- Make use of community services;
- Carry out caring responsibilities for a child.
Proportionate and Appropriate conversations about need
Unlike a conversation about individual Wellbeing there is not a requirement to talk about all of the areas of need described in the Care Act, regardless of whether they appear to be present or not. Instead the conversation about needs must be proportionate and appropriate to each adult's situation and you should be mindful to make the best use of available information from existing assessments and plans.
Preparing to talk about need
Often the key to an effective conversation about need is preparation and you should take whatever steps are available to ensure that the adult is as prepared as possible for the conversation:
- Provide information that will support the adult to understand the areas of need described in the Care Act and why establishing needs is important;
- Offer advice about the things that an adult may want to think about before having a conversation about needs;
- Make sure that anybody who will be supporting the adult understands needs and is confident and appropriate to support the adult to prepare for and have the conversation; and
- Consider whether any tools may be helpful to support the adult to think about needs.
Talking about need
Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.
Click here to access the range of tools that are available and practice guidance around the use of tools.
A conversation about needs can be a very difficult conversation for an adult to have. Not everyone will feel happy, confident or able to talk about their needs. Some people may lack insight into their needs, particularly if they are still going through a period of adjustment to the need.
Any questions that are used to support an adult to think about needs must:
- Be proportionate to the level of information required;
- Be appropriate, taking into account the adult's specific needs around communication and their specific circumstances;
- Be realistic in respect of the adult's mental capacity and ability to be able to answer the question; and
- Be asked in a manner that is accessible to the adult.
Powerful questions
A powerful question is a specific type of open question that:
- Encourages an adult to reflect;
- Is thought-provoking;
- Supports an exploration of options; and
- Helps the person to gain a greater insight into their situation.
Powerful questions should be framed in a positive way to promote engagement of the person and promote a strengths based approach.
Powerful Question | Open Question (not powerful) |
Why do you think that means so much to you? | What do you think that for? |
What works well about the support you have? | Who does that for you? |
Why do you think that didn't quite go as expected? | Why didn't that work out? |
What made you decide to take that approach? | Why did you do that? |
Appreciative Enquiry
An appreciative enquiry is a conversation that is led by the adult and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.
The listener should invite the adult to:
- Talk about a time or times when something has been working well in their life;
- Explore what it was that worked well and supported them at that time;
- Think about how that experience could support them now in making a plan for the future.
Some key questions to support an appreciative enquiry approach include:
- Tell me about a time when things were going well for you?
- What did you learn about your strengths at that time?
- If you had a magic wand what would the future look like?
- What is it that you value most in your life now?
- What small changes would make the most difference?
The use of tools
A tool can be helpful to shape and focus a conversation about need, making sure that you consider everything that needs to be considered from a statutory perspective. Tools are also useful because they:
- Can be completed with the adult as part of any conversation you have with them; or
- The adult can complete them in their own time as part of their preparation for the conversation.
Click here to access the range of tools that are available and practice guidance around the use of tools.
Fluctuating need
To ensure an accurate assessment of need it is important that you identify whether an adult has needs that fluctuate (change over time).
Fluctuating needs are needs that:
- May not be apparent at the time of the assessment; but
- Have been an issue in the past; and
- Are likely to arise again in the future.
A simple question to ask an adult to establish whether their needs fluctuate is 'How do your needs change over time?'
Every adult with fluctuating needs will experience fluctuations differently. For example:
- Some people's needs fluctuate throughout each and every day;
- Some people's needs fluctuate on some days each week;
- Some people will have periods of stability that could last several weeks or months with no fluctuation;
- Some people's fluctuations are related to a physical or mental health condition (for example Bi-Polar Disorder); and
- Some fluctuations are a response to a change in circumstance or environment (for example the weather affecting mobility).
Because of the variance in fluctuation possible it is not appropriate to simply assess an adult as having 'fluctuating' needs. Neither should you make a judgement about need based solely on either a 'worse case' or a 'best case' scenario. Doing so would not provide a true representation of the adult's whole needs and it would be likely that any support the Local Authority did subsequently provide would be inappropriate or disproportionate (too much or not enough) to cover periods of fluctuation.
You need to be able to effectively demonstrate:
- How often the adult experiences a fluctuation in needs;
- The type of fluctuations that are experienced and the impact on other needs and Wellbeing;
- What the potential causes or triggers are for fluctuations; and
- What measures are effective in managing periods of fluctuation or reducing the risk that they will occur.
