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Matching interventions and people: A decision-making tool

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

Updated: February 2023

COVID-19 and the subsequent Public Health England guidelines on social distancing 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 care practitioners to decide the best method, or combination of methods, for a given interaction.

It can be used for any social care interaction and/or intervention 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 explored for interaction in the decision-making tool are:

What to consider

When deciding what is the best way to carry out an interaction or intervention (which normally comprises a series of interactions) the key elements to consider are:

  1. Legislative requirements.
  2. Type of intervention (including the purpose).
  3. The individual and their circumstances.
  4. The professional and their circumstances (including the organisation).
  5. Social Care Practice principles.

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.

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. To follow are extracts from the Statutory Guidance which highlights 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.

2. Type of intervention (including the purpose)

To help you consider the best approach for each intervention, consider the following questions:

  • What type of intervention are you considering/undertaking?
    • Different types of meetings – e.g. formal case conferences – may be better suited to a video conference call.
  • What is the main purpose of the specific interaction?
    • gather or confirm objective information like demographics
    • facilitate engagement
    • identify potential risks
    • make a decision
    • identify the individual needs
    • introduce yourself, etc.
  • Do others need 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 does the intervention entail?
    • Is it necessary to complete in one conversation, or
    • can it be split in different parts and carried out using different methods for each interaction?

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

3. The individual and their circumstances

To determine the best method for an interaction the Care Act guides us to support the individual to take a lead. As such it is key to ask the individual what their preferences are, taking into account all their circumstances and considering 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 methods of working that aren’t face-to-face. For example, some autistic people 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 other methods of intervention.

You may utilise one or more methods during an intervention. For example, you may:

  • Complete the basic details such as date of birth, address, etc. 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.

4. The social care practitioner and their circumstances

While the Care Act informs us that any interaction with the adult or carer should be carried out in a manner that is appropriate and proportionate to the individual’s circumstances, 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. Some considerations are:

  • 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.
  • Organisational policies regarding online platforms or approaches. Using Zoom, for example, is barred in some authorities because of concerns about its security.
  • The involved social care practitioner’s personal circumstances – especially when working from home. They will have to consider whether they can be overheard, by children or other family members, or whether confidentiality can be safely maintained.
  • However, now that hybrid working has become practice normality it is important to minimise distractions given that we will be talking with people during very difficult circumstances. Consider the impact that a barking dog; a supermarket delivery; being passed a cup of tea, etc. can have during the interaction.
  • Competence with technology should not be an issue. Unless there are specific reasons why a social care practitioner would struggle with, for example, video conferencing – such as having sensory impairments – then the employer should ensure staff receive appropriate training to enable competency.
  • The social care practitioner 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.

5. Social Care Practice principles

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

Although the ethical framework was developed in light of the pandemic, it embodies the key practice principles and ethical values that adult social care 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 how to determine the most appropriate method of working with people. The principles and values are linked together.

General pros and cons of each way of intervention

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

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

Key social care practitioner’s competences for telephone or video call interactions

The below is not meant to be comprehensive but an indication of the key competences a social care practitioner should have to enable successful rapport and building meaningful relationships through technology.

Note: the competences have been adapted from the competences for telephone and e-counselling framework developed by the British Association for Counselling and Psychotherapy (BACP).

People may behave differently online

When establishing online interactions social workers and social care practitioners should be able to:

  • Draw on knowledge that people may behave differently online from how they would do in a face-to-face interaction.
  • Recognise the implications of the above differences in the process.
  • Be aware that the sense of anonymity can play a role in the behaviour the adult and/or carer may display in an online interaction, as well as the practitioner’s behaviour.
  • Take into account that, without face-to-face checking, developing inaccurate assumptions may be more likely. They should therefore ‘reality check’ any assumptions, gaining clarification, evidence, corroboration, etc. and proactively identifying when assumptions could have been made.

Potential differences in impact of written word

Social workers and social care practitioners must be fully aware of the impact of the written word as opposed to a verbal message – ‘it can acquire a sense of permanence, it can appear more authoritative than the spoken word its meaning cannot be moderated by contextual features’ (BACP).

Potential blurring of boundaries

Social workers and social care practitioners should be able to establish appropriate professional boundaries using technology in their interactions.

Appropriateness of online interaction

Social workers and social care practitioners should determine the best way to interact with a given adult and/or carer.

The decision-making tool aims to support you to determine which is the best method(s) for an intervention and assess suitability for phone or video calling. This decision should be made jointly with the adult and/or carer.

Some things to consider are: the adult’s preference regarding the type of technology to be used, their competence in using different technologies, and whether the adult would feel comfortable communicating and/or expressing their feelings using particular technologies.

In some cases, supplementary ways of communication or additional questions may be needed to get a full picture of the adult and/or carer and their circumstances and needs.

Identify and manage risk

Identification, assessment and risk management is core in social work and social care interventions. Using phone or online communication could prevent professionals from identifying risks that could have been easily observed in a face-to-face interaction. Having said this, the professionals should carry out interventions in a way that allows the identification of risks in a different way.

Social workers and social care practitioners should understand that it can be difficult to identify risks in phone and online interactions without input from non-verbal communication and observing the context. They should therefore use verbal communication to gather information otherwise gathered by observation.

They should also be able to manage their own anxieties in relation to the change in practice and potential limitations in identifying, assessing or managing risk.

Professional skills

Social workers and social work practitioners should have the necessary abilities to behave in a professional manner using phone and online communication. This includes:

  • ability to open the conversation in a professional and approachable manner
  • conveying empathy and ensuring the adult feels listened to
  • being able to infer the adult’s and/or carer’s emotional state without non-verbal communication
  • being able to gather evidence and information through questions and nuances
  • ability to end the phone or online communication appropriately.

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. Use processes, procedures and forms to support your intervention, not to drive it. Shape your intervention within the legislative context in-line with the individual’s circumstances.
  • Be confident about your own ability to manage technology.
  • Work efficiently, but balance this against the needs of the people you support.
  • Prepare – many virtual 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.
  • Make assumptions, get background information from evidence and corroborate asking the individual.
  • Decide the best method for the interaction without the individual’s input.
  • Allow your insecurities or prejudices about a particular mean of communication to get in the way.

Case study: About Lucy

Lucy is 35. She has a sister that lives local to her and two brothers who live some distance away, but they stay in contact via WhatsApp.

Lucy lives in a small residential home for young people with learning disabilities. She is very close to the other people who live in the home and gets on well with most of the people who support her. Lucy has some communication barriers, but is known to be thoughtful, caring and funny. She loves to be part of the action of the home, and if there is laughter, Lucy is most likely the one to be laughing or causing others to laugh.

Lucy has a very strong character, with a positive outlook on life and she often brightens the day of those she meets.

Alun recently came to live in the same house as Lucy, but she has struggled to adjust to his character. She is withdrawing from the activity of the home and asking her brothers to come and take her to their houses.

Lucy’s sister has made contact with Adult Social Care as she is concerned about this change in Lucy, but Lucy does not wish to talk to her about how she is feeling or why she now wants to live with her brothers.

Using the practice principles

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

The social care practitioner may consider the following when using the practice principles.

Find out more