Introduction, Legal Requirements and Tools (Occupational Therapy)

1. When to use these Procedures

These procedures should be used by any Occupational Therapy practitioner working in adult Care and Support that has been allocated or asked to carry out any process that establishes needs under the Care Act, including any formal assessment or reassessment of need.

Unless specified the procedures apply equally to;

1. Practitioners providing a service under the duty to prevent, reduce and delay needs; and
2. Practitioners providing a service under the duty to meet eligible needs.

These procedures should not be used to carry out the assessment of a child's needs under the Children Act 1989 or any other legislation, where reference should instead be made to available children's procedures.

The procedures provide comprehensive general guidance that is applicable across all service areas in adult Care and Support. Click here to access additional practice guidance that can support the processes of establishing needs, planning and review when the person has specific or complex needs.

2. Establishing Needs v. Assessment

Under the Care Act any method of establishing needs is known as an assessment and this is the legally recognised term. Assessment is an integral part of adult Care and Support.

The term 'assessment' covers;

1. The range of methods that can be used to establish needs, some of which are formal ( for example, a face to face assessment) and some of which are not so formal (for example, a short telephone conversation); and
2. The range of models and frameworks used to support or shape the process of information gathering.

Unfortunately the word 'assessment' is all too often associated with outdated practices to gather information that do not support the ethos of the Care Act. For example, being;

1. A process led by the assessor;
2. A structured process involving the use of forms and arbitrary questions;
3. An 'interview' of the person being assessed; and
4. A gateway to funding and services, the nature of which is decided by the assessor.

As a mechanism to promote and support new practices around assessment that are in line with the Care Act ethos and duties, these procedures intentionally use the phrase 'Establishing Needs' alongside the legal term 'assessment'. This supports users of the procedures to think more flexibly about what an 'assessment' can, and may need to involve so that it is;

1. Proportionate, only being formal or lengthy when it needs to be;
2. Led by the person with care and support needs;
3. Appropriate to the person and their situation; and
4. A method of supporting the person to find their own solutions to issues identified.

3. The Purpose of an Assessment

What the Care Act says

Under the Care Act the main purpose of any assessment is;

1. To provide a full picture of the person's needs, with a particular focus on the impact that those needs have on their Wellbeing and the outcomes they want to achieve in their day-to-day life; so that;
2. The Local Authority can put in place appropriate, proportionate and timely arrangements for that person in order to meet their needs and promote individual Wellbeing. This response might range from offering guidance and information to arranging for services to meet the needs.

A good assessment will also;

1. Support people to understand their strengths and capabilities within the context of their situation;
2. Support people to understand the support that may be available to them within the community or through other networks and services; and
3. Support people to consider some of the different ways that the Local Authority may be able to support them (for example through another prevention service).

The information gathered will help the Local Authority to;

1. Make a determination about eligibility (where eligibility is a factor in meeting assessed needs); and
2. Understand the kind of equipment, aids and adaptations that could be explored when planning how to meet needs.

Common assumptions about the purpose of an Occupational Therapy assessment

Referrals to Occupational Therapy often describe specific equipment or an adaptation as the reason that the assessment is being requested, for example;

1. To adapt a bathroom into a wet room;
2. To obtain specialist seating;
3. To lower the units in the kitchen; or
4. To fit grab rails around the home.

Assuming the outcome of the assessment in this manner suggests that the person making the referral may not understand the purpose of an assessment under the Care Act as a mechanism to assess needs (not services), and may have unrealistic expectations about the whole process that you will need to manage.

There should not be any assumptions made prior to an assessment that the provision of equipment or an adaptation will always be the outcome. Instead the assessment must identify;

1. All of the needs that a person appears to have;
2. Whether any of the needs that the person appears to have can be prevented, reduced or delayed; and
3. If so, whether the provision of low level equipment or minor works is the most appropriate and proportionate way to do so; and
4. Whether any of the needs that the person appears to have are on-going (in which case an eligibility determination must be made and eligible needs met); and
5. Whether the provision of equipment or adaptation is the most appropriate and proportionate way to meet on-going needs.