The kind of questions you could ask an adult to help understand their fluctuating needs includes:
- How long has it been since you had a good/bad day?
- What does a good/bad day look like?
- What changes in support do you have on a bad day?
- How often do your needs change on a bad day?
- Which areas change the most on a bad day?
Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.
Click here to access the range of tools that are available and practice guidance around the use of tools.
The length of extension to an assessment process to ensure that fluctuating needs are understood should be based on the individual needs and circumstances of the adult and could be a day, a week or several months in duration.
It may also be appropriate to pause an assessment to enable the adult to access support that may then prevent or reduce the number of fluctuations occurring (for example to allow a new medication to take effect or to access to a health service to support anxiety).
Talking about need when the adult lacks Capacity
Some people will lack capacity to have a conversation or communicate information about their needs (verbally or through another means). For example, they may be too unwell to do so or have a significant learning disability. Where this is the case the duty to ensure their involvement still applies.
There are a range of ways that you can ensure the involvement of a person who lacks capacity, including but not limited to:
- The involvement of the adult's parents (unless there is a reason not to a best interest decision should normally be made to involve the adult's parents when they lack capacity; additionally if the adult is under 18 you are required to do so at all times when the parent has parental responsibility);
- An appropriate other person or independent advocate to support the adult to engage and ensure that they are represented;
- Spending time with the adult can show you what needs they have and how they are currently being supported;
- Consulting with a range of people who know the adult before reaching a judgement about need. Speaking to a family member, a health professional, a paid carer, a college tutor and a day services manager will give a much better picture of the person's needs than relying on the views of one person;
- Use other available evidence to support you to understand need (for example ABC charts, carer's notes and other records).
All information gathering and sharing should be carried out with regard to the Caldicott Principles and local information sharing policies.
Use the tri.x Resources tab to access further information about the Caldicott Principles in the glossary.
Click here to access the local Data Protection policy.
Exploring and Managing different views about need
Different people involved with the adult are likely to have different views about need. For example, the adult them self is likely to have a subjective view about their needs, which may be dominated by worries or concerns they have about their presenting situation (for example the potential impact of a serious health diagnosis), whereas someone who is emotionally removed from the situation may see things more objectively.
It is important that you recognise when an adult's views about their needs may not be holistic and take steps to try and support them to gain insight or broaden their thinking. One way of doing this is to seek the views of family members and others involved in their life. This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support. This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support. You can seek the views of others:
- When the adult consents to this; or
- When the adult is under 18 and the views are to be sought from a person with parental responsibility; or
- When the adult lacks capacity, a best interest decision is made to this effect.
Even with the involvement and perspective of others certain needs may still be difficult for people to recognise, acknowledge or explore. If it is your view that these needs exist and are having an impact on the adult then you must raise them for the purposes of:
- Supporting the adult to gain insight into their needs and situation;
- Developing the adult's resilience through talking about difficult situations and exploring options to find a solution;
- Providing information and advice;
- Preventing, reducing or delaying the need for Care and Support.
You should also make effective use of supervision to explore and develop skills that will support you to have difficult and sensitive conversations with people in a positive way.
Talking about short term needs
Sometimes it is necessary to talk about needs that you know are likely to change at some point in the near future. For example:
- When an adult is expected to make a full recovery from a health related condition;
- When an adult's needs are likely to be temporary (e.g. needs relating to upcoming surgery to resolve a physical need); or
- When an adult's needs are related to their circumstances and these circumstances are going to change (e.g. needs relating to social isolation when the adult is going to be moving into a shared lives placement).
If those needs are eligible the duty to meet the needs applies, even if the need is only likely to be short term.
Where needs are likely to be changing over time it is important to make arrangements with the adult to monitor and review the needs over an appropriate timeframe that reflects the individual circumstances of the adult.
Talking about needs in a crisis
Sometimes it is necessary to establish needs during a period of crisis. For example:
- When an informal caring relationship has completely broken down with immediate effect; or
- When the adult's physical or mental health condition deteriorates rapidly and current services being provided are no longer working.
At times of crisis the presenting needs that an adult has may not be a true representation of their on-going needs for care and support. As such it is important to make arrangements with the adult (or their representative or parent (if they are under 18)) to monitor and review their needs and situation, re-assessing where there is evidence that long term needs are clear.
