The Skilled Conversation (Occupational Therapy)

1. A Strengths Based Approach

Wherever possible, every conversation with a person should be from a strengths perspective. This means that before you talk about service solutions to the presenting issue you must support the person to explore whether there is:

1. Anything within their own power that they can do to help themselves; or
2. 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 person 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:

1. Taking a holistic view of the person's needs in the context of their wider support network;
2. Helping the person to understand their strengths and capabilities within the context of their situation;
3. Helping the person to understand and explore the support available to them in the community;
4. Helping the person to understand and explore the support available to them through other networks or services (e.g. health);
5. 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. See: Care Act Guidance on strengths-based approaches . Note: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.

2. Carers

Under the Care Act carers have to be a part of the cared for person's assessment, even if the cared for person does not want them to be. This is because the Local Authority needs to:

1. Understand the person's needs, how they are currently being met and whether this is appropriate and sustainable; and
2. Identify and support carers.

When a person has not consented to the carer being a part of the assessment you should:

1. Advise the person that you have a duty to involve the carer;
2. Explain the benefits of the carer being involved; and
3. Agree the most appropriate way to involve the carer (for example a separate meeting with the carer).

If the person 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 (or another vulnerable adult or child) at risk of abuse or neglect.

3. A Whole Family Approach

What the Care Act says

Under the Care Act it is important that the person'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:

1. Understand the impact of the person's Care and Support needs on all family members, not just those that may be instantly recognisable as carers; and
2. 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.

When taking a whole family approach you should consider involving the following people in the assessment:

1. Adult's living in the same household as the person;
2. Children living in the same household as the person;
3. Adults living elsewhere but who form part of the person's support network;
4. Children living elsewhere but who form part of the person's support network.

Specifically you need to understand:

1. The impact of the person's needs on family members (both adult and children);
2. Whether the role that other adults or children in the family have constitutes a caring role under either the Care Act 2014 or the Children and Families Act 2014;
3. 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
4. Whether the support being provided is sustainable.

If a family member is identified as a carer through a whole family approach you have a duty to:

1. Offer the carer an assessment; and
2. If accepted, carry out a carer's assessment (or arrange for one to be carried out).

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 person 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 (including Occupational Therapy) would be of benefit to any adult family member you speak to, either to support them as a carer for the person 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 person'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. Whilst you are not expected to understand children's legislation in your role you are expected to 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:

1. 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;
2. Whether the adult with Care and Support needs presents with behaviours that place the child at risk of harm or abuse;
3. Whether the child is at risk of neglect because the adult with care and support needs has caring responsibilities towards them that they cannot adequately meet as a result of their own needs;
4. 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 an adult;
5. 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.

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 dialing 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 young person 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 young person 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 of the adult's needs upon the child.

If the young carer is not already being supported by children's services you should make the relevant referral.

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. See: Promoting Individual Wellbeing.

What you must establish about Wellbeing

In order to promote individual Wellbeing you must first understand what Wellbeing means to the person. The Care Act sets out 9 domains of Wellbeing that you must consider. See: Wellbeing Domains.

As part of any process to establish needs you must understand:

1. Which areas of Wellbeing are most important to the person at that moment in time;
2. Which areas of Wellbeing are least important at that time;
3. Whether there are other areas of the person's life important to them but not listed as a domain (the domains under the Act are not definitive as Wellbeing is personal);
4. Which areas of Wellbeing are causing the person concern or worry;
5. What impact any concern or worry is having (or could have) across the Wellbeing domains (is there a destabilising effect?); and
6. How the person 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 person whose Wellbeing it is.

Important rules when talking about Wellbeing

1. A sense of Wellbeing is extremely personal and will be different for every person;
2. Never make assumptions about what is important and what is not important to a person;
3. The person is the expert in relation to their own Wellbeing;
4. If a person tells you they have no worries in a particular area this does not mean the area is not important to them; and
5. 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 person is as prepared as possible for the conversation:

1. Provide information that will support the person to understand the concept of Wellbeing and why it is important;
2. Offer advice about the things that a person may want to think about before having a conversation about Wellbeing;
3. Make sure that anybody who will be supporting the person understands Wellbeing and is confident and appropriate to support the person to prepare for and have the conversation; and
4. Consider whether any tools may be helpful to support the person to think about Wellbeing.

