Improving outcomes for service users in adult placement - Commissioning and care management

Making good placements - Risk assessment

Assessment of risk and a risk management strategy should form part of the care management/care programme approach assessment and care plan. In adult placements the responsibility for risk associated with the person in the placement is shared between the referring body, the scheme, the adult placement carer and the service user. National minimum standards call for service users to be 'supported to take risks as part of an independent lifestyle’, and require that risk management strategies are agreed and recorded in the service user’s plan (based on the care management care plan). Under the Mental Capacity Act 2005 (15) and codes of practice (16) people must be presumed to have the capacity to make decisions and risks unless assessed otherwise./p>

Ali, who is 23 and has learning disabilities, has lived with her adult placement carer Lynne (her former foster mother) since she was a child. Ali is quite independent, has a part-time job, and goes out with friends to clubs. Now Ali has a boyfriend, and talks about wanting a sexual relationship with him. Lynne does not want Ali to bring the boyfriend back to her room (she does not allow her own children to do so); she is also worried that Ali is vulnerable to sexual and/or emotional abuse. Ali is meeting with her social worker, the scheme worker and Lynne to make sure Ali is sufficiently aware and informed, discuss what she wants from the relationship, and support her to make responsible decisions about this new aspect of her life.

Discussion group issues

Scheme staff were clear that the scheme is responsible for carrying out an environmental assessment (of the adult placement carer’s premises), but there was uncertainty among discussion group participants about who - service user, adult placement carer, scheme, care manager - is accountable for risk to (or from) a service user. Discussion among participants suggests that many local authority staff are not yet aware of the implications of mental capacity legislation and do not implement best practice risk management.

Participants discussed the need to anticipate possible risks at the point of referral, agreeing who is responsible for which aspects of risk assessment or whether a joint risk assessment is called for; to consider risk issues (including sexual relationships) as a matching issue; and to clarify the process that would be followed if things go wrong in a placement - a 'what if’ clause, one social worker said. There is danger that risk plans get 'cast in stone’ and prevent service users moving on in their lives; as they become more independent, people may want and need to begin taking more risks.

Adult placement carers stressed that the quality of information about potential risks is paramount, but that they often did not receive complete and relevant information. In one placement, the carer had not been told that the referred person was 'light fingered’ or prone to fits of violence and he was not prepared to deal with the person’s behaviour. Several adult placement carers also expressed indignation at being required to sign a standard risk form which they felt made them 'take all the risk’, while also making unreasonable and non-family-like demands (e.g. the service user has to sit in the back seat of the car behind the passenger seat; the placement carer has to carry a charged mobile at all times).

Practice points

Directors of adult social services should:

Line managers should:

Care managers should: