Adult placements and person-centred approaches

Assessment and referral

What national minimum standards say

The referral process is defined in Standard 2 of the national minimum standards for adult placement schemes. The scheme can accept a referral only on the basis of a full assessment of the individual, undertaken by trained staff, involving appropriate communication methods, and with an independent advocate as appropriate.

Findings from the practice survey

• most people in adult placements access funding through local authority care management / care coordination.
• despite the requirement for a needs assessment and care plan, the practice survey found that this happens rarely, and applied only to those recently referred to schemes, with the majority of placements pre-dating national minimum standards.
• unfortunately, the quality of information about people referred to schemes is often poor, and all schemes visited were carrying out their own detailed assessment of the referred person

Practice points

How should the assessment be done? Want should the assessment cover? What information should go to the adult placement scheme?

How should the assessment be done?

A comprehensive needs assessment, informed by a person-centred plan, is essential in ensuring that the adult placement is tailored to the individual. The person-centred plan should be the basis of the referral to the adult placement scheme. The service-user plan and placement agreementare informed by the needs assessment (see below), and set out the way in which the placement will meet the identified needs of the person in the placement.

The scheme has a responsibility to ensure that this needs assessment involves the individual

Person-centred planning is different from a general assessment of need. Whilst the latter takes place in the world of the care manager, person-centred planning takes place in the world of the service user, and a move to person-centred planning requires an investment from local authority staff across the board if it is to be effective. There are a number of useful tools that can be used in the development of person-centred plans.

Needs assessments and care plans are the responsibility of care managers and care coordinators. It is vital that these people have the knowledge, skills and time to carry out assessments that are based on person-centred plans.

What should the assessment cover?

The needs assessment should cover the following areas:

• requirements for accommodation and personal support
• meaningful education, training and occupation
• family and social contact
• adequate income
• assessment and management of risk
• cultural and faith needs
• physical and mental health care
• specific condition-related needs and specialist input
• provision of disability equipment, including arrangements for payment and supply
• treatment and rehabilitation programmes
• methods of communication
• potential restrictions on choice, freedom, services or facilities-based on specialist needs or required by a treatment programme-likely to become part of a prospective service user's individual plan.

Where placements pre-date the introduction of the national minimum standards, the scheme should ask the care manager to carry out a comprehensive review of the needs of the person placed (ideally informed by a person-centred plan).

Schemes have limited powers to influence care-management practice. For new placements, where the scheme feels that the needs assessment is inadequate, the scheme should feel at liberty to refuse the referral. Alternatively, the scheme may carry out its own needs assessment. The needs assessment should cover the areas listed above and should involve the individual.

The service user may also like an independent advocate to help with the process, and it should be the role of the care manager to identify someone suitable.

The assessment should also include others who have the service user's best interests at heart, even if those interests conflict with the views of the service user. It can offer a comprehensive and accurate picture of what the adult placement scheme needs to think about in finding an appropriate match.

What information should go to the adult placement scheme?

The adult placement scheme should not accept a referral from a care manager unless it is accompanied by a comprehensive needs assessment

The care manager must provide detailed information to the adult placement scheme for a suitable placement to be found. This frees up the adult placement staff to focus on the carers, so it is essential that policies, procedures, paperwork and other minimum requirements be agreed between the local authority and the scheme.

It is clear from the practice survey that this level of assessment and information sharing is not always happening: this can lead to conflict in the role of the adult placement scheme, as it can take the worker away from supporting the carer.

The care plan should be supported by an assessment of risk, and there should be on-going contact between the care manager, the scheme and the service user to ensure all parties are aware of developments.

The same principles should apply in an emergency placement, where emotions and anxieties may be even greater, and service users will want a familiar face to support them through a potentially traumatic transition. In this instance, a full person-centred placement may not be available, but attention should be given to prioritising the hopes and fears of the service user.

All assessments should be carried out according to 'Fair access to care services' (7) guidance. This should be used in conjunction with the single assessment process when assessing an older person; integrated with the Care Programme Approach for those with mental health issues; and consistent with ' Valuing people ' guidelines for those with a learning disability.