Talking about Wellbeing

A conversation about Wellbeing can be a very difficult conversation for a person 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 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 a person to think about Wellbeing must:

1. Be proportionate to the level of information required;
2. Be appropriate, taking into account the person's specific needs around communication and their specific circumstances;
3. Be realistic in respect of the persons mental capacity and ability to be able to answer the question; and
4. Be asked in a manner that is accessible to the person.

Powerful questions

A powerful question is a specific type of open question that:

1. Encourages a person to reflect;
2. Is thought-provoking;
3. Supports an exploration of options; and
4. 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 person 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 person to:

1. Talk about a time or times when something has been working well in their life;
2. Explore what it was that worked well and supported them at that time;
3. 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:

1. Tell me about a time when things were going well for you?
2. What did you learn about your strengths at that time?
3. If you had a magic wand what would the future look like?
4. What is it that you value most in your life now?
5. 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:

1. Can be completed with the person as part of any conversation you have with them; or
2. The person can complete them in their own time as part of their preparation for the conversation.

See: Tools and Practice Guidance to Establish Needs.

Wellbeing and Capacity

Some 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 a person who lacks capacity, including but not limited to:

1. An appropriate other person or independent advocate to support the person to engage and ensure that they are represented;
2. Spending time with the person 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);
3. Consulting with a range of people who know the person 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 person than relying on the views of one person;
4. 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, Data Protection legislation and local information sharing policies.

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 person 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 the potential impact of a serious health diagnosis), whereas someone who is emotionally removed from may see things more objectively.

It is important that you recognise when a person'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 (with the person's consent or in their best interests if they lack capacity). This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support.

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:

1. Supporting the person to gain insight into their situation;
2. Developing the person's resilience through talking about difficult situations and exploring options to find a solution;
3. Providing information and advice;
4. 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.

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

A person'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 a person's Wellbeing in the context of their current situation, but to monitor and review Wellbeing as things change.

Promoting Wellbeing

When you have understood a person's individual Wellbeing you have a duty to promote it. To do this you must understand:

1. The things that they want to achieve;
2. The things they want to change; and
3. The things that they want to stay the same.

These things are known as the person's outcomes. In order to promote Wellbeing you should explore with the person during the assessment the steps that they can take to achieve their outcomes, as the two things are intrinsically linked.

NHS Choices have an online resource: 5 steps to mental wellbeing.

If, following assessment the Local Authority meets any eligible needs that the person has you will need to explore not only what steps the person 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 person

You have a duty to promote a person'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 a person's Wellbeing.

For example, if promoting the 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 a person appears to have are eligible.

A person'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

Although you must assess all of the needs that the person appears to have, you do not have 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, conversations about need must be proportionate and appropriate to each person's situation.

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 person is as prepared as possible for the conversation:

1. Provide information that will support the person to understand the areas of need described in the Care Act and why establishing needs is important;
2. Offer advice about the things that a person may want to think about before having a conversation about needs;
3. Make sure that anybody who will be supporting the person understands needs and is confident and appropriate to support the person to prepare for and have the conversation; and
4. Consider whether any tools may be helpful to support the person to think about needs.

Talking about need

A conversation about needs can be a very difficult conversation for a person 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 a person to think about needs must:

1. Be proportionate to the level of information required;
2. Be appropriate, taking into account the person's specific needs around communication and their specific circumstances;
3. Be realistic in respect of the persons mental capacity and ability to be able to answer the question; and
4. Be asked in a manner that is accessible to the person.

Powerful questions

A powerful question is a specific type of open question that:

1. Encourages a person to reflect;
2. Is thought-provoking;
3. Supports an exploration of options; and
4. 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 person 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 person to:

1. Talk about a time or times when something has been working well in their life;
2. Explore what it was that worked well and supported them at that time;
3. 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:

1. Tell me about a time when things were going well for you?
2. What did you learn about your strengths at that time?
3. If you had a magic wand what would the future look like?
4. What is it that you value most in your life now?
5. 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:

1. Can be completed with the person as part of any conversation you have with them; or
2. The person can complete them in their own time as part of their preparation for the conversation.