Failing to assess in a holistic way increases the risk that;

1. Not all needs will be identified;
2. Unmet needs will remain after assessment;
3. Needs will not be met in the most proportionate and appropriate way;
4. Opportunities to prevent, reduce and delay needs (and promote independence) may be missed;
5. Opportunities to work jointly with others to achieve better outcomes for the person may be missed;
6. Ways to meet needs may not be explored from a strengths based approach; and
7. Opportunities to identify and support carers could be missed.

4. Legal Requirements of a Needs Assessment

Across the country and even within each Local Authority there are a range of models and frameworks used to support or shape the process of information gathering to establish needs. The Care Act recognises that different approaches are used but all must fulfil the same legal requirements.

5. Tools and Practice Guidance to Establish Needs

General practice guidance

These procedures contain comprehensive general practice guidance to support an effective assessment process.

Legal Requirements and Statutory Guidance

The Care Act does not require that a specific tool (or any tool at all) is used to support or shape the assessment process, but it does acknowledge that a good tool can be helpful. However, any tool should;

1. Facilitate and maximise the person's involvement;
2. Support the information gathering process;
3. Be flexible and adaptable; and
4. Be appropriate and proportionate to the situation and needs of the person being assessed.

See below for details of the tools that are available for you to use as required.

Considerations when using tools

The process of establishing needs involves having a skilled conversation about;

1. Wellbeing and outcomes;
2. Needs; and
3. Risk.

You should consult with the person and/or others when arranging the assessment to understand the specific communication needs that the person has so that any assessment tool you use will ensure their involvement in the conversation.

If you not feel that the assessment tools available to you will be appropriate you should speak to your manager about how they can be adapted.

Sometimes you may need to supplement the available tools with more bespoke tools to support the specific communication needs of the person. For example, you may need to use photographs or pictures. This is entirely appropriate under the Care Act as it will ensure the involvement of the person and will also support you to meet the duty to provide information in an accessible way.

Available tools

Across the country and even within each Local Authority there are a range of models and frameworks used to support or shape the process of information gathering to establish needs. These are known as tools.

Focussed assessments

In some instances, the Occupational Therapy service will utilise a focused assessment to gather specific information which will assist in identifying needs. This tool aims to augment the information gathered at first contact with an individual and further establish the nature / likelihood that the identified risks will occur. This process will help with any determination regarding the priority that should be assigned to each case and the time frame that the need will be met.

This tool will gather additional information in a proportionate manner through a telephone conversation and virtual analysis of the individual’s daily function. This process will be led by the individual and will be their description of the issues that create difficulties with the successful completion of tasks essential to their life roles and lifestyle. The focused assessment tool will identify both the level of need and provide detail regarding the potential interventions that may resolve the problem. If needs can be clearly identified utilising this tool and this process, the Occupational Therapy service will discuss possible solutions directly with the person and agree recommendations regarding an equipment and make a direct provision. See Occupational Therapy Focused Assessment policy for more information.

Other tools

The following are other tools available to you that may enhance any assessment conversations and accessibility.

Click here to to access a range of tri.x person centred tools that can;

1. Support a person to think about what matters most to them, now and in the future;
2. Support a person or family member to think about Wellbeing;
3. Support a person or family member to think about needs and what a good day/bad day looks like; and
4. Support a person or family member to think about what is working/not working about a Care and Support Plan and any services or support they receive.

Think Local Act Personal have also produced an online tool to support everything from preparing a person for an assessment, to having a skilled conversation and developing a Care and Support Plan through to review. This can be accessed by clicking here.

The Local Authority subscribes to Research in Practice for Adults (RiPfa) who provide a range of tools and resources to support skilled conversations.

RiPfa can be accessed by clicking here.

If you have difficulties accessing the resources speak to your line manager.

'Supporting Outcomes-Focused Practice' is a supplementary RiPfa website, available without normal subscription. It can support you to develop your skills, knowledge and practice in working with outcomes. Click here to access it.