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Introduction Beginnings Making sense of the information Deciding what to do Reviewing the plan

Stage 2 - Making sense of the information

Case Information

  • Tom the social worker has decided the team should assess the family, based on his view that there are many dimensions of need and risk affecting all three family members. This does not literally involve all members of the team - which typically consists of social worker, nurse, psychiatrist and support workers. The team will have working practices enabling members to be allocated to particular tasks.
  • So far, it appears to Tom there will need to be work done, possibly by three different workers, with Marta and Jan as carer and Jan and Kristina as clients. Jan and Marta have agreed to a carer assessment, which entitles them to their own keyworker. This implies at least three individual care co-ordinators, coming together with one worker who care co-ordinates the whole family. Tom suggests to his colleagues he can care co-ordinate the family. Tom knows from experience, this will be necessary to monitor family dynamics as work with individuals proceeds. Workers will complete a risk plan, a crisis and contingency plan with each family member.
  • It is necessary to carry out the assessment as quickly as possible. Practitioners are audited on outcome standards. Current good practice aims to make initial contact within 48 hours, carry out the assessment within one month and put any equipment in place within a week.
    Note: Sometimes, practitioners in the team will work in pairs. It may be advantageous for a learning disability (LD) nurse and a learning disability (LD) social worker to carry the assessment out together. In this case, there are three family members presenting various problems. The team may split the work between several practitioners, one assessing the family, others assessing the three family members.
  • Kristina has problems with her speech, sometimes replying to questions in a muddled way and losing concentration on conversations. This makes it necessary to be careful when talking with her not to asking leading questions, otherwise she tends to say what she thinks you want to hear.
  • A lot of Kristina's challenging behaviour in the past and the present may be attention seeking and as a means of gaining reassurance that other people will respond and take notice of her, even if in a negative way.
  • There are aspects of Kristina's situation which can be improved. In the short term, task centred work can be used to focus on problems she is experiencing. The advantage of task centred work in this is that it is not likely to reinforce any stigma she feels and does not pathologise her problems, that is, define them in terms of any assumed shortcomings on her part.
  • The team take up Tom's suggestion. It is agreed three workers will work with family members. Tom will work will be the keyworker in work with all three family members, though other workers will carry out work with Kristina and Marta. Tom as care coordinator for the family has responsibility for coordinating and reviewing the work. Jan and Marta have agreed to a carer assessment, which entitles them to their own keyworker.
  • There is a need for Tom to ensure that the three workers with family members work together, to ensure the non-repetitive, user-centred single assessment is carried out.
  • Tom also has to ensure clarity about which resources will be statutory, which voluntary and which provided by the family.
  • Tom needs to ensure the services provided are coordinated, sequential and focus on meeting family members' needs.

Key Questions

Values-based Questions

  • What balance would you strike between empowerment and intervention, in working with Kristina, Jan and Marta?
  • How would you justify in terms of each family member a decision which whilst protecting one or more of theme from risk also had disempowering consequences?

Practice-led Questions

  • What are Marta's, Jan's and Kristina's own view of their needs?
  • What do members of the team regard as the needs of the three family members?
  • What approach would help this family? We are using a task centred approach. You could use other approaches, such as solution focused therapy or the exchange approach.
  • Which resources, ideally, would meet the needs of the three family members?
  • What resources are available to meet the needs of Kristina, Marta and Jan?

Research Focused Questions

Knowledge-based Questions

  • What local policies would you need to consider? These are likely to include policies on Case Recording and Client Access in response to the Access to Personal Files Act (1987), superseded by the Data Protection Act (1998), Fair Access to Care policy, Local Carer Assessment policy and Supervision of Vulnerable Adults policy.
  • What knowledge of disability would you use to help your interpretation of this family's circumstances?
  • What needs are family members in this situation likely to have and how best might they be met?

Skills-related Questions

  • How would you assess the needs of family members?
  • How would you assess the relative importance of meeting needs, managing risks and attending to protective factors.

Relevant Knowledge

Task centred work

Task centred work is not the only approach which could be adopted, but it is the approach selected by practitioners in this case.
Four particular problem areas can benefit from a task centred approach in this case:

  1. Jan and Kristina ideally should acknowledge the problems;
  2. they should be able to undertake some identifiable tasks;
  3. they should be able to specify what the problems are;
  4. the problems should arise from their unsatisfied wants, not their needs as identified by the team of workers.

Task centred work may be useful where, as with Kristina:

  • the client accepts the nature of her problems
  • the problems can be specified clearly
  • the problems are what the client wants to change in her life. (Payne, 1997, pp. 104-5)

Doel, M. and Marsh, P. (1992) Task-centred Social Work Aldershot, Ashgate
deals with task-centred work as practised in Britain.

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