Strengths-based assessments are a viable method of delivering more effective and sustainable adult social care but flaws in the approach need to be acknowledged, according to an influential discussion paper.
The Institute for Public Care at Oxford Brookes University has published a paper by former Department of Health social care finance director Professor John Bolton, which is a follow-up to his 2017 publication of a six-step approach to delivering effective outcomes and managing demand in adult social care.
Bolton visited six local authorities who claimed to be having some success in improving outcomes and managing demand across England – Coventry, Leeds, Manchester City, Somerset, Swindon and Thurrock.
He identified from their progress three key practice and organisational elements, which were:
- Asset-based or strengths-based practice
- A focus on promoting independence
- Outcome-based commissioning
Alongside these, the most important organisational qualities needed for effective implementation were:
- Vision and clarity on the role of adult social care
- Acknowledging the importance of staff – ensuring they were committed to the vision and had the freedom to innovate
- Committed and stable leadership
Bolton concluded from his research that strengths-based assessments did offer a more positive and constructive relationship with service users to share solutions, but the approach did have some limitations.
Success tied to community knowledge
Success, in terms of ability to help people, was very tied to the strength of the community services available and to the assessor’s knowledge and understanding of those services.
“It is still the outcome of the assessment that matters and the menu of options that are open to the customer and assessor from which to choose the best possible help. If the options are limited, then the assessment will be limited too. Those undertaking the assessment must have both a knowledge of the community services that might assist someone, as well as the help that someone might need from a care agency that will support them in the short term with an aim to assisting in gaining or regaining degrees of independence,” the paper states.
Secondly, the assessments did not ensure informal family carers could be better heard and supported. In fact, the approach increased the risk of a negative impact on carers.
“For some people their family carers are their greatest asset. There is a risk that this could be taken for granted in the strengths-based model, ignoring the carer as a person in their own right.”
He said assessments could often be rushed because of pressure on the system, however, carers usually needed a great deal of time and sensitive encouragement to discuss their needs in a way that addressed both the emotional stresses of being a carer as well as the practical challenges.
Finally, the assessments were often used to make long-term decisions, yet the conversations could only ever be a ‘moment in time’ with the assessor unable to really know the person.
Bolton promotes a ‘trusted assessor’ model working alongside a strengths-based assessment model where providers are involved in assessing and helping service users make longer term decisions once the service user is known and seen on a regular basis.
The paper also states that some of the councils in the research had seen success because social work staff had been empowered to drive innovation and develop community provision.
Social workers tasked with finding their own solutions
He cited the case of Leeds adult social care, where the director asked social workers to innovate and gave them three rules in doing so: don’t blow the budget, don’t break the law and do no harm.
Social workers were tasked with finding their own solutions to achieving better outcomes and this has so far included a new design for the referral and assessment form (reducing it from 21 pages to 2 pages), a new approach to peer support and new assessment arrangements in ‘talking point’ drop-in centres. Social workers also offer more support to those working in the initial contact centre.
The data indicates that despite increased referrals and demand, the number of Care Act assessments has been reduced.
Desired impact on finances and communities
However, Bolton also cited the approach by Coventry where social workers have been taken out of the initial assessment process to be replaced by occupational therapists with a sole aim of promoting independence. Only those with longer-term social assistance needs or safeguarding issues are referred to the social work team.
Finally, Bolton stated that many councils were not attempting to measure whether a strengths-based approach to assessment was having the desired impact on finances and on communities because it was felt to be too difficult.
“If the strengths-based model assists in developing a sustainable care model one might expect to find that fewer people are assessed as needing longer term care and that particular groups of people will less frequently enter the formal care system. This needs to be measured and monitored. It is accepted that to gain these results will take time,” he added.