Improving outcomes for service users in adult placement - Commissioning and care management
Appendix 1: Key findings from first-stage project
The practice survey aimed to identify emerging and developing practice where person-centred approaches have successfully been applied to adult placements. Visits to 16 'good practice’ placements selected by the four participating schemes showed that these placement carers were working in a person-centred way with service users although they were not using formal 'person-centred planning’ systems. The National Association of Adult Placement Services’ model adult placement standards and processes help schemes support adult placement carers to support service users, from referral to review, to achieve choice, independence and inclusion. Schemes were clear that adult placement is founded on the relationship between user and carer in a family setting, and that carers’ attitudes and values are the key to person-centred practice.
Discussions with scheme staff, adult placement carers and service users, however, highlighted a number of issues affecting person-centred working in adult placement, including:
Assessment and referral
- Many social workers/care managers/care coordinators are unfamiliar with adult placement.
- Few people referred for placement have a care management assessment or care plan, and the quality of information about the person referred is often poor.
- Referrals are influenced by funding availability (e.g. Supporting People), and therefore are not always needs-led.
Matching and introductions
- Placements are usually the best match available, not an ideal match.
- A successful placement may develop from a short-break/emergency placement as well as from following 'textbook’ person-centred adult placement processes.
- The person referred may have little life experience for making a decision about where to live.
In the placement
- Some long-standing (unregistered) placements do not have a placement agreement and service user plan
- Service users and placement carers believe day-to-day support, choices and activities are more important than written plans and goals.
- Social workers rarely remain engaged once the placement is settled.
- Service users and carers are unclear about the difference between placement reviews, care plan reviews, and other monitoring and review meetings, and do not find them particularly helpful.
- Social workers are not active participants in reviews.
- Adult placement scheme workers rely on subjective criteria - 'gut feeling’ - to judge the success of a placement (while recognising the need for evidence).
- Formal person-centred planning does not have a high profile among scheme staff or adult placement carers (or local authorities).
- Informal person-centred working can be effective.
- People’s 'dreams’ are more likely to be about who they live with than about where they live; and more about daily life than about the future.
- Schemes are changing from a 'forever’ to a 'move-on’ model of adult placement, but in practice scheme workers and placement carers respect the person’s wishes.
- Many service users say they do not ever want to leave their placement (even if moving on/living independently is a specified long-term goal).
Adult placement carer training
- Some longer-standing carers believe they know best how to support the person in the placement, and do not value or attend scheme training events.
Adult placement carers’ views on placement caring
- Where there is no social work support for the person in the placement, the placement carer may resent the scheme worker’s attention to the service user and feel less valued by the scheme.
- Adult placement carers are motivated by what they gain from being a carer (someone to love and care for, company, feeling valued) as well as by the happiness and progress of the person placed with them.
- There can be tensions in an adult placement between the placement carer’s and the service user’s needs and rights.
- Adult placement requires the give-and-take and compromise of family life - no one in a family can just do what they want without consideration of others.
- Family contact is important but continuing inappropriate parental/family control over decision-making and money can deter independence.
- People living in adult placements rarely have independent advocates.
- While adult placement service users participate in a variety of community activities, the quality of some day services is disappointing.