Matching interventions and people

A decision-making tool to establish the best means of working with people

Updated: September 2020

COVID-19 and the subsequent Public Health England guidelines on social distancing have changed social work practice. Many previously face-to-face interactions have been carried out or are being carried out either over the phone or through video calling.

Some benefits of face-to-face interactions are undeniable in terms of the increased ability to gather non-verbal communication, direct observation of the person in their own environment, and of the environment itself. There are instances, however, where this way of interaction is not necessary, does not add value, or could be too intrusive for the individual.

This decision-making tool supports social workers and social care practitioners to decide the best format, or combination of formats, for a given interaction.

It can be used for any social care interaction including provision of information and advice, assessment, Mental Capacity Assessment, care and support planning, or simply a regular catch-up to see how a person is doing.

The options for interaction in the decision-making tool are:

What to consider

When deciding what is the best way to carry out an intervention the key elements to consider are:

  1. Legislative requirements.
  2. Public Health England advice.
  3. Type of intervention (including the purpose).
  4. The individual and their circumstances.
  5. The professional and their circumstances (including the organisation).

Once the above elements are considered using helpful prompts below, you can find some pros and cons for each mean of intervention in a later section. There is also a checklist designed by BASW to determine whether face-to-face visits should be carried out during the pandemic.

1. Legislative requirements

Your starting point should be to consider whether what is proposed is lawful.

Care Act 2014

The Care Act 2014 is clear in the legal duty to be proportionate and appropriate in the performance of an assessment, and the duty to be flexible in other interventions such as support planning, financial assessment or support plan reviews (Care Act Statutory Guidance, 6.3, 6.28, 8.16, 10.50, 10.58, 13.16, 13.17).

The Care Act emphasises the importance of ensuring that any interaction with the adult or carer is carried out in a manner that is appropriate and proportionate to the individual’s circumstances. That means that not every interaction needs to be face to face – all or part of it may be done by phone, in writing, via an app, or by video calling.

  • 6.3 Open

    An ‘assessment’ must always be appropriate and proportionate. It may come in different formats and can be carried out in various ways, including but not limited to:

    • a face-to-face assessment
    • an online or phone assessment.
  • 6.28 Open

    Where appropriate, an assessment may be carried out over the phone or online. In adopting such approaches, local authorities should consider whether the proposed means of carrying out the assessment poses any challenges or risks for certain groups, particularly when assuring itself that it has fulfilled its duties around safeguarding, independent advocacy, and assessing mental capacity.

    6.28. Local authorities have a duty of care to carry out an assessment in a way that enables them to recognise the needs of those who may not be able to put these into words.

  • 10.50 Open

    10.50 The level of involvement should be agreed with the individual … there may be instances where remote involvement is just as effective, such as over the telephone, through video conferencing, or other means.

  • 13.16 Open

    13.16 Local authorities should have regard to ensuring the planned review is proportionate to the circumstances, the value of the personal budget and any risks identified. … there should be a range of review options available, which may include self-review, peer-led review, reviews conducted remotely, or face to face reviews with a social worker or other relevant professional.

2. Public Health England advice

If an intervention is lawful, you will need to consider whether it is compliant with Public Health England guidance in relation to COVID-19 or other public health issues.

The considerations below have to be thought through if there isn’t any Public Health England advice or legislative requirement which rules out a particular approach.

3. Type of intervention (including the purpose)

  • What type of intervention are you considering?
  • Do others have to join or would it be beneficial if others join all or part of the intervention?
  • If so, what are the possibilities or abilities for those to join using the different ways?
  • What is the main purpose? Gathered objective information like demographics, confirm demographics, facilitate engagement, identify potential risks, make a decision, identify the individual needs, introduce yourself, etc.
  • Does the intervention have or can be split in different parts and carried out using different ways? What does it entail?
  • Different types of meetings – e.g. formal case conferences – may be better suited to a video conference call.

Once you have defined the above, you would be able to ascertain the pros and cons of each of the options.

4. The individual and their circumstances

To determine the best way or ways for an interaction, it is key to take into account the individual and all their circumstances, and consider things such as:

