Holistic assessment form (v4) guidance

Transcription

1 Holistic assessment form (v4) guidance

2 Before you start Holistic assessment (v4) guidance Contents Introduction... 3 Good practice... 3 Section A Key information... 4 Section B About the client... 4 Section C Origins... 4 Section D Housing / homelessness history... 4 Section E Care history... 5 Section F Benefits and finance... 5 Section G Legal issues... 6 Section H General physical health... 6 Section I Mental health... 7 Section J Drug use... 8 Section K Alcohol use... 9 Section L Education and employment... 9 Section M Client s own assessment of need... 9 Action planning

3 Holistic assessment (v4) guidance Introduction The Crisis/Shelter holistic assessment form is a tool for identifying and discussing issues with clients in order to plan solutions. Comprehensive and detailed information about the whole range of issues that may be relevant is a basis for action planning with a client and addressing needs in a holistic way. It is not a replacement for statutory assessments that require a clinical judgement. These notes are intended to provide guidance to key workers, as they are not expected to be an expert in every specialist field. However, key workers are in the best position to both develop a working rapport with clients and observe any changes over time. They are in a key position to both identify issues and then follow up and ensure the client, the project and other service providers take the action that is needed. Completing an assessment with someone is not a paper exercise it is about building a professional relationship. It implies taking responsibility in four key areas: If someone gives information that leads you to believe that either their safety or that of others is at risk you must take action this might mean that a risk assessment is triggered, or direct contact with the emergency services is made. The assessment process must result in a realistic action plan. The expectations of clients need to be managed, and people enabled to make changes and progress rather than used as test cases. The client and key worker both need to be clear about the boundaries of confidentiality. If information is recorded on the assessment form the client needs to be clear that it may be shared with certain agencies agreements on this can be identified in the action planning. It is the key workers responsibility to ensure that the confidentiality policy is explained in such a way that the client understands it. Good practice It is good practice to fill in as much information from existing records and check this through with clients. It is useful to know the form well enough so that it is easy to jump between sections in order to accommodate the flow of conversation. Many subject areas are interrelated; for example drug or alcohol use will have a big impact on someone s finances. Also different questions come at subject areas from different angles. If there are inconsistencies in information this is not necessarily an indication that someone is deliberately lying. It is human to hold contradictory pictures about ourselves in different aspects of our lives. The assessment is not intended to be an interrogation, but a way of working for change with people from where they are. If a client is not comfortable with an area of questioning then move on and possibly come back later. Filling in the assessment is about negotiating priorities for action and support to make it happen. This requires a balance between being assertive and realistic so that clients can take responsibility at their own pace. The assessment does not always directly ask questions about areas where someone might need support to take action. However, it is designed so that key issues for people will come out. For example: Questions about finance might bring up the need to develop numeracy skills or the life skill of budgeting 3

4 Questions about previous housing history, or relationships might bring up the need for anger management support. The assessment may take over an hour sufficient time needs to be set aside. The form can also be completed over several sessions. It is best to complete the form in a quiet location where the client will not be overheard and feel at ease. The assessment should not be used to collect information for its own sake it is about identifying action. Review dates need to be set to ensure that action is tracked and followed up. Section A Key information The first page of the assessment gives key information about the client at a glance. It is probably best to fill this part of the form at the end of the interview. The national insurance number will ensure that it is possible to follow up benefit claims on behalf of clients. The contact person in case of emergency should be next of kin if possible. It is important to be clear what constitutes an emergency. For example: Emergency = a situation that is life threatening for the client and where they are unable to make their own wishes known. Contact details for other case or key workers (probation officer, resettlement worker etc) may be useful to ensure information about key circumstance changes are shared, that agreed action is followed up and to ensure work is not duplicated. Section B About the client This section should be filled in from existing records and checked for accuracy with the client. Section C Origins This section is useful to put client at ease; it is a neutral way of getting someone to begin his or her life story. It could lead to details about connections and contacts that might be part of the solution. It might identify possibilities for a family mediation approach with someone. It is important to consider how formal and informal support structures will play a part in identifying the optimum solutions with a client. However, family history might be the root cause of someone s homelessness. It might be a painful area to talk about, in which case concentrate on the homelessness history. Section D Housing / homelessness history The housing history of a client can provide a valuable insight into patterns of homelessness and suggest where previous resettlement plans may have failed. It is important to demonstrate a local connection in order to establish that agencies have a responsibility to provide services. In particular the housing department will usually consider whether someone has a local connection as part of their assessment of statutory duty. Local connection is interpreted more of less strictly in each area. It generally consists of: length of time living in an area immediate family connection 4

5 a historic connection. Local statutory services are not legally restricted from providing services to people who do not have a local connection. In terms of housing, only a local connection elsewhere can legally restrict the access to a housing application. The new categories for priority need have been extended in the Homelessness Act 2002 to include for the first time: people who are vulnerable as a result of spending time in the armed forces or having been in prison or remanded in custody people who are vulnerable as a result of fleeing violence (or threats of violence) all 16 and 17 year olds unless they have been in care then they are the responsibility of the social services department (see below). It is important to discover why people have left their housing as this may impact on the housing options open to them, for example previous arrears or a decision that someone became intentionally homeless. Section E Care history If someone has been in care it might mean there is more leverage available to access services. Previous key workers may be able to assist in developing an action plan. Also, extended categories of priority need in the Homelessness Act include: care-leavers aged 18, 19 or 20 years old who were looked after, accommodated or fostered when aged 16 or 17, and who are not students. people aged 21 or over who are vulnerable as a result of being looked after, accommodated or fostered by the local authority, and who are not students. if someone has been in care or accommodated by social services they may be exempt from the housing benefit single room rate if they are under 21. Section F Benefits and finance This section first covers the benefits that a client is receiving. This is to ensure that people are receiving their full entitlement. For example if someone has health problems, are they entitled to disability living allowance? If a client has no ID it is important to provide them with the advice or practical support to get some. Ultimately clients will need at least two forms of ID to access Housing Benefit or open any type of bank or savings account. If a client had absolutely no ID then they may need support to obtain a duplicate birth certificate from. With this the benefit office will be able to issue a National Insurance number and your client can get a passport. A duplicate birth certificate can be obtained in four ways: By going in person to the Family Relations Centre, 1 Myddelton St, London, EC1R 1UW during office hours. A fee of 6.50 will be charged and the duplicate will be sent after four working days. By going in person to the Registry Office where the birth was registered. A fee of 6.50 will be charged and the duplicate will be sent after four working days. By applying in writing to the General Registration Office, PO Box 2, Southport, Merseyside, PR8 2JD. Payment of 11 must be included for a response within 3 4 weeks. 27 must be included for a response within two working days. Telephoning fees as above will have to be paid by credit card. 5

6 The general enquiry number is It is important to work with clients to address financial matters. Talking through income, expenditure and debt liability can bring a wide range of issues to the surface, and point to areas that need to be worked on. For example it might illustrate how someone needs support on budgeting, that they have a gambling problem, or that particular habits are taking all someone s energy and resources to sustain. Looking at financial realities can open up the options where people can begin to make different choices about their lives. Debts, particularly rent arrears can always be negotiated to a level where their impact does not continue to contribute to homelessness. It may be useful to talk through alternatives to obtaining income from legitimate sources. For example, although begging is not strictly illegal, it may be useful to talk through the alternatives e.g. benefits, employment, training or the Big Issue. The aim should be to move people towards thinking about the longerterm picture. Section G Legal issues Clients are often reticent to engage with services because there are outstanding legal issues they are afraid will result in them getting refused or caught. Someone s perception of the legal trouble they are in may be totally disproportionate to the actuality. It is important to enable clients to deal with pending legal issues in order for them to be able to engage with resettlement and rebuilding their life. Ideally clients will choose to tackle their outstanding warrants. This may require more specialist legal advice. This section can also highlight if there are other agencies already working with the client. Though it may seem contradictory, sometimes it is a huge achievement to get someone to return to prison. Section H General physical health If someone is not registered with a GP then they should be supported to register. Ideally this should not be a temporary registration. Often people think they are registered but are not, as a temporary registration has come to an end. As GPs are the gateway to other NHS services, registration is very important. Everyone living in the United Kingdom has the right to register with a GP, even if they only have a temporary point of contact address such as a hostel or day centre, the GP s address or that of the health authority. To register, a person must first identify a GP. The person needs to choose a practice, find out the opening times and visit or phone to make an appointment to register. At the surgery the person will be asked for: address/contact point date of birth medical card. A medical card is not needed to register with a GP. If the person has a medical card, it should be handed to the new GP. If not, a form (FP1) should be completed at the surgery which will enable the health authority to provide one. In either case a new medical card will be issued. If the person prefers a woman doctor, or one who speaks a particular language, the health authority can provide details of any such surgeries in the area. There are two types of GP registration. Until recently many homeless people were usually only registered temporarily but this is changing. 6

7 Permanent registration If a person has been living within the GP s practice area for three months, or has reason to believe that they will be doing so, they should be registered as a permanent patient. Temporary registration This allows a person to be taken onto the GP s list for a three-month period and should apply only if a person will be staying for three months or less within the GP s practice area. There are important differences between temporary and permanent registration. Temporary registration does not: enable the transfer of previous medical records to the GP, for example records of hospital treatment enable a medical card to be issued to the patient ensure continuity of care. A GP has the right to refuse to register any patient, without giving a reason. If anyone has difficulty in finding a local GP, or in registering, they should contact the health authority or Community Health Council. The health authority can allocate a patient to a GP, which obliges the GP to temporarily register them. To do this, an allocation form, which can be obtained from the health authority, should be filled in. Allocation takes up to 14 days. GPs are on a rota for allocation, and the GP assigned may not be the nearest. GPs have the power to remove a patient from their list, but if they do so they remain responsible for that patient s care for 14 days. GPs have the power to remove violent patients from the list immediately but if the patient has or might have a mental illness, their needs should be addressed before the decision to remove them from the list is made. If a person is not registered and becomes ill, they can go to a local GP. They have a right to treatment for up to 14 days. During this time they are entitled to the same treatment as a registered patient. If someone is registered disabled or should be then this will have an impact on their benefit entitlement as well as the type of accommodation that will be suitable. However, they may also have disabilities that affect the type of support they need without being registered. For example, conditions such as recurrent chest problems, asthma and diabetes should all be taken into account when considering accommodation needs. The main purpose of asking about a client s medication / prescription is to check that it has been reviewed recently and that the client is clear what they are taking and why. If someone is continuing to take repeat prescription or is unsure what their medication is for, it may be a good idea to ensure they clarify these things with a GP. Some medication (for example methadone, diamorphene, sleeping medication, anti-depressants or some pain killers) are valuable. They may be liable to be stolen or sold. Supporting a client to keep medication secure may be advisable. A client may need advice, support or advocacy to get the best out of their GP and ensure they are getting and understanding the optimum treatment. Section I Mental health The responses to the questions in this section are designed to give a clearer picture about the client s mental health. It is not a diagnostic tool, or intended to replace qualified assessment. However, it will provide an indication if someone needs support, and the type of detailed language that professionals will understand about someone s symptoms. 7

