Unit 20- Care Planning Process
in Health and social care
• Examine the influence of theoretical models and methods of
assessment and planning in practice in the workplace (L01)
• P1 Compare the different models of assessment and their
implementation in healthcare
• P2 Discuss the application of theoretical perspectives to the care
planning process in a healthcare setting
Assessment in Health/ social care
• Assessment ‘involves collecting and analysing information about
people with the aim of understanding their situation and determining
recommendations for any further professional intervention’ (Crisp et
• Characteristics of Assessment
• critical social constructionist.
• The process-focused group of definitions concentrates on assessment
as an essential, practical function that must be carried out with
professional sensitivity and competence. Of all the approaches,
process-focused definitions are the nearest to an implicitly technical,
even ‘scientific’, view of the assessment task as a set of methods to be
learned and professionally applied.
• Process-focused approaches vary on a number of dimensions. They
are more or less oriented to judgements based on professional or
organisational criteria and procedures more or less oriented to need,
eligibility, service user aspiration or resource availability more or less
oriented to care or control.
• The approaches also vary by their conception of assessment as:
• a distinct stage
• a series of distinct stages
• a fluid and dynamic process throughout the life of the ‘case’
• The contingent type has some similarities with the process approach
but is contingent in the sense that the nature and direction of
assessment is taken to differ according to particular independent
factors. It is implied either that the approach to assessment is
determined by a given independent factor, or variable, or that a given
approach to assessment is particularly suited to that variable.
Variables that are influential on assessment include:
• the type of service for which assessment is being made
• the goals of assessment
• the conceptual framework or map chosen to make sense of
• The contestation-focused type differs from process-oriented approaches in
not viewing assessment procedurally, but shares with contingent
approaches the recognition that other variables condition assessment.
However, the focus is on the conflict or contestation between variables.
Hence, the approach defines assessment as an area of contestation
between different policies, perspectives and priorities represented, for
• emphasis on need vs. eligibility
• social worker idealism vs. realism
• needs vs. risks vs. resources. (Scie, 2019)
Critical social constructionist
• The critical social constructionist type proceeds from the view that
the act of assessment involves the construction of meanings as
distinct from the determination of objective facts and causes of
problems. The understandings that constitute assessment are socially
constructed by those involved, reflect their contexts and may be
contradictory. The assessment made by the social worker represents
his or her construction of a narrative or story about the situation in
question and may, accordingly, reflect the perspective of the social
worker more than of the client. In the process, particular people
become defined as service users or carers and ‘clienthood’ is
constructed (Hall et al, 2003).
Models of assessment
• AS-SESS P-LAN I-NTERVENE R-EVIEW EVALUATE
• Most nurses are familiar with problemsolving approaches such as ASPIRE
(Assessment, Systematic nursing
diagnosis, Planning, Implementation,
Recheck and Evaluation) (Barrett et al,
2012). Though approaches such as this
guide us in what to do when care
planning, they don’t give much detail on
how to do it. For example, a problemsolving approach alone may not tell us
what questions a patient needs asking
during an assessment or what sort of
interventions to carry out.
Process of ASPIRE MODEL
Social Care needs Assessment : Well-being and
Meaning of well-being
• Securing rights and entitlements
• Social and economic well-being and suitability
of living accommodation
• For adults, it also includes control over day to
day life and participation in work
• For a child, it includes physical, intellectual,
emotional, social and behavioural
development and welfare
• New duty on local authorities and local health
boards to assess the need for care and
support in their area including carers
• Local authorities and local health boards
must produce an evidence base outlining
carers’ needs including range and level of
services required to meet need
• Must then publish a population plan for
carers and report to the Minister
Duty to provide a range of preventative
The range and level of preventative services
must seek to promote the well-being of
people who need care and support and
carers who need support
Common Principles of Assessment
The common principles for assessment
• That the role played by unpaid carers,
parents, partners and other family
members in an individual’s care and
support is recognised, and these are
appropriately supported and recorded
The Duty to Assess (Carers)
A local authority must offer an assessment
• Any carer where it appears to the
authority that the carer may have needs
• This is an important change, as previously
a carer could only request an assessment
The Duty to Assess (Carers)
The duty is triggered if it appears to the local
authority that a carer may have needs for
The duty to assess applies regardless of the
authority’s view of the level of support the
carer needs or the financial resources he or
she has or the financial resources of the
person needing care
The Duty to Assess (Carers)
An assessment of a carer must include:
• The extent to which the carer is able and
willing to provide the care and to continue
to provide the care
• The outcomes the carer wishes to achieve
• The local authority must involve the carer
and where feasible the person for whom the
carer provides or intends to provide care in
The Duty to Assess (Carers)
An assessment of a carer must also have regard to:
• Whether the carer wishes to work and whether
they are participating or wish to participate in
education, training, or leisure activities
• An individual must feel that they are an equal
partner in their relationship with professionals
• A local authority may combine a
person’s needs assessment with the
needs assessment of his or her carer
if it considers it would be beneficial to
However, the local authority may only
do so if valid consent is given
|Characteristics of the social model|
|Holistic care||Society evolves|
|Person centred care||Providing support mechanisms to meet
the needs of the individual
|Assessing needs of clients||Diversity welcomed|
|Providing reasonable adjustments||Training and workshops available|
|Professionals could involve social worker,
|Providing access to education, leisure,
employment interest etc
Identify barriers and making solutions
|Various resources made available to suit
the need of individual
Characteristics of medical model
This Photo by Unknown Author is licensed under CC BY-NC-ND
|Access to a variety of health care
Impairment is the focus of attention
|Person centred care ( within remit
|Focus on the illness and not the person|
|Provision of test, x-rays etc||Intervention based- Palliative care,
|Consultation||Doctor centred (Medical professionals )
|Access to multidisciplinary teams||Aim is to tackle health problems
Not concerned with other issues of
individual other than medical diagnosis
to health and social care
Evaluate the usefulness of psychological
approaches to health and social care
• There are many theories in psychology but some work better in certain areas than others.
Psychodynamic works best with people who have good communication skills.
How do you chose an approach?
Most care workers will be able to use a problem solving framework to help them decide which
approach to use. However, some care workers will specialise in certain approaches. Factors
which help them decide include:
What has worked well in the past
Approaches which give quick results
What training has been given
Age, culture and understanding of the client.
Evaluating approaches – looking at strengths and
• A care practitioner may choose from the theories to
help their client.
• It would depend on the nature of the client’s
concerns, the training and experience of the
practitioner and how comfortable the care worker felt
with using a particular model.
• To evaluate an approach, the strengths and
weaknesses need to be considered as well as the
impact it would have on a service user.
•The Behavioural approach looks at observed behaviour
•The Cognitive approach listens to the client
•The Humanistic approach listens to the client and gives the
•The Psychodynamic approach interprets what the person
says and does
In pairs think about the strengths and
weaknesses of each approach
Think of ONE health or social care example
where the approach would work
Behavioral theories only focus on observable behaviors
(rather than unseen, e.g. unconscious).
Forces in the environment and outside the person have
the primary influence on behavior.
The focus is on the present
Behaviors are shaped by the environment.
Applied Behavioral Analysis
• Behavioral therapy based on Skinner’s operant
• Requires careful analysis of the environments in which
problem behavior occurs.
• Careful assessment of the antecedents and
consequences of problem and non-problem behaviors.
• This information is analyzed by the therapist who then
describes to the child and important adults how the
child’s behavior is being shaped.
• Systematic desensitization (Wolpe, 1958).
• Used to treat phobias with a technique called reciprocal
inhibition = pairs a response that inhibits anxiety
(typically relaxation) with the source of the phobia.
• Explain how it works.
• Theory is easy to understand
• Experimental work to show how behaviour
• It’s objective and people can agree on what
is happening- only observable behaviour is
• Easy to put into practice – people do this
• Results can be quick and it is shown to work
• Doesn’t rely on communication skills so can
work with all ages and abilities
• Also easy to use on anxious service users
• Can “shape behaviour” gradually and a
person can develop “new” behaviours and
• Doesn’t label people as “abnormal” and so
avoids labelling people
• Doesn’t look at what is going on inside
someone’s head – makes it narrow and limited
• People can’t work on helping themselves as
there is no thinking involved
• Deals with symptoms not causes so can be
• Behaviours caused by anxiety etc can be
exhibited in other ways and behaviours –
• Time out and other methods of behaviour
modification can be seen as upsetting and
demeaning – how is it different from
• Manipulative and dehumanising – sees
humans as people who simply respond and
repeat actions which give them pleasure
• Deterministic – doesn’t allow humans choice
• Does it follow the care base values?
• Viennese physician trained in neurology.
• While treating patients suffering from hysteria, he began to
develop his theory of psychoanalysis.
• Freud worked with another physician, Joseph Breuer, from
whom he learned the technique of catharsis, the so-called
• The treatment of hysteria.
• Free association.
• Hypnosis (Breuer & Freud)
• Dream interpretation
• Gets to the root of problems
• Effective as it gives the client an insight
into why they think or feel as they do
• Can change many parts of their lives,
not just behaviour
• Been used for a long time and has been
seen to work effectively
• Can be used for a wide range of
problems including sexual disorders,
depression and eating problems.
• Tries to work out why irrational beliefs
arise which leads to many problems
being looked at all at the same time
• Theories very complicated to understand
• Practitioners need specialist training which may
take a long time – they view themselves as the
“expert” and only they can sort out the
• Client can get over reliant on therapist
• Theory is not based on science but how the
psychotherapist interprets what the client says
• Based on unconscious thoughts and
analysation of what people think and do
• Harmful as the insights can be very distressing
for the client
• False memory syndrome is controversial
• Deterministic view of life – we have little
control of our actions because of what has
happened in our early childhood
• Lengthy and costly
• Some claim it doesn’t actually work and it is
hard to assess or measure it’s success as an
• Theory is based on Freud who worked with
middle class patients in Vienna at the end of
the last century – how relevant are his
interpretations to modern life?
• Structured approach of understanding and changing
• Theory is easy to understand and process of theory
is understood – it makes sense to the client.
• Pays attention to what the client says – what the
person thinks and feels
• Therapist then looks for faulty or dysfunctional
beliefs which affects how the client behaves.
• There is no therapist interpretation or finding
• Direct approach
• Easy to learn and apply – clients can learn the
techniques and use themselves in other areas of
• Aims for independence of the client –
empowerment is key and so follows the care value
• Widely used in health care and can be applied to a
wide range of issues e.g. stress, anxiety, anger
• Cost effective and can be relatively quick
• Not suitable for all as it relies on good
language skills – the client needs to
be able to express their thoughts and
understand what the counsellor
wants them to do
• Hard to use with those that can’t
follow a rational train of thought
• Doesn’t deal with the underlying
causes of problems
• One problem worked on at a time
• Debate on it’s effectiveness – some
studies show it works, some show it
• Person centred
• Therapist is non intrusive – meet clients as
equals in the process and not as the expert
• Training is not dependant on other
• Doesn’t label client
• Follows the care value base
• Unconditional regard, empathy and
genuineness are qualities many health care
workers have already
• Centres around the thought that people have
choices and can change their lives – to
become much more than they are (self
• Can be applied to many situations
• Very positive view!
• Focuses on the short term nature of therapy
• Ignores innate problems that
could be causing behaviours
• Short term
• Client needs good
• Difficult to show effectiveness
• No uniformity in training
• Key terms difficult to understand
e.g. congruence, self
• Therapist has be non
judgemental to all people which
can be hard to obtain
Humanistic therapies – Carl Rogers
Based upon a phenomenological view of human life &
Ideas: genuineness, nonjudgmental caring, & empathy.
Every living being has an actualizing tendency to realize
The therapist has an attitude of respect.
• Congruence, unconditional positive regard, empathy.
• Unconditional positive regard
will I use with
this service user?
AM I trained and competent
In this approach?
Does it seem to fit the with the presenting
Does it fit with our
Care value base?
What are the risks?
Are these risks acceptable?
Will it work?
Has it worked in the
Is it cost effective?
Can I do an assessment?
What interventions can I use?
What questions should a care worker ask before using an approach?
• Investigate the models of
assessment and theoretical
principles used in your work
place in care planning
• Create a 5 minute talk to the
class on the purpose of
Anderson, R.M., & Funnell, M.M. (2009). Patient Empowerment: Myths and
Misconceptions. Patient Education and Counseling 79(3), 277-282.
DeJong, P., & Berg, I. K. (2013). Interviewing for solutions. Pacific Grove, CA:
Marty, D., Rapp, C. A., Carlson, L. (2001). The experts speak: The critical
ingredients of strengths model case management. PsychiatricRehabilitation
Rapp, C. A., Saleebey, D., & Sullivan, W. P. (2005). The future of strengths based
social work. Advances in Social Work 6(1), 79-90.
Scie.org.uk. (2019). Assessment in social work: a guide for learning and teaching –
The nature of assessment. [online] Available at:
ons.asp [Accessed 4 Oct. 2019].