Talking about how to meet needs
At this point in the assessment process you will not yet have made a formal determination about eligibility, although you may have gathered enough information to give a good indication. As the formal determination has not yet been made you should restrict conversations about ways that needs could be met to:
- Ways that the adult could meet their needs (either independently or with the support of their informal support networks or community);
- Information and advice about prevention services that could delay, reduce of prevent needs; and
- Broad information about the type of services available in the marketplace that may be appropriate to meet needs (if the adult appears to have eligible needs).
A more specific conversation about how the Local Authority could meet needs will take place as part of the Care and Support Planning process after:
- The formal eligibility determination is made; and
- The adult has confirmed that they wish for the Local Authority to meet their needs.
6. Talking about Outcomes (Assessment)
This section of the procedures should only be used when talking about outcomes as part of the process to establish needs. When talking about outcomes at any other time you should refer to the full procedure for outcomes. This can be found by clicking here.
Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.
Click here to access the range of tools that are available and practice guidance around the use of tools.
During the assessment conversation about Wellbeing the adult should naturally identify:
- Things they want to achieve;
- Things they want to change; and
- Things they want to stay the same.
These things are known as the adult's outcomes. In order to promote Wellbeing you should explore with the adult during the assessment the steps that they can take to achieve their outcomes, as the two things are intrinsically linked.
If, following assessment the Local Authority meets any eligible needs that the adult has you will need to explore not only what steps the adult can take to achieve their outcomes, but also how the support/services provided can help them do so too.
7. Talking about Risk
Understanding what risk is
Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.
The aim of any conversation about risk is to maximise the benefits and reduce the likelihood of harm.
Why talking about risk is important
When you have a conversation about promoting Wellbeing, meeting needs or ways to achieve an outcome there will at some point be a need to talk about risk and doing so at an early stage can support the adult (and anyone else) to:
- Explore and understand the benefits of taking the risk;
- Explore and understand the potential harmful consequences of taking the risk;
- Think about the measures they can take to reduce the likelihood of a negative consequence; and
- Make an informed decision about whether to take the risk.
The process of talking about risk can be very empowering for an adult and build resilience, confidence and independence.
Talking about risk
Examples of risk you may need to talk about when establishing need can include:
- Risk associated with an impairment or disability (e.g. falls);
- Risk of accidental injury (e.g. from traffic when in the community or using a household appliance at home);
- Risks around an adult's ability to manage medication;
- Risks around the use of drugs or alcohol; and
- Risk of abuse or neglect (e.g. exploitation by others);
Depending on the level of risk a formal risk assessment may need to be carried out in addition to any other assessment process. Click here to access the procedures for carrying out a risk assessment.
If the information gathered during the good conversation suggests that there is a fire risk you should seek the consent of the carer to make a referral to the London Fire Brigade for a free home fire safety visit and check. For further details visit www.london-fire.gov.uk/safety/the-home/.
8. Good Information and Advice and Prevention
The duty to provide good information and advice and to consider ways to prevent, reduce or delay needs for Care and Support applies at all times.
It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.
Click here to read about the duty to prevent, reduce or delay needs.
Click here to read about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it.
Before any conversation to establish needs begins it is important that the adult and everyone else involved understands:
- Your role and how you can be contacted;
- The role of their parent (when they are under 18);
- The role of anyone else involved (for example an advocate or carer);
- Why the process is taking place;
- What is going to happen during the process, including how long it may take;
- What the possible outcomes of the process may be and the implications (for example for the adult's finances); and
- What is going to happen next, including how long it is likely to be until further contact is made and any further processes that may then be carried out (for example Care and Support planning).
During the process it is important that you:
- Offer information and advice as appropriate, including signposting to other sources;
- Discuss options to prevent, reduce or delay the need for Care and Support; and
- Give the adult and anyone else involved opportunities to ask questions or seek clarity.
Depending on the adult's situation and needs specialist information and advice that may be required could include:
- Advice around the financial assessment process;
- Advice about becoming a Lasting Power of Attorney or Deputy;
- Advice about becoming an Appointee;
- Advice about making a complaint about the Local Authority;
- Information about the local market place for Care and Support or health services.
Click here to access the general information and advice procedures, including access to local and national information and advice resources (general and specialist).
9. Safeguarding and Deprivation of Liberty
Safeguarding
If, as part of any conversation you have with an adult or their family you become concerned that a vulnerable adult or a child is experiencing, or at risk of abuse or neglect you must respond appropriately by raising a concern.
Adults
Click here to access the safeguarding adults procedures. They explain how to recognise abuse or neglect and how to raise a concern.