See: Tools and Practice Guidance to Establish Needs.

Fluctuating need

To ensure an accurate assessment of need it is important that you identify whether a person has needs that fluctuate (change over time).

Fluctuating needs are needs that:

1. May not be apparent at the time of the assessment; but
2. Have been an issue in the past; and
3. Are likely to arise again in the future.

A simple question to ask a person to establish whether their needs fluctuate is 'How do your needs change over time?'

Every person with fluctuating needs will experience fluctuations differently. For example:

1. Some people's needs fluctuate throughout each and every day;
2. Some people's needs fluctuate on some days each week;
3. Some people will have periods of stability that could last several weeks or months with no fluctuation;
4. Some people's fluctuations are related to a physical or mental health condition (for example Parkinson's Disease or Bi-Polar Disorder); and
5. Some fluctuations are a response to a change in circumstance or environment (for example the weather affecting arthritis).

Because of the variance in fluctuation possible it is not appropriate to simply assess a person 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 person's whole needs and it would be likely that any equipment or adaptations that 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:

1. How often the person experiences a fluctuation in needs;
2. The type of fluctuations that are experienced and the impact on other needs and Wellbeing;
3. What the potential causes or triggers are for fluctuations; and
4. What measures are effective in managing periods of fluctuation or reducing the risk that they will occur.

The kind of questions you could ask a person to help understand their fluctuating needs includes:

1. How long has it been since you had a good/bad day?
2. What does a good/bad day look like?
3. What changes in support do you have on a bad day?
4. How often do your needs change on a bad day?
5. Which areas change the most on a bad day?

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 person and could be a day, a week or several months in duration.

It may also be appropriate to pause an assessment to enable the person 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 person 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:

1. An appropriate other person or independent advocate to support the person to engage and ensure that they are represented;
2. Spending time with the person can show you what needs they have and how they are currently being supported;
3. Consulting with a range of people who know the person 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;
4. 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, Data Protection legislation and local information sharing policies.

Exploring and Managing different views about need

Different people involved with the person are likely to have different views about need. For example, the person 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 a person'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 (with the person's consent or in their best interests if they lack capacity). This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support.

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 person then you must raise them for the purposes of:

1. Supporting the person to gain insight into their needs and situation;
2. Developing the person's resilience through talking about difficult situations and exploring options to find a solution;
3. Providing information and advice;
4. 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.

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:

1. When a person is expected to make a full recovery from a health related condition;
2. When a person's needs are likely to be temporary (e.g. needs relating to upcoming surgery to resolve a physical need); or
3. When a person's needs are related to their circumstances and these circumstances are going to change.

Short term needs still have to be met when:

1. Longer term needs can be prevented, reduced or delayed through intervention; or
2. Needs are eligible for Care and Support under the Care Act.

Where needs are likely to be changing over time it is important to make arrangements with the person to monitor and review the needs over an appropriate timeframe that reflects the individual circumstances of the person.

Talking about needs in a crisis

Sometimes it is necessary to establish needs during a period of crisis. For example:

1. When an informal caring relationship has completely broken down with immediate effect; or
2. When the person'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 a person 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 person (or their representative) to monitor and review their needs and situation, re-assessing where there is evidence that long term needs are clear.

6. Talking about how to Meet Needs

Talking about how to meet needs

It is perfectly normal for a person to wish to explore available ways to meet their needs as part of an assessment. However, conversations should always be:

1. Strengths based to promote independence and resilience; and
2. Broad rather than specific (unless needs are to be met through a major adaptation).

The decisions that must be made about meeting needs at assessment are:

1. Whether Occupational Therapy is an appropriate service to meet needs; and
2. If so, whether needs are best met with equipment or an adaptation (minor works or major adaptation).

Talking about how to meet needs with equipment

If a decision is made that the provision of equipment is the best way to meet the identified need you should:

1. Broadly explore the range of equipment that may be appropriate to meet needs;
2. Explain that the provision of equipment by the Local Authority is subject to an eligibility determination under the Care Act;
3. Provide information and advice about how appropriate equipment can be provided through other means (including how the person could access the equipment informally).