8 Responses could produce a variety of outcomes including referral to a mental health worker / GP. If you feel that a client is a risk to themselves or others you must take, and note down, the appropriate action that is identified in your risk assessment policy. Although the responses might suggest that the client is experiencing symptoms of mental distress, it is worth bearing in mind that there could be other explanations (use of alcohol or drugs, physical health problems): felt so low you did not want to get out of bed feelings of low mood, lack of energy, melancholy and hopelessness may be an indication of depression had problems sleeping or getting to sleep disturbed sleep may indicate depression, especially if the client is finding it easy to get to sleep but is then waking up early in the morning (possibly feeling very anxious) felt cut off and distant to things going on around you slowing down of mental and physical activity, withdrawal from social relationships should be noted as they may be symptoms of mental distress felt panic, extreme fear or shortness of breath panic attacks involve a rapid build up of anxiety, may include feelings of faintness and a fear of losing control wanted to end your life or harm yourself a client who has recently had thoughts about self-harm or suicide should be seen as someone at risk of harming themselves; a risk assessment should be carried out and any other workers involved with the client may need to be notified acted on these feelings gain more information about this as part of the risk assessment. Ensure that you pass along this information and develop an action plan in association with colleagues. Take this seriously. felt as though people were talking about you, watching you or making plans to harm you the belief that you are being persecuted may be an indication of mental distress, but it may also reflect a reality of homelessness especially if the client has been assaulted or threatened while on the street or in a hostel heard someone speaking to you when you are on your own hallucinations can be disturbing and unpleasant, particularly if what is being heard is critical or will not stop. If a client who reports hearing voices frequently is not already seeing a doctor or a mental health worker this could be an opportunity to suggest getting some help. Alongside the responses to these questions it is useful to record any changes you have noticed in the client over time, e.g. changes in mood, changes in the level of self-care or changes in sleep patterns. This information could also support your case with professionals or at multi-agency panels. Section J Drug use This section is designed to provide information about whether a client needs specialist support with regard to drugs. It should also be an opportunity to identify any areas where a drug lifestyle is holding someone back. Detox and rehabilitation is only effective if someone has made the decision to seek and accept help. If a client expresses a commitment to seek and accept help this should be the strongest recommendation to get a service response, even if they have not fully succeeded in the past. Exploring any previous history of treatment is useful to establish why previous attempts to get on top of a substance misuse issue have not been totally effective. Different approaches to addressing addictions work for different people. 8

9 If a client clearly has some problems arising from their drug use, but is not yet prepared to admit that drugs are a problem, it is probably better to focus on other areas of support needs or look at harm minimisation strategies. For example: eating healthily needle exchanges financial planning ensure that the client is persuaded to be honest about their consumption with their GP agree a future time to take another look at the issue a fresh. However, it is also important to be aware that a lack of readiness to address drug use may impact on the effectiveness of other measures, and the willingness of agencies to get involved. Drugs and alcohol should be looked at in conjunction. Section K Alcohol use See Section I Drug use Section L Education and employment This should identify the potential that someone has to take advantage of existing training and / or welfare to work opportunities. It should identify if there are particular barriers that could be addressed in order for people to access the training that exists. Section M Clients own assessment of need This section is to bring the conversation back to the clients own priorities in preparation for action planning. It is useful to prompt people to talk about their big dreams, but also some practical steps that will set people on a path towards their own goals. Action planning Key points to remember: agree on bite size chunks of action that can be achieved, for example getting a permanent registration with a GP or obtaining two types of ID ensure it is a joint action plan and that the client and key worker are clear on who is doing what and by when include a review date in order to track progress and identify further action. 9

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11 64 Commercial Street 88 Old Street London E1 6LT London EC1V 9HU Tel: Tel: / Fax: : swatip@shelter.org.uk enquiries@crisis.org.uk 2: theresa_zlonkiewicz@shelter.org.uk Website: Website: Crisis UK (trading as Crisis). Charity no Company no Registered charity number Company number