An 8-Step Toolkit

The Core Methodology Underpinning Everything We Do.

Working with people with mental illness can be challenging but also immensely rewarding when done correctly. However, doing things correctly is often easier said than done, and when you have to take into consideration risk assessment, safeguarding, person-centred approach, dignity, choice, mental capacity etc etc… it can all become a bit overwhelming.

We have found that when it comes to care-planning, as well as any decision-making process, a methodical approach can ensure the support you deliver is to the highest possible standards. Here’s what we do…

  1. Gather Information
    Look at historical information such as old care-plans, PEN pictures, life history work and anything else that is already in the residents file. Use assessment toolkits to gather information about the service users needs and consult external reviews and reports. Most importantly, sit down and talk to the service user themselves; get to know them, build up a rapport and take notes.
  2. Identify and Contact Support Network
    Identify anyone who is already part of the service users support network, as well as your co-workers these will include professionals, family, friends, volunteers, day centres, advocates etc. Make sure you have up-to-date contact details for everyone and know when they should be contacted. Be mindful of confidentiality when sharing information. Make sure everyone who needs to be is “in the loop”.
  3. See things from their point of view
    Put yourself in the service user’s shoes and ask yourself what needs they have and what causes that need. What areas do they struggle with, what can they do independently and what do they need support with? It is important that this step is PERSON-CENTRED and recognises the service user as an individual and not a collection of symptoms.
  4. Identify any risks
    If left unaddressed is the service user at risk of harming themselves or others who come into contact with them? Is the service users able to avoid this harm themselves or is intervention required? Think about the situations the service user will be in and what potential hazards there may be.
  5. Decide how the current needs will be met
    Think about a way of delivering support that addresses the service user’s needs, and manages all of the risks, in a way appropriate to them and is the least restrictive possible. Does the support take the form of a medication approach? Change in environment? Psychological or emotional support? Remember to manage risks in the least restrictive way possible and take the service user’s mental capacity into consideration. The service users should feel empowered to take as much control of their own life as possible.
  6. Set goals for the future
    Setting goals is a good way of focusing support, measuring progress and empowering the service user, but only if the goals set are realistic and appropriate. Try to work in a timeframe so it is easy to see progress towards to the goal. Try to stick to goals as much as you can but remember that they are not written in stone and so if you find one of the goals you set become inappropriate or just needs changing, then do what is in the individuals best interest.
  7. Think about how the support will be delivered
    What form will the support take? Verbal encouragement? Active participation from the staff? