The Skilled Conversation (Child's Needs Assessment)

Wherever possible, every conversation with a young person (and their parents) should be from a strengths perspective. This means that before you talk about service solutions to the presenting issue you must support the young person (and their parents) to explore whether there is:

  1. Anything within their own power that they can do to help themselves; or
  2. Anything within the power of their family, friends or community that they can use to help themselves.

A strengths based approach is empowering for the young person (and their parents) and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the Local Authority intervenes with support, but this decision will have been reached knowing that it is the most proportionate response available.

Adopting a strengths based approach involves:

  1. Taking a holistic view of the young person's needs in the context of their wider support network;
  2. Helping the young person to understand their strengths and capabilities within the context of their situation;
  3. Helping the young person (and their parents) to understand and explore the support available to them in the community;
  4. Helping the young person (and their parents) to understand and explore the support available to them through other networks or services (e.g. health);
  5. Exploring some of the less intrusive/intensive ways the Local Authority may be able to help (such as through prevention services or signposting).

SCIE have produced clear and practical guidance around how to use a strengths based approach in practice. See: Care Act guidance on Strengths-based approachesNote: SCIE requires a login to access resources, but any social care practitioner can create one quickly and easily.

Under the Care Act anyone with parental responsibility must be involved in the assessment because parental responsibility applies until the young person is 18. This is the case whether the young person consents to their involvement or not.

Parents may also be carers for the young person and, if so this is another reason to involve them as carers must be involved in any assessment of the cared for person.

Sometimes the relationship that the young person has with their parent (or the relationship that parents have with each other) may not maximise the involvement of the young person in the assessment process. For example:

  1. The young person may become overly distracted by their presence;
  2. The young person may become distressed at their presence;
  3. Parents may be estranged and there is a high risk of conflict during meetings.

You have a duty to maximise the involvement of the young person so will need to consider any adjustments you need to make to the planned process.

Examples of adjustments could include:

  1. Holding separate meetings with each parent;
  2. Meeting with the young person without the parent's presence;
  3. Involving a parent via consultation only; and
  4. Involving the parent in some aspects of the assessment but not others.

Under the Care Act carers have to be a part of the child's needs assessment, even if the young person does not want them to be.

This is because the Local Authority needs to:

  1. Understand the young person's needs, how they are currently being met and whether this is appropriate and sustainable; and
  2. Identify and support carers.

When a young person has not consented to the carer being a part of the assessment you should:

  1. Advise the young person that you have a duty to involve the carer;
  2. Explain the benefits of the carer being involved; and
  3. Agree the most appropriate way to involve the carer (for example a separate meeting with the carer).

If the young person has requested particular information not relating to needs is withheld from the carer, and they have capacity to do so normal confidentiality rules apply unless:

  1. Doing so would put the person at risk of abuse or neglect; or
  2. Doing so would prevent a parent from fulfilling their parental responsibilities to the young person (where the carer is a parent).
Example:

Pritesh is a carer for his brother Ash. Ash is happy for Pritesh to be involved in the assessment, but asks the social care practitioner not to discuss difficulties he is currently having in his relationship with his girlfriend while Pritesh is present, as he feels this is a private matter and bears no impact on his care needs.

The young person's parents have to be involved in the assessment. However, under the Care Act it is important that the young person's needs are considered within the context of their whole family network wherever possible. This is what is meant by a whole family approach.

Taking a whole family approach enables the Local Authority to:

  1. Understand the impact of the young person's needs on all family members, not just parents and those that may be instantly recognisable as carers; and
  2. Identify and support carers (both these things are duties under the Care Act).

Taking a whole family approach also builds the resilience of families and increases the likelihood that a non-service led self-sustainable method of meeting needs will be identified.

Need to know

You should establish who relevant family members (other than parents) are and arrange for them to be involved in the assessment when:

  1. The young person consents;
  2. The family member is a carer (there is a duty to involve carers);
  3. The young person is over 16, lacks capacity and a best interest decision is made to involve the family member; or
  4. The young person is under 16, lacks competence and a person with parental responsibility consents.

When taking a whole family approach you should consider involving the following people in the assessment:

  1. Other adult's living in the same household as the young person;
  2. Children living in the same household as the young person;
  3. Adults living elsewhere but who form part of the young person's support network;
  4. Children living elsewhere but who form part of the young person's support network.

Specifically you need to understand:

  1. The impact of the young person's needs on family members (both adult and children);
  2. Whether the role that other adults or children in the family have constitutes a caring role under either the Care Act 2014 or the Children and Families Act 2014;
  3. Whether the support currently being provided to adults and children to manage the impact is appropriate (or whether a carer's/young carer's assessment should be offered); and
  4. Whether the support being provided is sustainable.

Where there is an appearance of need in a carer you have a duty to offer an assessment.

Any conversations with adult family members must give regard to the duty to provide good information and advice about adult Care and Support. This could be in relation to the likely needs of the young person being assessed when they become 18, in relation to their own apparent needs or in relation to another adult that they support or are concerned about.

You must also consider whether any prevention service would be of benefit to any adult family member you speak to, either to support them as a carer for the young person or in their own right. Where they appear to have a need for a prevention service themselves you should support them to access this service.

Example:

Joy has an older Aunt called Mary. As part of Joy's assessment you consult with Mary who supports Joy to go to the cinema each week. Mary tells you that she wishes she lived in a bungalow like Joy, because she is starting to find using the stairs in her own home difficult due to reduced mobility. You offer advice to Mary about the possible benefit of an assessment from an Occupational Therapist. Mary considers this and feels it would be of benefit to her, so you support Mary to make the referral for an assessment.

Where you take action to support another adult in the young person's family via a whole family approach you should make sure that you make appropriate and proportionate recordings for the action you have taken or the information and advice you have provided.

The Duty to safeguard children

Children are protected under different legislation to adults. You must know your statutory responsibilities in relation to protecting children so that you can respond appropriately.

Things that you must consider in relation to all children living in the household:

  1. Whether the child is taking part in any caring activities that may be inappropriate for their age, gender or that cause them physical difficulty or emotional distress;
  2. Whether the young person being assessed presents with behaviours that place the child at risk of harm or abuse;
  3. Whether the child is at risk of neglect because the young person being assessed has caring responsibilities towards them that they cannot adequately meet as a result of their own needs;
  4. Whether the child is at risk of neglect because a carer has caring responsibilities towards them that they cannot adequately meet as a result of caring for the young person being assessed;
  5. Whether the home environment or any caring role is having a negative impact on the child's well-being, education or development.

If you are concerned about the safety of a child, or that they are at risk of abuse and neglect you must take action to protect them.

If you are concerned that a child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

Responsibilities to young carers

The legal definition of a young carer under the Children and Families Act is:

"a person under 18 who provides or intends to provide care for another person (of any age, except where that care is provided for payment, pursuant to a contract or as voluntary work)".

There is a duty to meet the needs of young carers under the Children and Families Act in the same way as there is a duty to meet the needs of adult carers under the Care Act. This means that if you become aware that a child or young person under the age of 18 is providing care you must take steps to ensure they are appropriately supported.

The first thing you should do is liaise with children's services to establish whether the child or young person is already being supported as a young carer.

If support is in place you should provide children's services with any new information you may have about the impact of the adult's needs upon the child, but you will not need to provide any further support to the child.

If the young carer is not already being supported by children's services you should discuss and agree with your line manager and children's services who is best placed to assess them.

Option 1

If the young carer is not approaching the age of transition any assessment and subsequent support they receive will be provided under the Children Act 1989. The practitioner carrying out a young carer's assessment under the Children Act must be suitably skilled, knowledgeable and competent to do so.

Option 2

If the young carer is approaching the age of transition (or is at a time of their life when it would be of significant benefit for transition to begin) a young carer's assessment under the Children and Families Act or Care Act may be more appropriate. This will involve the development of a transition plan that will support the young carer through the transition to adult Care and Support (when they become 18).

There is a legal duty to ensure that transition planning and the whole transition experience is positive for the young carer. To this end an element of joint work will likely be required to ensure the young carer receives the support they need both now and into adulthood.

Wellbeing is the single most important concept of the Care Act and is a primary factor used to determine whether needs are eligible.

The duty to promote individual wellbeing applies at all times; in every single process, conversation or decision that is made and you must be able to demonstrate that you have done so during the transition process, which includes when carrying out the child's needs assessment.

It is vital that you understand your duties in relation to promoting individual Wellbeing. See: Promoting Individual Wellbeing.

In order to promote individual Wellbeing you must first understand what Wellbeing means to the person. The Care Act sets out 9 domains of Wellbeing that you must consider. See: Wellbeing Domains.

As part of any process to establish needs you must understand:

  1. Which areas of Wellbeing are most important to the young person at that moment in time;
  2. Which areas of Wellbeing are least important at that time;
  3. Whether there are other areas of the person's life important to them but not listed as a domain (the domains under the Act are not definitive as Wellbeing is personal);
  4. Which areas of Wellbeing are causing the young person concern or worry;
  5. What impact any concern or worry is having (or could have) across the Wellbeing domains (is there a destabilising effect?); and
  6. How the young person thinks their needs interact and impact on Wellbeing.

It is important to remember that under the Care Act the Wellbeing domains are all as important as each other. Any hierarchy can only be determined or described by the young person whose Wellbeing it is.

A sense of Wellbeing is extremely personal and will be different for every young person;

  1. Never make assumptions about what is important and what is not important to a young person;
  2. The young person is the expert in relation to their own Wellbeing;
  3. If a young person tells you they have no worries in a particular area this does not mean the area is not important to them; and
  4. Conversations about Wellbeing should be 'genuine' person centred conversations, not process led.
Need to know

Remember: see the tri.x Resources to access additional practice guidance that can support the processes of establishing needs, Care and Support Planning and review when the young person has specific or complex needs.

Often the key to an effective conversation about Wellbeing is preparation and you should take whatever steps are available to ensure that the young person is as prepared as possible for the conversation:

  1. Provide information that will support the young person (and their parents) to understand the concept of Wellbeing and why it is important;
  2. Offer advice about the things that a young person may want to think about before having a conversation about Wellbeing;
  3. Make sure that anybody who will be supporting the young person understands Wellbeing and is confident and appropriate to support the young person to prepare for and have the conversation; and
  4. Consider whether any tools may be helpful to support the young person (and their parents) to think about Wellbeing.
Need to know

Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.

A conversation about Wellbeing can be a very difficult conversation for a young person (and their parents) to have. Not everyone will feel happy, confident or able to share with you how they are feeling about the different areas of their life. For many people, this will be the first time they have been asked or given an opportunity to think about their own Wellbeing in this way, and they are also doing so whilst preparing for a significant change in their life.

Any questions that are used to support a young person to think about Wellbeing must:

  1. Be proportionate to the level of information required;
  2. Be appropriate, taking into account the young person's specific needs around communication and their specific circumstances;
  3. Be realistic in respect of the young person's mental capacity/competence and ability to be able to answer the question; and
  4. Be asked in a manner that is accessible to the young person.

Powerful questions

A powerful question is a specific type of open question that:

  1. Encourages a young person to reflect;
  2. Is thought-provoking;
  3. Supports an exploration of options; and
  4. Helps the young person to gain a greater insight into their situation.

Powerful questions should be framed in a positive way to promote engagement of the person and promote a strengths based approach.

Powerful Question Open Question (not powerful)
Why do you think that means so much to you? What do you think that for?
What works well about the support you have? Who does that for you?
Why do you think that didn't quite go as expected? Why didn't that work out?
What made you decide to take that approach? Why did you do that?

Appreciative Enquiry

An appreciative enquiry is a conversation that is led by the young person and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.

The listener should invite the young person to:

  1. Talk about a time or times when something has been working well in their life;
  2. Explore what it was that worked well and supported them at that time;
  3. Think about how that experience could support them now in making a plan for the future.

Some key questions to support an appreciative enquiry approach include:

  1. Tell me about a time when things were going well for you?
  2. What did you learn about your strengths at that time?
  3. If you had a magic wand what would the future look like?
  4. What is it that you value most in your life now?
  5. What small changes would make the most difference?

The use of tools

A tool can be helpful to shape and focus a conversation about Wellbeing, making sure that you consider everything that needs to be considered from a statutory perspective. Tools are also useful because they:

  1. Can be completed with the young person (and their parents) as part of any conversation you have with them; or
  2. The young person can complete them in their own time as part of their preparation for the conversation (either independently or with support).

See: Tools and Practice Guidance to Establish Needs.

Some young people will lack capacity (over the age of 16) or competence (under the age of 16) to have a conversation or communicate how they feel about their own Wellbeing at a particular moment in time (verbally or through another means). For example, they may be too unwell to do so or have a significant learning disability. Where this is the case the duty to maximise their involvement still applies.

There are a range of ways that you can maximise the involvement of a person who lacks capacity, including but not limited to:

  1. A parent already involved acting as an appropriate person under the Care Act;
  2. An independent advocate to support the young person to engage and ensure that they are represented;
  3. Spending time with the young person can show you what they enjoy about life and what may be most important to them (this could be a person, a place or something they do with their time);
  4. Consulting with a range of people who know the young person before reaching a judgement about Wellbeing. Speaking to a family member, a health professional, a paid carer, a college tutor and a day services manager will give a much better picture of what appears to matter most to the young person than relying on the views of one person;
  5. Use other available evidence to support you to understand Wellbeing (for example ABC charts and other records that show behaviour changes clearly linked to an event, person or place).

All information gathering and sharing should be carried out with regard to the Caldicott Principles, Data Protection Legislation and local information sharing policies.

Because Wellbeing is extremely personal different people are likely to have different perspectives about the same domains. The young person themselves is more likely to have a subjective view about their Wellbeing which may be dominated by worries or concerns they have about their presenting situation (for example if they are going to be leaving school), whereas someone who is emotionally removed from may see things more objectively.

It is important that you recognise when a young person's views about their Wellbeing may not be holistic and take steps to try and support them to gain insight or broaden their thinking. One way of doing this is to seek the views of family members and others involved in their life. This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support. You can seek the views of others:

  1. When the young person consents to this; or
  2. When the views of parents or carers are being sought; or
  3. When the views of any other person with parental responsibility is being sought; or
  4. When the young person is over 16, lacks capacity and a best interest decision is made to this effect; or
  5. When the young person is under 16, lacks competence and a person with parental responsibility consents.

Even with the involvement and perspective of others certain factors effecting Wellbeing may still be difficult for people to recognise, acknowledge or explore. If it is your view that these things are having an impact on Wellbeing then you must raise them for the purposes of:

  1. Supporting the young person (and their parents) to gain insight into their situation;
  2. Developing the young person's resilience (and the resilience of their parents) through talking about difficult situations and exploring options to find a solution;
  3. Providing information and advice;
  4. Preventing, reducing or delaying the need for Care and Support from the age of 18.
Example:

John has recently been diagnosed with cancer. However, he is declining to acknowledge his diagnosis and talk about the future. Instead he focuses his thoughts on the supported living tenancy he plans to move into and tells his social care practitioner that he has no worries about his health when having a conversation about Wellbeing. Even though it is challenging for the practitioner they talk to John about his diagnosis because by ignoring it the duty to prevent, reduce and delay needs cannot be met.

Skills for Care (SFC) has developed general guidance around effective communication. See: Communication skills in social care.

You may also find the tool Six Tips to Help You Have Difficult Conversations useful.

You should also make effective use of supervision to explore and develop skills that will support you to have difficult and sensitive conversations with people in a positive way.

A young person's wellbeing is always affected by what is happening in their life at that time. It changes as their situation changes, and sometimes the changes in Wellbeing that take place can be quite dramatic. It is therefore important to understand a young person's Wellbeing in the context of their current situation, but to monitor and review Wellbeing as things change.

When you have understood a young person's individual Wellbeing you have a duty to promote it. To do this you must understand:

  1. The things that they want to achieve;
  2. The things they want to change; and
  3. The things that they want to stay the same.

These things are known as the young person's outcomes. In order to promote Wellbeing you should explore with the young person during the assessment the steps that they can take to achieve their outcomes, as the two things are intrinsically linked.

NHS Choices have an online resource: 5 steps to mental wellbeing.

Need to know

Outcomes should reflect the things that the person wants to achieve and not what other people want to happen.

You have a duty to promote a young person's individual Wellbeing but this is not a duty at the detriment of others. The Wellbeing of others must be taken into account and may determine the action that you then do or do not take to promote a young person's Wellbeing.

For example, if promoting one person's Wellbeing will put another vulnerable adult or a child at risk then you must not do so unless risks can be mitigated. The duty to protect people from abuse or neglect overrides the duty to promote individual Wellbeing.

Need to know

Don't forget that any existing EHC assessments and plans should be used to inform the child's needs assessment, and where possible the two assessments should be combined. You should not duplicate information gathering unnecessarily.

The purpose of a child's needs assessment is to understand both the needs that the young person has now and the needs that they are likely to have from the age of 18. This can only be done by talking about needs.

A person's needs also often directly impact on their Wellbeing, which you have a duty to promote. Therefore understanding needs will also support you to fulfil the duty to promote Wellbeing.

The Care Act sets out 10 areas of need that must be assessed whenever it appears that they exist:

  • Manage and maintain nutrition;
  • Maintain personal hygiene;
  • Manage toilet need;
  • Being appropriately clothed;
  • Be able to make use of their home safely;
  • Maintain a habitable home environment;
  • Develop/maintain family and other personal relationships;
  • Access/engage in work, training, education or volunteering;
  • Make use of community services;
  • Carry out caring responsibilities for a child.

Unlike a conversation about individual Wellbeing there is not a requirement to talk about all of the areas of need described in the Care Act, regardless of whether they appear to be present or not. Instead the conversation about needs must be proportionate and appropriate to each young person's situation and you should be mindful to make the best use of available information from existing assessments and plans.

Example:

Simon is a single male. He has a mental health issue but has no physical disability. Unless further evidence was provided it would not be appropriate to ask Simon about needs in relation to managing the toilet and carrying out caring responsibilities for a child. Furthermore, when talking about areas (such as being appropriately clothed or maintaining personal hygiene) it would not be appropriate to ask Simon about his physical abilities to carry out tasks because, from the available evidence his needs relate to his mental health.

Example:

Jill has multiple learning and physical disabilities. She is not able to carry out any care and any support functions without support, and has several health conditions that require monitoring throughout the day so that she stays well. Due to the range of needs that Jill appears to have it would be proportionate and appropriate to talk about most of the areas in the Care Act, with the exception of responsibilities for a child.

Need to know

Remember: see the tri.x Resources to access additional practice guidance that can support the processes of establishing needs, Care and Support Planning and review when the young person has specific or complex needs.

Often the key to an effective conversation about need is preparation and you should take whatever steps are available to ensure that the young people (and their parents) are as prepared as possible for the conversation:

  1. Provide information that will support the young person (and their parents) to understand the areas of need described in the Care Act and why establishing needs is important;
  2. Offer advice about the things that a young person may want to think about before having a conversation about needs;
  3. Make sure that anybody who will be supporting the young person understands needs and is confident and appropriate to support the young person to prepare for and have the conversation; and
  4. Consider whether any tools may be helpful to support the young person (and their parents) to think about needs.
Need to know

Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.

A conversation about needs can be a very difficult conversation for a young person to have. Not everyone will feel happy, confident or able to talk about their needs. Some people may lack insight into their needs, particularly if they are still going through a period of adjustment to the need, or their needs have changed recently.

Any questions that are used to support a young person (and their parents) to think about needs must:

  1. Be proportionate to the level of information required;
  2. Be appropriate, taking into account the young person's specific needs around communication and their specific circumstances;
  3. Be realistic in respect of the young person's mental capacity/competence and ability to be able to answer the question; and
  4. Be asked in a manner that is accessible to the young person (and their parents).

Powerful questions

A powerful question is a specific type of open question that:

  1. Encourages a young person to reflect;
  2. Is thought-provoking;
  3. Supports an exploration of options; and
  4. Helps the young person to gain a greater insight into their situation.

Powerful questions should be framed in a positive way to promote engagement of the young person and promote a strengths based approach.

Powerful Question Open Question (not powerful)
Why do you think that means so much to you? What do you think that for?
What works well about the support you have? Who does that for you?
Why do you think that didn't quite go as expected? Why didn't that work out?
What made you decide to take that approach? Why did you do that?

Appreciative Enquiry

An appreciative enquiry is a conversation that is led by the young person and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.

The listener should invite the young person to:

  1. Talk about a time or times when something has been working well in their life;
  2. Explore what it was that worked well and supported them at that time;
  3. Think about how that experience could support them now in making a plan for the future.

Some key questions to support an appreciative enquiry approach include:

  1. Tell me about a time when things were going well for you?
  2. What did you learn about your strengths at that time?
  3. If you had a magic wand what would the future look like?
  4. What is it that you value most in your life now?
  5. What small changes would make the most difference?

The use of tools

A tool can be helpful to shape and focus a conversation about need, making sure that you consider everything that needs to be considered from a statutory perspective. Tools are also useful because they:

  1. Can be completed with the young person (and their parents) as part of any conversation you have with them; or
  2. The young person can complete them in their own time as part of their preparation for the conversation (either independently or with support).

See: Tools and Practice Guidance to Establish Needs.

To ensure an accurate assessment of need it is important that you identify whether a young person has needs that fluctuate (change over time).

Fluctuating needs are needs that:

  1. May not be apparent at the time of the assessment; but
  2. Have been an issue in the past; and
  3. Are likely to arise again in the future.

A simple question to ask a young person to establish whether their needs fluctuate is 'How do your needs change over time?'

Every young person with fluctuating needs will experience fluctuations differently. For example:

  1. Some people's needs fluctuate throughout each and every day;
  2. Some people's needs fluctuate on some days each week;
  3. Some people will have periods of stability that could last several weeks or months with no fluctuation;
  4. Some people's fluctuations are related to a physical or mental health condition (for example Bi-Polar Disorder); and
  5. Some fluctuations are a response to a change in circumstance or environment (for example the weather affecting mobility).

Because of the variance in fluctuation possible it is not appropriate to simply assess a young person as having 'fluctuating' needs. Neither should you make a judgement about need based solely on either a 'worse case' or a 'best case' scenario. Doing so would not provide a true representation of the young person's whole needs.

You need to be able to effectively demonstrate:

  1. How often the young person experiences a fluctuation in needs;
  2. The type of fluctuations that are experienced and the impact on other needs and Wellbeing;
  3. What the potential causes or triggers are for fluctuations; and
  4. What measures are effective in managing periods of fluctuation or reducing the risk that they will occur.

The kind of questions you could ask a young person (and their parents) to help understand their fluctuating needs includes:

  1. How long has it been since you had a good/bad day?
  2. What does a good/bad day look like?
  3. What changes in support do you have on a bad day?
  4. How often do your needs change on a bad day?
  5. Which areas change the most on a bad day?
Need to know

Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.

The length of extension to an assessment process to ensure that fluctuating needs are understood should be based on the individual needs and circumstances of the young person and could be a day, a week or several months in duration.

It may also be appropriate to pause an assessment to enable the young person to access support that may then prevent or reduce the number of fluctuations occurring (for example to allow a new medication to take effect or to access to a health service to support anxiety).

Some young people will lack capacity (over the age of 16) or competence (under the age of 16) to have a conversation or communicate how they feel about their needs (verbally or through another means). For example, they may be too unwell to do so or have a significant learning disability. Where this is the case the duty to maximise their involvement still applies.

There are a range of ways that you can maximise the involvement of a young person who lacks capacity, including but not limited to:

  1. A parent already involved acting as an appropriate person under the Care Act;
  2. An independent advocate to support the young person to engage and ensure that they are represented;
  3. Spending time with the young person can show you what they enjoy about life and what may be most important to them (this could be a person, a place or something they do with their time);
  4. Consulting with a range of people who know the young person before reaching a judgement about Wellbeing. Speaking to a family member, a health professional, a paid carer, a college tutor and a day services manager will give a much better picture of what appears to matter most to the young person than relying on the views of one person;
  5. Use other available evidence to support you to understand Wellbeing (for example ABC charts and other records that show behaviour changes clearly linked to an event, person or place).

All information gathering and sharing should be carried out with regard to the Caldicott Principles, Data Protection Legislation and local information sharing policies.

Different people involved with the young person are likely to have different views about need. For example, the young person them self is likely to have a subjective view about their needs, which may be dominated by worries or concerns they have about their presenting situation (for example the potential impact of a serious health diagnosis or the prospect of leaving school), whereas someone who is emotionally removed from the situation may see things more objectively.

It is important that you recognise when a young person's views about their needs may not be holistic and take steps to try and support them to gain insight or broaden their thinking. One way of doing this is to seek the views of family members and others involved in their life. This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support. This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support. You can seek the views of others:

  1. When the young person consents to this; or
  2. When the views of parents or carers are being sought; or
  3. When the views of any other person with parental responsibility is being sought; or
  4. When the young person is over 16, lacks capacity and a best interest decision is made to this effect; or
  5. When the young person is under 16, lacks competence and a person with parental responsibility consents.

Even with the involvement and perspective of others certain needs may still be difficult for people to recognise, acknowledge or explore. If it is your view that these needs exist and are having an impact on the young person then you must raise them for the purposes of:

  1. Supporting the young person (and their parents) to gain insight into their needs and situation;
  2. Developing the young person's resilience through talking about difficult situations and exploring options to find a solution;
  3. Providing information and advice;
  4. Preventing, reducing or delaying the need for Care and Support.
Example:

Peter has Autism and lives in his own tenancy within a supported living scheme. When asked to describe his needs around meal preparation he says that he has no needs. However, the social care practitioner is aware that Peter's parents support him to prepare his main meals for the week every Sunday and feel that he lacks some insight and understanding around his needs. The social care practitioner asks Peter to break down the stages of meal preparation which supports him to recognise that there are some elements that he can do independently (using the microwave) but others where he has a need for support (cooking and shopping for food).

Example:

Maureen tells her social care practitioner that she is no longer able to clean her home because of changes in her mobility. The social care practitioner knows that Maureen was carrying out some tasks until a few weeks ago when she fell over. Maureen recovered well from her fall but appears to have lost confidence in her abilities. She speaks to Maureen about this possibility and by doing so supports her to recognise that anxiety about falling is the barrier to her carrying out household tasks. Acknowledging this allows Maureen to think about ways that she can gain confidence to carry out the tasks once more.

Skills for Care (SFC) has developed general guidance around effective communication. See: Communication skills in social care.

You may also find the tool Six Tips to Help You Have Difficult Conversations useful.

You should also make effective use of supervision to explore and develop skills that will support you to have difficult and sensitive conversations with people in a positive way.

If the young person has needs that you know are likely to change in the near future, and may not be present when they become 18 you should understand these needs as they exist now, so that any current need for support can be identified, but you should not record the needs as likely future needs. For example:

  1. When a young person is expected to make a full recovery from a health related condition;
  2. When a young person's needs are likely to be temporary (e.g. needs relating to upcoming surgery to resolve a physical need); or
  3. When a young person's needs are related to their circumstances and these circumstances are going to change (e.g. needs relating to social isolation when the young person is going to be moving into a shared lives placement).

The child's needs assessment should not be carried out in times of crisis. If a crisis occurs during the assessment process you should provide any support under the Children Act 1989 or the Children and Families Act 2014 using the procedures available to do so outside of this site.

The child's needs assessment should be paused and rescheduled or recommenced at a time when the crisis is resolved and carrying out the assessment would be of 'significant' benefit.

During the assessment it will be necessary to:

  1. Ensure that current methods of meeting needs are effective; and
  2. If not, take steps under relevant children's legislation to meet needs; and
  3. Establish whether there are any needs likely from the age of 18; and
  4. If so, explore broadly how these needs could possibly be met by adult Care and Support.

Any decisions about meeting needs will be made at a time when the needs established through the child's needs assessment are confirmed and deemed eligible by adult Care and Support.

Need to know

Remember that using a tool to support the process of establishing needs or formal assessment can be useful for all involved.

See: Tools and Practice Guidance to Establish Needs.

During the assessment conversation about Wellbeing the person should naturally identify:

  1. Things they want to achieve now;
  2. Things they want to change now; and
  3. Things they want to stay the same.

They should also be supported to explore the things they want to achieve in the future when they become 18.

These things are known as the young person's outcomes. In order to promote Wellbeing you should explore with the young person during the assessment the steps that they can take to:

  1. Achieve their outcomes now (and the support they will require to do so); and
  2. Achieve their outcomes in the future when they become 18 (and the support they may require to do so).
Need to know

Outcomes should reflect the things that the person wants to achieve and not what other people want to happen.

Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.

The aim of any conversation about risk is to maximise the benefits and reduce the likelihood of harm.

When you have a conversation about promoting Wellbeing, meeting needs or ways to achieve an outcome there will at some point be a need to talk about risk and doing so at an early stage can support the young person (and their parents) to:

  1. Explore and understand the benefits of taking the risk;
  2. Explore and understand the potential harmful consequences of taking the risk;
  3. Think about the measures they can take to reduce the likelihood of a negative consequence; and
  4. Make an informed decision about whether to take the risk.

The process of talking about risk can be very empowering for a young person and build resilience, confidence and independence.

Examples of risk you may need to talk about when establishing need can include:

  1. Risk associated with an impairment or disability (e.g. falls);
  2. Risk of accidental injury (e.g. from traffic when in the community or using a household appliance at home);
  3. Risks around a young person's ability to manage medication;
  4. Risks around the use of drugs or alcohol; and
  5. Risk of abuse or neglect (e.g. exploitation by others);

Depending on the level of risk a formal risk assessment may need to be carried out in addition to any other assessment process. See: Risk Assessment.

The duty to provide good information and advice and to consider ways to prevent, reduce or delay needs for adult Care and Support in the future applies at all times.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

See: Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs.

See: Providing Information and Advice for information about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it.

Before any conversation to establish needs begins it is important that the young person (and their parents) and everyone else involved understands:

  1. Your role and how you can be contacted;
  2. The role of their parents;
  3. The role of anyone else involved (for example an advocate or carer);
  4. Why the process is taking place;
  5. What is going to happen during the process, including how long it may take;
  6. What the possible outcomes of the process may be and the implications (for example if there are no likely needs apparent from the age of 18); and
  7. What is going to happen next, including how long it is likely to be until further contact is made and any further processes that may then be carried out (for example the development of a transition plan).

