Introduction, Legal Requirements and Tools

Deciding whether enablement is appropriate 

The enablement service provides a bespoke function to directly support people with a disability, who have a mental health issue or who are recovering from illness to:

1. Learn the skills of daily living to enable them to live independently (or with as little support as possible);
2. Re-learn lost skills of daily living (either fully or to a point where independence is increased as much as it can be);
3. Learn to 'live well' with a condition and develop strategies to be as independent with daily living skills as possible for as long as possible;
4. Build confidence across any other areas of life that are important to the person so as to increase their independence (for example building social skills).

Identifying 'other' needs for Care and Support

Because the enablement assessment should be holistic in nature if the person has any other needs for Care and Support these will also be identified. You will need to establish what action to take in respect of these non-enablement needs. Examples of possible action include:

1. No action (only if needs have already been assessed and are being met through a Care and Support Plan);
2. Providing information and advice to the person (or their carer) about ways that the needs could be met;
3. Requesting joint work with another service within the Local Authority (for example social work or occupational therapy).

Identifying carer's needs 

The enablement assessment must involve any carer that the person has because under the Care Act carers must be involved in any Carer and Support process. As part of the assessment of the person you must establish:

1. Whether the carer has the appearance of a need for Support in their own right; and
2. If so, whether the carer is being supported through a Support Plan; and
3. If there is no Support Plan, whether the carer wishes to have a carer's assessment.

The Local Authority has a duty to identify and support carers and enablement is often an opportunity to do so at an early stage.

Referrals to Occupational Therapy often describe specific equipment or an adaptation as the reason that the assessment is being requested, for example:

1. To adapt a bathroom into a wet room;
2. To obtain specialist seating;
3. To lower the units in the kitchen; or
4. To fit grab rails around the home.

Assuming the outcome of the assessment in this manner suggests that the person making the referral may not understand the purpose of an assessment under the Care Act as a mechanism to assess needs (not services), and may have unrealistic expectations about the whole process that you will need to manage.

There should not be any assumptions made prior to an assessment that the provision of equipment or an adaptation will always be the outcome. Instead the assessment must identify:

1. All of the needs that a person appears to have;
2. Whether any of the needs that the person appears to have can be prevented, reduced or delayed; and
3. If so, whether the provision of low level equipment or minor works is the most appropriate and proportionate way to do so; and
4. Whether any of the needs that the person appears to have are on-going (in which case an eligibility determination must be made and eligible needs met); and
5. Whether the provision of equipment or adaptation is the most appropriate and proportionate way to meet on-going needs.

Failing to assess in a holistic way increases the risk that:

1. Not all needs will be identified;
2. Unmet needs will remain after assessment;
3. Needs will not be met in the most proportionate and appropriate way;
4. Opportunities to prevent, reduce and delay needs (and promote independence) may be missed;
5. Opportunities to work jointly with others to achieve better outcomes for the person may be missed;
6. Ways to meet needs may not be explored from a strengths based approach; and
7. Opportunities to identify and support carers could be missed.

The Care Act does not require that a specific tool (or any tool at all) is used to support or shape the assessment process, but it does acknowledge that a good tool can be helpful. However, any tool should:

1. Facilitate and ensure the person's / carer’s involvement;
2. Support the information gathering process;
3. Be flexible and adaptable; and
4. Be appropriate and proportionate to the situation and needs of the person / carer being assessed.

See below for details of the tools that are available for you to use as required.

The process of establishing needs involves having a skilled conversation about:

1. Wellbeing and outcomes;
2. Needs; and
3. Risk.

You should consult with the person / carer and/or others when arranging the assessment to understand the specific communication needs that the person / carer has so that any assessment tool you use will ensure their involvement in the conversation.

If you do not feel that the assessment tools available to you will be appropriate you should speak to your manager about how they can be adapted.

Sometimes you may need to supplement the available tools with more bespoke tools to support the specific communication needs of the person / carer. For example, you may need to use photographs or pictures. This is entirely appropriate under the Care Act as it will ensure the involvement of the person / carer and will also support you to meet the duty to provide information in an accessible way.

Across the country and even within each Local Authority there are a range of models and frameworks used to support or shape the process of information gathering to establish needs. These are known as tools.

First and foremost you should have regard for any available practice guidance or good practice examples provided by the Local Authority.

The following are other tools available to you that may enhance any assessment conversations and accessibility.

tri.x has developed a range of person centred tools that can:

1. Support a person / carer to think about what matters most to them, now and in the future;
2. Support a person / carer to think about Wellbeing;
3. Support a person / carer to think about needs and what a good day/bad day looks like; and
4. Support a person / carer to think about what is working/not working about a Care and Support / Support Plan and any services or support they receive.

See: Resources for Person Centred and Strength Based Conversations.

Think Local Act Personal have also produced an online tool to support everything from preparing a person for an assessment, to having a skilled conversation and developing a Care and Support Plan through to review. See: Personalised Care & Support Planning.