Children
Urgent concerns relating to a child should be raised by calling 0208 255 2888. Outside office hours call 0208 726 6400 and ask to speak with the out of hours team.
Non-urgent referrals should be made using the Single Point of Contact Referral Form.
Note: When raising an urgent concern by telephone you must also complete the Single Point of Contact Referral Form.
Click here to access the online version of the Referral Form.
A downloadable version of the form is also available at the Croydon Council website.
If you wish to consult with a social worker before making a referral you can call 0208 726 6464 during office hours. However you should only do so if the case is not already allocated to a social worker and the child lives in the Croydon area.
For more information about Safeguarding Children visit the Croydon Safeguarding Children Board website by clicking here.
If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialling 999.
Where the safeguarding is in respect of the adult whose needs are being established a decision will need to be made about the need to pause the assessment process to allow a safeguarding enquiry to take place.
There are 3 possible options:
- The needs assessment process continues alongside any safeguarding process;
- The needs assessment is paused with no on-going intervention by the person carrying out the assessment whilst a safeguarding process takes place; or
- The needs assessment is paused but urgent interim support is arranged to ensure needs are met whilst a safeguarding process takes place.
Any decision should involve the person carrying out the needs assessment, the person who will be carrying out any safeguarding process, the adult (or their representative), any carer and anyone with parental responsibility (when the adult is under 18).
Deprivation of Liberty
You must consider any appropriate action required to authorise deprivations of liberty whenever:
- The person lacks capacity to make decisions about the Care and Support provided to them; and
- You feel the level of restriction being imposed on the person is depriving them of their liberty; or
- You feel the level of restriction required to meet their care and support needs following assessment is likely to deprive them of their liberty.
Click here to access the Recognising and Responding to Deprivations of Liberty Procedure for further practice guidance.
10. Pausing the Conversation
Under the Care Act an assessment should be carried out in a timely way based upon the needs and circumstances of the adult.
Sometimes it may be appropriate to pause the process part way through. For example:
- Safeguarding concerns have been raised and a safeguarding process is to take place;
- To allow a service aimed at delaying, preventing or reducing needs for Care and Support to be provided (for example a period of reablement or a piece of equipment);
- To allow the adult time to recuperate following a period of ill health;
- In response to a change in the adult's personal circumstances (for example the death of a carer).
Any decision to pause the process should be made with regard to:
- The adult's thoughts, wishes and feelings;
- The thoughts, wishes and feelings of anyone with parental responsibility (when the adult is under 18);
- The likely impact on the person's Wellbeing; and
- The views of any carer or other person involved or being consulted.
Whenever the conversation recommences you must make sure that you review the original information gathered and ensure that any changes in need and Wellbeing that have occurred are reflected.
11. Making a Record of the Conversation
During the conversation
It is quite appropriate to take notes during a skilled conversation to ensure that you are able to satisfactorily recall and capture what has been discussed and agreed in a formal record. However, there are some general good practice rules to follow when doing so:
- Think beforehand about the level of note-taking that may be required-ensure you have to right tools and that they are proportionate;
- Explain to the adult and anyone else present that you will be taking some notes and why;
- Reassure the adult and anyone else present that you will still be listening to them even when you are making notes;
- Don't record everything that is said. This will prevent you from engaging in the conversation and cause distraction-you need to pick out what is relevant and important;
- Make sure you record everything that the adult says is important to them, even if it does not appear to be relevant to you or others;
- If the adult uses a certain phrase that is powerful or indicative to the context you should record this word for word;
- Sometimes information is detailed or complex and taking notes could take a little longer than expected. If this is the case you should consider making a polite request for a brief pause to allow for notes to be made;
- Sometimes people provide a lot of information without a pause-perhaps they are anxious or simply have a lot to say. Trying to keep up can lead to you over-recording (recording everything regardless of relevance); missing key points, failing to understand what is being said or appearing disengaged from the conversation. If this is the case you should consider politely requesting a pause to allow for clarity and notes to be made;
- Refer to your notes to summarise what has been said during the conversation, reflect and seek clarity about what has been agreed and next steps;
- Try to make notes in a legible way and take care to use appropriate language-the adult (or their parents if they are under 18) may request to see the notes or be provided with a copy;
- Confidentiality must be maintained at all times. Make sure that the notes are kept securely and only available to people authorised to see them;
- Always file or dispose of any notes securely when a formal record of the conversation has been made.
After the conversation
Click here to access the procedure for making a formal record of the conversation.