During the process it is important that you:

  1. Offer information and advice as appropriate, including signposting to other sources;
  2. Discuss options to prevent, reduce or delay the need for Care and Support; and
  3. Give the young person, their parents and anyone else involved opportunities to ask questions or seek clarity.

Depending on the young person's situation and needs specialist information and advice that may be required could include:

  1. Advice around the financial assessment process;
  2. Advice about becoming a Lasting Power of Attorney or Deputy;
  3. Advice about becoming an Appointee;
  4. Advice about making a complaint about the Local Authority;
  5. Information about the local market place for Care and Support or health services.

See: Providing Information and Advice, which includes access to local and national information and advice resources (general and specialist).

If, as part of any conversation you have with a young person or their family you become concerned that a vulnerable adult or a child is experiencing, or at risk of abuse or neglect you must respond appropriately.

See Safeguarding Adults, which also includes information about how to raise a concern about a person under the age of 18.

If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

Where the safeguarding is in respect of the young person whose needs are being established a decision will need to be made about the need to pause the assessment process to allow a safeguarding enquiry to take place.

There are 3 possible options:

  1. The child's needs assessment process continues alongside any safeguarding process;
  2. The needs assessment is paused with no on-going intervention by the person carrying out the assessment whilst a safeguarding process takes place; or
  3. The needs assessment is paused but urgent interim support is arranged to ensure current needs are met whilst a safeguarding process takes place.

Any decision should involve the person carrying out the needs assessment, the person who will be carrying out any safeguarding process, the young person (or their representative), their parents and any carer.

You must consider any appropriate action required to authorise deprivations of liberty whenever:

  1. The young person lacks capacity to make decisions about the care and support provided to them; and
  2. You feel that the level of restriction being imposed on them now is depriving them of their liberty; or
  3. You feel the level of restriction required to meet their care and support needs from the age of 18 is likely to deprive them of their liberty.

See: Recognising and Responding to Deprivations of Liberty.

Under the Care Act an assessment should be carried out in a timely way based upon the needs and circumstances of the young person.

Sometimes it may be appropriate to pause the process part way through. For example:

  1. Safeguarding concerns have been raised and a safeguarding process is to take place;
  2. To allow a service aimed at delaying, preventing or reducing likely needs for adult Care and Support to be provided (for example a period of reablement or a piece of equipment);
  3. To allow the young person time to recuperate following a period of ill health;
  4. In response to a change in the young person's personal circumstances (for example the death of a carer).

Any decision to pause the process should be made with regard to:

  1. The young person's thoughts, wishes and feelings;
  2. The young person's parent's thoughts, wishes and feelings;
  3. The likely impact on the person's Wellbeing; and
  4. The views of any carer or other person involved or being consulted.

Whenever the conversation recommences you must make sure that you review the original information gathered and ensure that any changes in need and Wellbeing that have occurred are reflected.

It is quite appropriate to take notes during a skilled conversation to ensure that you are able to satisfactorily recall and capture what has been discussed and agreed in a formal record. However, there are some general good practice rules to follow when doing so:

  1. Think beforehand about the level of note-taking that may be required-ensure you have to right tools and that they are proportionate;
  2. Explain to the young person and anyone else present that you will be taking some notes and why;
  3. Reassure the young person and anyone else present that you will still be listening to them even when you are making notes;
  4. Don't record everything that is said. This will prevent you from engaging in the conversation and cause distraction-you need to pick out what is relevant and important;
  5. Make sure you record everything that the young person (and their parent) says is important to them, even if it does not appear to be relevant to you or others;
  6. If the young person (or their parent) uses a certain phrase that is powerful or indicative to the context you should record this word for word;
  7. Sometimes information is detailed or complex and taking notes could take a little longer than expected. If this is the case you should consider making a polite request for a brief pause to allow for notes to be made;
  8. Sometimes people provide a lot of information without a pause-perhaps they are anxious or simply have a lot to say. Trying to keep up can lead to you over-recording (recording everything regardless of relevance); missing key points, failing to understand what is being said or appearing disengaged from the conversation. If this is the case you should consider politely requesting a pause to allow for clarity and notes to be made;
  9. Refer to your notes to summarise what has been said during the conversation, reflect and seek clarity about what has been agreed and next steps;
  10. Try to make notes in a legible way and take care to use appropriate language-the young person (or their parents) may request to see the notes or be provided with a copy;
  11. Confidentiality must be maintained at all times. Make sure that the notes are kept securely and only available to people authorised to see them;
  12. Always file or dispose of any notes securely when a formal record of the conversation has been made.

Last Updated: November 9, 2021

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