Care Planning Process in Health and social care

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Unit 20- Care Planning Process
in Health and social care
O Okuwobi
Session 2
Objectives
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
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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
al, 2003)
Characteristics of Assessment
process-focused
contingent
contestation-focused
critical social constructionist.
Process-focused
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.
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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’
Contingent
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
assessment.
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Contestation-focused
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
instance, by:
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).
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Models of assessment
AS-SESS
P-LAN
I-NTERVENE
R-EVIEW
E-VALUATE
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
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Social Care needs Assessment : Well-being and
outcomes
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
Population assessments
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
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Preventative services
Duty to provide a range of preventative
services
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
include:
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
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The Duty to Assess (Carers)
A local authority must offer an assessment
to:
Any carer where it appears to the
authority that the carer may have needs
for support
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
support
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
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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 assessment
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
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Combining Assessments
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
do so…
However, the local authority may only
do so if valid consent is given
Social Model

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,
local authorities
Providing access to education, leisure,
employment interest etc
Relationship nurtured
Identify barriers and making solutions
Various resources made available to suit
the need of individual

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Characteristics of medical model
This Photo by Unknown Author is licensed under CC BY-NC-ND

Access to a variety of health care
professionals
Impairment is the focus of attention
Observation centred
Diagnosis centred
Person centred care ( within remit
medical facilities)
Focus on the illness and not the person
Provision of test, x-rays etc Intervention based- Palliative care,
therapy, etc
Consultation Doctor centred (Medical professionals )
MDT
Access to multidisciplinary teams Aim is to tackle health problems
Not concerned with other issues of
individual other than medical diagnosis
and symptoms.

Understand psychological
approaches
to health and social care
#
Evaluate the usefulness of psychological
approaches to health and social care
practice
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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.

assessment

 

Working
hypothesis

 

intervention

 

review

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
weaknesses.
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.
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•The Behavioural approach looks at observed behaviour
•The Cognitive approach listens to the client
•The Humanistic approach listens to the client and gives the
client choices
•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 Treatments
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.
Ivan Pavlov
John Watson
Classical conditioning
Operant conditioning
The focus is on the present
Behaviors are shaped by the environment.
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Applied Behavioral Analysis
Behavioral therapy based on Skinner’s operant
conditioning paradigm.
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.
Classical Conditioning
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.
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Behavioural approach
Theory is easy to understand
Experimental work to show how behaviour
reinforcement works
It’s objective and people can agree on what
is happening- only observable behaviour is
looked at
Easy to put into practice – people do this
approach “naturally”
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
skills.
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
short term
Behaviours caused by anxiety etc can be
exhibited in other ways and behaviours –
symptom substitution
Time out and other methods of behaviour
modification can be seen as upsetting and
demeaning – how is it different from
punishment
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?
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Sigmund Freud
1856-1939
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
talking cure.
The treatment of hysteria.
Free association.
Hypnosis (Breuer & Freud)
Dream interpretation
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Psychodynamic
Approach
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
Respectful
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
problems
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
approach
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?
Cognitive approach
Structured approach of understanding and changing
behaviour
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
“hidden meanings”
Direct approach
Easy to learn and apply – clients can learn the
techniques and use themselves in other areas of
their lives
Aims for independence of the client –
empowerment is key and so follows the care value
base
Widely used in health care and can be applied to a
wide range of issues e.g. stress, anxiety, anger
management
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
doesn’t
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Humanistic Approach
Person centred
Therapist is non intrusive – meet clients as
equals in the process and not as the expert
Training is not dependant on other
professional qualifications
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
actualisation)
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
communication skills
Difficult to show effectiveness
No uniformity in training
Key terms difficult to understand
e.g. congruence, self
actualisation
Therapist has be non
judgemental to all people which
can be hard to obtain
Humanistic therapies – Carl Rogers
Person-Centered Therapy
Based upon a phenomenological view of human life &
helping relationships.
Carl Rogers.
Ideas: genuineness, nonjudgmental caring, & empathy.
Every living being has an actualizing tendency to realize
their potential.
The therapist has an attitude of respect.
Nondirective attitude.
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Carl Rogers
Congruence, unconditional positive regard, empathy.
Congruence
Unconditional positive regard
Self-actualization
What approach
will I use
with
this service user?
AM I trained and competent
In this approach?
Does it seem to fit the with the presenting
Problem?
Does it fit with our
Care value base?
What are the risks?
Are these risks acceptable?
Will it work?
Has it worked in the
past?
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?
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Group work
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
assessment.
Reference
Anderson, R.M., & Funnell, M.M. (2009). Patient Empowerment: Myths and
Misconceptions.
Patient Education and Counseling 79(3), 277-282.
Doi:10.1016/j.per.2009.07.025
DeJong, P., & Berg, I. K. (2013).
Interviewing for solutions. Pacific Grove, CA:
Brooks/Cole.
Marty, D., Rapp, C. A., Carlson, L. (2001). The experts speak: The critical
ingredients of strengths model case management.
PsychiatricRehabilitation
Journal 24
(3).
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:
https://www.scie.org.uk/publications/guides/guide18/natureofassessment/definiti
ons.asp [Accessed 4 Oct. 2019].
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