It is your responsibility to familiarise yourself with local guidance about the equipment that can be provided before discussing options with the person.

Talking about how to meet needs with a major adaptation

When deciding whether a major adaptation is the best way to meet needs you should refer to:

1. Local policy about adaptations that can be provided under the Housing Grants, Construction and Regeneration Act 1996 (HGCRA);
2. Local policy about adaptations that cannot be provided under the HGCRA; and
3. The needs domains as set out under section 23 of the Housing Grants, Construction and Regeneration Act 1996 (HGCRA) to make sure that the needs identified during assessment will be eligible under the HGCRA.

If the person does not appear to have a need under the criteria used by the HGCRA a major adaptation may not be the most appropriate way to meet needs and alternative options may need to be explored.

If the person has one or more need under the HGCRA criteria, a decision is made that a major adaptation is the best way to meet the identified need you will need to:

1. Agree the nature of the adaptation required (for example 'the provision of a wet room' or 'extension of a kitchen';
2. Provide information and advice about the available ways that the adaptation can be provided (including ways that the person can make their own arrangements);
3. Explain that, if the person wishes for the Local Authority to arrange and carry out the adaptation this is subject to approval by the Housing Authority;
4. Explain that the eligibility criteria of the HGCRA is applied to all major adaptation applications, and this will determine whether the works are carried out and whether a Disabled Facilities Grant is awarded;
5. Explain that Disabled Facilities are subject to application and means testing.

When deciding the nature of the adaptation you must consider:

1. All of the available ways to meet the identified need; and
2. Whether there are other ways to meet the needs that are more proportionate.

If Occupational Therapy is not an appropriate service

If an Occupational Therapy intervention is not an appropriate way to meet needs you must be able to provide information and advice about:

1. Ways that the person could meet needs (either independently or with the support of their informal support networks or community);
2. Information and advice about other prevention services that could delay, reduce of prevent needs;
3. Broad information about the type of other services available in the marketplace that may be appropriate to meet needs (if the person appears to have eligible needs).

If a practitioner from an appropriate service is already involved with the person you should:

1. Notify them that an assessment has been carried out, the outcome of the assessment and the rationale; and
2. Provide them with access to the information gathered during the assessment so they can prioritise and consider the most appropriate course of action.

If the person is not known to an appropriate service you will need to make the relevant referral.

The responsibility for agreeing the best way to meet needs

The Local Authority is responsible for making decisions about the best way to meet needs. As such you are responsible as the local authority's representative.

Managing disagreement about the best way to meet needs

You are responsible for ensuring that all reasonable steps have been taken to agree with the person the best way to meet their needs. As long as you have done this then, where disagreement remains you are ultimately responsible for making the decision about how best to meet needs.

Where ongoing disagreement persists you should:

1. Seek the support and advice of your line manager as required; and
2. Make proportionate records of any conversations you have had to try and resolve the differences.

You must also make the person (or their representative) aware of their right to complain about the decision that has been made.

7. Talking about Outcomes (Assessment)

During the assessment conversation about Wellbeing the person should naturally identify:

1. Things they want to achieve;
2. Things they want to change; and
3. Things they want to stay the same.

These things are known as the person's outcomes. In order to promote Wellbeing you should explore with the person 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 person has you will need to explore not only what steps the person can take to achieve their outcomes, but also how the support/services provided can help them do so too.

8. 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.

Risk and Occupational Therapy

Risk assessment is a key part of Occupational Therapy assessment and the subsequent safe provision of equipment.

Frequently referrals to Occupational Therapy are made based on evidence or perception of risk to the person or a carer.

It is important that you talk about risk at an early stage and in a positive way so that the person is supported to:

1. Explore and understand the benefits of taking the risk;
2. Explore and understand the potential harmful consequences of taking the risk;
3. Think about the measures they can take to reduce the likelihood of a negative consequence; and
4. Make an informed decision about whether to take the risk.

The process of talking about risk can be very empowering for a person and build resilience, confidence and independence.

Talking about risk

Examples of risk you may need to talk about when establishing need can include:

1. Risk associated with an impairment or disability (e.g. falls);
2. Risk of accidental injury (e.g. from traffic when in the community or using a household appliance at home);
3. Risks around a person's ability to manage medication;
4. Risks around the use of drugs or alcohol; and
5. Risk of abuse or neglect (e.g. exploitation by others);

Depending on the level of risk, and the likely outcome of assessment a formal risk assessment may need to be carried out in addition to any other assessment process. See: Risk Assessment.

If, following assessment equipment is provided you will also need to:

1. Identify any risks to the person and/or carer from the equipment to be provided; and
2. Provide appropriate support to mitigate the risk of harm from using the equipment provided.

9. Good Information and Advice

The duty to provide good information and advice about all aspects of adult Care and Support applies at all times.

It is vital that you understand your duties in relation to the above. Please use the link below to access further information as required.

See: Providing Information and Advice for information 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 person and everyone else involved understands:

1. Your role and how you can be contacted;
2. The role of anyone else involved (for example an advocate or carer);
3. Why the process is taking place;
4. What is going to happen during the process, including how long it may take;
5. What the possible outcomes of the process may be and the implications (for example for the person's finances if a DFG application is possible); and
6. 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 exploring available equipment options to meet needs)

During the process it is important that you:

1. Offer information and advice as appropriate, including signposting to other sources;
2. Discuss options to prevent, reduce or delay the need for Care and Support; and
3. Give the person and anyone else involved opportunities to ask questions or seek clarity.

Depending on the person's situation and needs specialist information and advice that may be required could include:

1. Advice around the financial assessment process or DFG process;
2. Advice about becoming a Lasting Power of Attorney or Deputy;
3. Advice about becoming an Appointee;
4. Advice about making a complaint about the Local Authority;
5. Information about the range of equipment that may be available to meet needs.

See: Providing Information and Advice, which includes access to local and national information and advice resources (general and specialist).

10. Safeguarding and Deprivation of Liberty

Safeguarding

If, as part of any conversation you have with a person 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.

See Safeguarding Adults, which also includes information about how to raise a concern about a person under the age of 18.

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 dialing 999.

Where the safeguarding is in respect of the person 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:

1. The needs assessment process continues alongside any safeguarding process;
2. The needs assessment is paused with no on-going intervention by the person carrying out the assessment whilst a safeguarding process takes place; or
3. 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 person with care and support needs (or their representative) and any carer.

Deprivation of Liberty

You must consider any appropriate action required to authorise deprivations of liberty whenever:

1. The person lacks capacity to make decisions about the Care and Support provided to them; and
2. You feel the level of restriction being imposed on the person is depriving them of their liberty; or
3. You feel the level of restriction required to meet their care and support needs following assessment is likely to deprive them of their liberty.

See: Recognising and Responding to Deprivations of Liberty.

11. 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 person.

Sometimes it may be appropriate to pause the process part way through. For example:

1. Safeguarding concerns have been raised and a safeguarding process is to take place;
2. 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 new medication to reduce fluctuations in need);
3. To allow the person time to recuperate following a period of ill health;
4. In response to a change in the person's personal circumstances (for example a death or loss of work).

Any decision to pause the process should be made with regard to:

1. The person's thoughts, wishes and feelings;
2. The likely impact on the person's Wellbeing; and
3. 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.

12. Making Notes

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:

1. Think beforehand about the level of note-taking that may be required-ensure you have to right tools and that they are proportionate;
2. Explain to the person and anyone else present that you will be taking some notes and why;
3. Reassure the person and anyone else present that you will still be listening to them even when you are making notes;
4. 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;
5. Make sure you record everything that the person says is important to them, even if it does not appear to be relevant to you or others;
6. If the person uses a certain phrase that is powerful or indicative to the context you should record this word for word;
7. 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;
8. 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;
9. 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;
10. Try to make notes in a legible way and take care to use appropriate language-the person may request to see the notes or be provided with a copy;
11. Confidentiality must be maintained at all times. Make sure that the notes are kept securely and only available to people authorised to see them;
12. Always file or dispose of any notes securely when a formal record of the conversation has been made.