SCIE Guide 14: Improving outcomes for service users in adult placement - Commissioning and care management
Practice points
Commissioning adult placement
Adult placement profile
Senior managers should:
- Ensure that service managers, social workers and care managers understand the adult placement model and what it can offer, and know about the local adult placement scheme.
Line managers should:
- Include information about adult placement in care management induction training.
Care managers should:
- Establish and maintain regular contact with the local adult placement scheme.
Adult placement schemes should:
- Work to communicate to local authority staff at all levels, through personal contact and other methods, the benefits of the adult placement model.
Systems and structures
Senior managers should:
- Make sure that the design and implementation of electronic information systems (e.g. CLIX, SWIFT, SID) - in place or being developed in all participating localities - take account of adult placement, and do not result in less person-centred practice.
Value for money
Senior managers should:
- Determine the range of costs of adult placements compared with other suitable service options, taking into account the needs of and outcomes for service users.
Adult placement schemes should:
- Understand their unit costs, and cost comparisons with other services, and ensure this information is available to service commissioners.
Local needs
Senior managers should:
- Be aware that adult placement can provide a variety of flexible and personalised services for a wide range of individuals, including - with effective advance planning and care management support - those with highly complex needs.
- Work with schemes to plan recruitment of adult placement carers with the skills to support local people’s needs, in areas where people want to live.
Adult placement schemes should:
- Work with commissioners to identify areas of unmet need, and plan the development of the adult placement service locally to meet those needs.
National agenda
Directors of adult social services should:
- Be aware that adult placement offers the kind of small, personalised service, provided by individuals in the community, that is valued by service users.
- Be aware that adult placement offers the service user choice, control and personalised support, and can help social services and primary care trusts meet the challenges of individualised funding, performance assessment framework indicators, local area agreements and other Government targets.
Making good placements
Assessment
Senior managers should:
- Ensure that care managers and their line managers have a clear understanding of the unique qualities and flexibility of adult placement when considering options for prospective service users.
- Ensure that their assessment protocols provide complete, placement-specific, specialist information about a referred person, in order to obtain a full picture of the person and make the best possible match with an adult placement carer. The adult placement scheme can give guidance on information needed to supplement the local authority’s standard assessment form.
- Ensure that an individual is not denied a placement because of disagreements between teams (e.g. learning disabilities and mental health) about who is responsible and/or which budget charged.
- Ensure that computerised assessment systems are individualised and person-focused, and do not result in tick box-type assessments.
Line managers should:
- Ensure that care managers recognise and adhere to adult placement procedures and protocols which represent best practice and are required by regulation.
- Consider requiring care managers to carry out assessments jointly with adult placement schemes, especially for complex assessments. Collaboration among all stakeholders, followed by joint decision-making, is more likely to result in a successful, stable outcome for the service user and the family.
Care managers should:
- Provide a recent, full care management assessment with each referral. Regular contact between care managers/coordinators and schemes - before formal referral and throughout the placement process - will help both parties to be ready to make timely and appropriate placements.
- Endeavour to provide the adult placement scheme with all information needed to make a good and safe referral.
- Plan early to ensure service users receive clear and timely information about housing and other benefits.
Adult placement schemes should:
- Ensure that referral processes are as streamlined as possible and mesh with local authority processes to avoid unnecessary duplication.
Emergency placements
Line managers should:
- Develop protocols between care managers and placement schemes for delivering minimum information requirements for emergency placements, and for providing follow-up information (meeting the requirements of national minimum standards).
- Recognise that a crisis in an existing placement needs care management re-assessment and social work input. Commissioners should not assume that the placement scheme will find an emergency placement with another adult placement carer (although sometimes this may happen); nor should they assume that difficulties within a placement require that the person be moved elsewhere.
- Ensure that care managers understand and respect the difference between planned short-stay and emergency placements. Commissioning bodies should have comprehensive strategies for providing both services; placement schemes may be able to help as part of this overall strategy.
Care plans
Line managers should:
- Understand the importance of the care management care plan and develop a strategy for tackling the backlog of adult placement service users who do not have a care plan.
Care managers should:
- Ensure that all adult placement service users have an up-to-date care management care plan, and that the role of adult placement in the person’s whole plan is clear.
Risk assessment
Directors of adult social services should:
- Ensure that the local authority’s approach to risk management supports the adult placement service user to make choices and live independently in the placement.
Line managers should:
- Ensure that care management assessments include risk assessment; that this information is shared appropriately with the adult placement carer and scheme; and that a risk management plan is agreed (and shares risk appropriately) between the care manager, scheme, adult placement carer and service user and forms part of the placement plan.
Care managers should:
- Ensure the personal risk assessment and risk management plan is reviewed and updated (involving the service user, adult placement carer and scheme) to reflect changing needs, abilities and aspirations.
Care management support
Senior managers should:
- Ensure that adult placement service users receive appropriate and sufficient support from a named care manager/social worker throughout the life of the placement, in line with their statutory duties and the regulatory requirements of adult placement services.
Line managers should:
- Ensure that care managers and other practitioners understand the adult placement model (care manager responsible for ongoing support to the service user, scheme responsible for support to the adult placement carer); the kind of support a person needs in adult placement (and how this is different from other services); and the purpose and importance of continuing care management involvement in the placement.
- Ensure that the system is sufficiently flexible so that care managers can respond quickly when alerted to a problem in the placement by the service user, adult placement carer or scheme worker to avoid a crisis situation and unnecessary breakdown of the placement.
Adult placement schemes should:
- Ensure that senior managers understand the importance to the safety and integrity of the placement of support from a named care manager/social worker for the person in the placement.
Review and change
Line managers should:
- Ensure that care managers carry out their duty to re-assess the service user and review the placement, and that they attend placement reviews, recognising that the scheme worker represents the adult placement carer, not the service user.
- Consider merging the annual care management review and the placement review (including other services provided to the service user).
Care managers should:
- Ensure that the placement review focuses on the needs and wishes of the service user, and that the person’s voice is heard at the review meeting (with support if needed) or by other means if the review meeting is too intimidating.
Person-centred practice
Senior managers should:
- Work to close the gap between service user aspirations as identified in person-centred planning, and assessed needs and eligibility criteria required by care management, to avoid misleading and disappointing service users.
- Cascade learning from local authority person-centred planning pilots into mainstream practice, including adult placement, and include adult placement scheme workers in person-centred planning training.
Line managers should:
- Ensure that care managers understand and practice person-centred working, as distinct from person-centred planning.
Adult placement schemes should:
- Explore the potential of formal person-centred planning tools to improve adult placement practice.
Advocacy
Directors of adult social services should:
- Press Government to expand local independent advocacy services, and ensure these services are available to adult placement service users.
Senior managers should:
- Ensure that each adult placement service user has, if they wish, a 'named person’, independent of the scheme and of social services - someone who cares about and is important to the service user - to support and speak out for that person.
Adult placement schemes should:
- Work with the person in the placement and their care manager/social worker to identify a 'named person’ independent of the scheme to support and speak out for them.
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