  • The person’s cognitive and communication abilities. As the Care Act Statutory Guidance explains, people with significant cognitive or verbal impairments may be less well able to engage with remote forms of interaction. That will not always be the case – video can be useful in the assessment of people with profound and multiple learning disabilities, for example, but should be borne in mind.
  • The person’s willingness to engage in different options. All social care interventions should consider the needs and wishes of the individual person. If someone is set against the idea of certain means of intervention, this should be respected. Alternatively, people might have specific preferences for ways of working that aren’t face to face. For example, some people with autism like the opportunity to engage over technology.
  • Technology – many people lack the confidence, skills, or equipment to work with some forms of technology, such as planning apps or video conferencing.
  • Breaks – video conferencing is tiring. Bear in mind people’s need for a rest.
  • Support networks. Video conferencing may be an ideal way of bringing physically remote members of a person’s network – be they family, friends, or other professionals – together in an efficient and effective way. The right of carers to a wholly separate assessment needs to be considered, however, as do any potential conflicts of interest or problems arising from group meetings
  • The known nature of the person’s needs/request for assistance. If the issue at hand is a safeguarding one, for example, being able to see the person may be important. Less complex matters may be more proportionately managed by remote interventions.
  • The person’s status in terms of vulnerability to COVID-19, and that of other people you may come into contact with during an interaction.

Also consider that the best alternative may be a combination of several ways. For example, you may:

  • complete the demographics using a phone call or by email
  • send the questions or context for the intervention in advance by email and provide an initial explanation by phone or video call
  • visit face to face to confirm understanding of the individual’s circumstances and needs and have the opportunity to observe them in their own environment.

5. The professional and their circumstances

Clearly, the person in potential need of care and support is not the only participant in any interaction. The circumstances of the professional(s), and those of the organisation they work for, need to be factored into the decision about managing an interaction in the best way. Issues include:

  • The professional’s IT equipment. If a staff member has unreliable broadband, for example, this may rule out certain activities, such as group video conferencing.
  • Similarly, some council policies may rule out particular platforms or approaches. Using Zoom, for example, is barred in some authorities because of concerns about its security.
  • The staff member’s personal circumstances – especially when working from home. A professional will have to consider whether they can be overheard, by children or other family members, or whether confidentiality can be safely maintained.
  • Consider potential distractions – a barking dog; a supermarket delivery; being passed a cup of tea. All of these can make you appear unprofessional, although many people are being very understanding of the pressures of home working.
  • Competence with technology should not be an issue. Unless there are specific reasons why a professional would struggle with, for example, video conferencing – such as having sensory impairments – then it should be expected that they learn how to use it.
  • The professional may wish to consider how much of themselves they reveal in backgrounds etc. during a video call. Consider avoiding having family photographs in the background, for example.
  • The professional’s status in terms of vulnerability to COVID-19, and that of other people with whom they live/interact.

BASW face-to-face visit checklist during COVID-19

During the COVID 19 pandemic, BASW guidance recommends that face-to-face visits are kept to a minimum, only taking place when essential and once all other options have been considered. Any visits should be based on managing the risks to the person/s and staff. This checklist should be considered as an addition to relevant local and national guidance. It does not take the place of local safety protocols unless explicitly agreed with your manager/organisation.

See the face-to-face visit checklist (BASW).

General pros and cons of each way of intervention

Please note that there is no need to choose one format for the entirety of the intervention, and that a combination of the below may be the most appropriate and proportionate approach.

  • Face to face Open

    Pros

    • Facilitates non-verbal communication.
    • Facilitates understanding of the individual in their own setting.
    • Allows observation of people’s home environment.

    Cons

    • Can be perceived as intrusive by the individual.
    • Travel time has to be considered.
    • Greater difficulty for breaks.
    • Greater difficulty for shorter sessions.
    • Could make participation more difficult for other parties and professionals.
    • COVID-19 risks are greater.
  • Email/messaging apps Open

    Pros

    • Enables preparation of message to be written.
    • Enables ability to re-read the information, and gives people time to think through and prepare their answers (often popular with people with autism).
    • Provides objective and consistent understanding of the message.
    • Information can be shared with other parties not present.
    • Lowers risks from COVID-19.

    Cons

    • Does not enable for explanation or gathering of feedback easily.
    • Requires certain level of technical knowledge and equipment.
    • Loses the ability to understand the person’s home environment.
    • Some safeguarding alerts will be harder to spot.
  • Phone Open

    Pros

    • Enables practitioners to pick up on verbal clues.
    • Efficient in terms of time.
    • A well-established technology that most people are familiar with.
    • Allows in-depth exploration of issues.
    • Some people find it easier discussing difficult topics when they cannot be seen.
    • Useful for short, regular check-ins.
    • Lowers risks from COVID-19.

    Cons

    • Loss of visual cues to person’s mood, environment etc.
    • Some safeguarding alerts will be harder to spot.
    • Some people will be uncomfortable not seeing the practitioner.
  • Video calling Open

    Pros

    • Easy to bring in other parties – e.g. relatives, other professionals – into a group discussion.
    • Video facility allows for easier connections to be made than with email, messaging or phone.
    • Seeing the person may alert people to safeguarding concerns, etc. more easily that by phone or messaging.
    • Useful for short, regular check-ins.
    • Lowers risks from COVID-19.

