Adult placements and person-centred approaches

Monitoring and review

What national minimum standards say

The adult placement scheme regularly supports, monitors and reviews each placement to ensure that the person's needs are met by the carer, and the aims and underlying principles of the placement (as set out in the placement agreement and service user's plan) are achieved. Standard 6 of the national minimum standards for adult placement schemes and Regulation 14 of the 'Adult Placement Schemes (England) Regulations' sets out how this is to be done.

Findings from the practice survey

• whilst the care manager should be present for reviews, the survey found that the adult placement scheme generally does it by default. The practice survey found a lack of social work involvement at all stages of adult placement, and a blurring of scheme and social work roles and responsibilities.
• in many cases, care managers tend to close cases after initial review, and any future contact is dealt with on a duty basis.
• this means service users rarely have a named social worker who knows them well and who can attend the (placement or care management) review.
• social workers are playing little part in the lives of service users, relying on adult placement schemes to ensure all is well in the placement. While this may be a 'vote of confidence' for schemes, it leaves a number of unresolved issues including:
  • inadequate referral information reducing the effectiveness of the matching process
  • lack of planning and reliance on emergency placements
  • unclear roles and responsibilities.
• the practice survey found that service users and carers were frequently unclear about the purpose of and differences between reviews (sometimes they were merged), and between reviews and scheme-monitoring visits.
• for users, carers and sometimes adult placement workers, annual reviews were seen as a chore, not a positive experience.
• when asked how they judge a successful placement, scheme staff all stressed 'gut feeling', based largely on observation.
• more objective positive indicators of success included:   carers achieving 'knowledge and skills statements' in NAAPS 'Learning the ropes' (23)
  • person starting to talk about moving on
  • person able to talk more freely about their feelings
  • good balance of respect and compromise between user and carer
  • person's confidence and self-esteem growing
  • 'amazing change' in person
  • person becoming known in local shops.

Findings from the literature review

The Tizard Centre said that service users reported mixed feelings about their reviews (supportive, frightening); and were confused about the differences between their placement officer, care manager, social worker and key worker.

Cambridge and McCarthy(24) found that some people with learning disabilities were distressed by their review meetings and confused by the difference between adult placement and social services staff.

Practice points

Care managers' involvement in the placement

In the best practice adult placement model, the scheme supports the adult placement carer and the whole placement, while the social worker or care coordinator retains responsibility for the service user. This would appear to be very different to the findings in the practice survey and is a fundamental issue for local authorities to consider. The comments from the literature review underline the importance of avoiding confusion.

Lack of care-manager involvement can put adult placement workers in a very difficult situation. It can compromise their role in supporting and monitoring carers. It also hinders person-centred approaches. Local authorities need to balance limited resources against the practice implications of ending active care-management involvement in adult placements.

The lack of care-management involvement in reviews inevitably compromises their value and independence. The practice of allocating 'duty care managers' to represent people at reviews increases the danger that their views will not be properly represented. Again this is an issue for local authorities.

Inevitably, provision is resource-driven, and care managers do not have the capacity to maintain involvement with everyone. This raises questions about person-centred planning, and whether a placement can be a long-term success without adequate support for everyone involved.

Good practice in placement reviews

Why have reviews?

They are an opportunity to:

• Hear views and identify issues or areas of conflict.
• Reflect upon the care plan, and see if its aims are being met.
• Make changes to the care plan to take developments into account, for either the service user or carer.

Who should organise the review?/p>

The national minimum standards say that this is the role of the scheme worker, who should support the placement and be responsible for the standard of care provided. The scheme worker should consider who should be involved with the review (for example, advocate, family members, care manager, carer) and ensure that they are informed.

Making reviews a positive experience

Adult placement workers should be imaginative and flexible in planning review meetings. They may want to try to find an appropriate place to hold the meeting-an environment in which the service user feels comfortable: for example in the practice survey, one person wouldn't talk if the adult placement worker was carrying a notebook; another wouldn't talk in her day centre. A series of shorter sessions may be easier for the person, talking about one issue at a time.

Service users may dread reviews just as much as carers. The care manager can have a key role to play in reassuring the service user, particularly if they know each other. They should consider a pre-review meeting. This is an opportunity to explain the process, ensuring that there are no surprises at the meeting and that the person is aware of any decisions that need to be made.

As well as reviewing the placement, the care plan should also be reviewed, and the care manager should initiate this process. If there is no person-centred plan this could be an opportunity to discuss if the service user is interested.

Carer reviews

The national minimum standards (Standard 7) say that the adult placement scheme should 'support and review the work of the adult placement carer to ensure that they have the resources, skills and knowledge to fulfil their responsibilities under the placement agreement and service-user's plan, according to the underlying principles of adult placement'.

The adult placement carer review focuses upon the carer, but feedback should be sought from all relevant parties on the performance of the carer. The views of the person in the placement are of particular importance.

Good practice suggests that this should be done through the care manager, who should be present. Yet this can be a problem if the care manager does not know the service user, and may lead to some resentment on the part of the carer.

Certainly the presence of an independent advocate or whoever knows the service user best should be facilitated.

The carer review is an opportunity to identify areas that the carer would like to develop and any training or learning needs. It is a good opportunity to discuss person-centred approaches and how these can be applied on a day-to-day basis in a placement.