    Cons

    • Many people lack the broadband, equipment, or skills to make this work reliably.
    • Some people find it intimidating, and/or have concerns about privacy and security.
    • Group conversations can be hard to manage, and people can find it difficult to have their say.
  • Support planning apps Open

    Pros

    • Evidence that they can be popular, especially with younger service users.
    • Specifically designed with social care assessment and planning in mind, and can be linked to databases.
    • Sense of control for people who use services.
    • Lowers risks from COVID-19.

    Cons

    • Not widely used.
    • May not suit all client groups.
    • Harder to input professional judgement at early stages.

Please refer to the Technology checklist for video calling an adult or carer to prepare for a video call.

Ethical framework

On the 19 March 2020, the Department of Health and Social Care (DHSC) published the Responding to COVID-19: the ethical framework for adult social care, and its easy read version. Skills for Care have also developed a one-pager version.

Although the ethical framework was developed in light of the pandemic, it embodies the key ethical values that adult social work is built upon. Therefore, it is a useful framework for social workers and social care practitioners at all times.

The below section details how the different values can relate to making decisions about matching interventions and people and establishing the best means of working with people. The principles and values linked together.

Respect

This principle is defined as recognising that every person and their human rights, personal choices, safety and dignity matters.

Have an open and honest conversation with the adult and/or carer about all the options available for the specific interaction and the pros and cons of any of them. Ensure that the individual knows that they have choices and that they can change their minds, and select different means for different purposes or parts of the intervention.

Reasonableness

This principle is defined as ensuring that decisions are rational, fair, practical, and grounded in appropriate processes, available evidence and a clear justification.

Any decision should be practical and feasible, not only for the professional, but mostly for the individual and their circumstances.

All options should be considered and the decision-making process should be clear and transparent.

Minimising harm

This principle is defined as striving to reduce the amount of physical, psychological, social and economic harm that the outbreak might cause to individuals and communities. In turn, this involves ensuring that individual organisations and society as a whole cope with and recover from it to their best ability.

Options and decisions should consider the aim of minimising harm for all parts. All participants should take responsibility for themselves and others, and honesty and transparency should be paramount.

Acknowledge that in order to minimise harm a ‘less preferred’ option may need to be chosen. All circumstances should be considered, the limitations of the chosen option acknowledged and recorded alongside with the reasons why the choice has been made.

Inclusiveness

This principle is defined as ensuring that people are given a fair opportunity to understand situations, be included in decisions that affect them, and offer their views and challenge. In turn, decisions and actions should aim to minimise inequalities as much as possible.

Individuals and/or their carers and all their circumstances, not only their problems, should be included in the decision-making process about the best way or ways for an intervention.

A strengths-based approach is key to these values and principles as we focus on the individual and all the circumstances of their life and not only on the presenting issue or problem ‘to solve’.

Accountability

This principle is defined as holding people, and ourselves, to account for how and which decisions are made. In turn, this requires being transparent about why decisions are made and who is responsible for making and communicating them.

The social worker or social care practitioner should be able to professionally explain the decision and the decision-making process in relation to the evidence, the circumstances of the individual and the legislative context.

Flexibility

This principle is defined as being responsive, able, and willing to adapt when faced with changed or new circumstances. It is vital that this principle is applied to the health and care workforce and wider sector, to facilitate agile and collaborative working.

Decision making processes, forms, procedures, etc. should be flexible to enable its adaptation to the individual circumstances and wishes and to current circumstances.

Social workers and social care practitioners should use procedures, forms, etc. flexibly to ensure they are adapted to the current circumstances and primarily to the individual and or carer circumstances and priorities.

Proportionality

This principle is defined as providing support that is proportional to needs and abilities of people, communities and staff, and the benefits and risks that are identified through decision-making processes.

When making the decision it is important to ensure that the most appropriate and proportionate way(s) of contact are chosen in relation to ALL the individual circumstances.

Community

This principle is defined as a commitment to get through the outbreak together by supporting one another and strengthening our communities to the best of our ability.

When deciding what means to use, social workers and social care practitioners should bear in mind the impact that their decisions have in others.

Case study: About Anna

Focus: Matching interventions

Mrs Anna Shah is a 75-year-old retired nurse. She has a son, daughter and three grandchildren who live about three hours from her. Anna was the main carer for her husband, Kevin, who died a month ago following a two-year battle with lung cancer.

Anna lives in a small city in the Midlands. She is very close with some of her neighbours and has many good friends. She regularly attends her local Church of England, where she has been a valued member of the choir. Members of the church refer to her as a friendly person, with a magnificent voice. She loves singing, but has not been able to attend that many choir practice sessions or musical concerts over the last two years, due to her caring responsibilities.

Anna has a very strong character, with a positive outlook on life and she often brightens the day of those she meets. Despite her caring responsibilities, she has maintained a strong link with her community, as this is important for her.

Anna is finding it difficult to cope on her own after Kevin’s death and the consequences of the COVID-19 pandemic. She has been unable to say goodbye to her husband, as she was not able to attend his funeral in person. Anna is becoming quite lonely, given that she is not able to see her family or friends and has not felt able to ask them for help.

Although she’s aware that Anna is grieving, Anna’s daughter, Mia, has contacted social services. Mia is concerned for her mum’s wellbeing because she is not eating and caring for herself as she used to. Mia has also noticed her mother is now more isolated since lockdown. Mia has told Anna that she has contacted social services out of concern. Anna is not keen to talk to anyone from social services.

Using the ethical framework

If a practitioner wants to engage with Anna, they may wish to consider the ethical framework in their decision on the best means for interacting with Anna. Professional skills are fundamental in all interactions, including when someone does not necessarily want to be contacted.

The social worker or social care practitioner may consider the following when using the ethical framework.

  • Respect Open

    • Anna’s right to self-determination alongside their duty of care and their duty to promote her wellbeing.
    • How to contact Anna with respect to her and her circumstances, bearing in mind that she has the ability to make choices based on her own values.
  • Reasonableness Open

    • Follow Public Health England safety guidelines.
    • Work with Anna through reasonableness to determine what and how many types of communication would be necessary and/or preferred before and for the assessment meeting.
  • Minimising harm Open

    • Aim to engage with Anna in a way that can establish a meaningful relationship that makes her aware of her current circumstances, and enables identifying together what would help her to get to a better place.
    • Balance this principle with others, as face-to-face interactions may need to be limited to reduce harm coming to Anna, her family and friends due to the current pandemic. Because of this, video calls may be the preferred way of contact, or a combination of phone calls, video calls and emails.
  • Inclusiveness Open

    • How to be inclusive and ensure that Mia, her brother, Anna’s neighbours and friends are included in the interactions, providing this is what Anna wants.
    • Perhaps plan a second interaction by phone or video call. Anna should be informed of her right to have someone present during the assessment meeting.
    • Prepare Anna for any interactions by sending her a copy of what will be discussed by email or letter, or having an initial conversation with her about it.
    • Explain to Anna the content of the assessment in advance, so that she can discuss this with her friends or family in preparation for the call. This would enable Anna the best opportunity to participate fully.
  • Accountability Open

    • Be accountable and make decisions based on evidence, as much as possible.
    • Communicate any outcomes or decisions to Anna and her representatives explaining the decision making process and the rationale for the decision made.
  • Flexibility Open

    • Writing to Anna in a way that enables flexibility on how and when they could correspond with her. The tone and content may suggest an initial phone call to ask her when and how she would like to interact with social services.
    • Perhaps asking her by letter whether she prefers a phone call, a video call or a home visit as an initial contact.
    • One or more phone or video calls may be needed before the preferred way of carrying out the assessment meeting is established.
  • Proportionality Open

    • Be proportionate to Anna’s circumstances in their approach.
    • Consider whether they know enough about Anna to decide the best way to contact her.
  • Community Open

    • Likely Anna would want her friends and neighbours to be part of at least some discussions and interventions, so they can support each other and benefit from the links that were already in place before the pandemic.
    • Respect this for Anna’s sense of community.

Dos and Don'ts

Do

  • Be open minded and person-centred.
  • Consider all the pros and cons and combinations of alternatives.
  • Be flexible – remember a combination of formats can be used, and everyone can change their mind at any point.
  • Be confident about your own ability to manage technology.
  • Work efficiently, but balance this against the needs of the people you support.
  • Prepare – many remote interactions can be made more productive by a preliminary phone call to discuss the purpose, tips and techniques.
  • Have a back-up plan – such as for a phone call – if technology fails.
  • Work within your professional standards and the Department of Health & Social Care’s Ethical Framework for social work during the pandemic.

Don't

  • Discard any option before you have considered it.
  • Assume one size fits all. Ask the individual and/or the carer their preferences providing enough information about the existing options for them to make a choice.
  • Compromise confidentiality.
  • Compromise anyone’s health and wellbeing unnecessarily.
  • Use your own IT equipment – use those belonging to your employer.

Support from SCIE

SCIE's COVID-19 hub contains more relevant information including safeguarding, Mental Capacity Act and infection control. It can be used when working and supporting people who are isolated or vulnerable through COVID-19, and can also be shared with community groups.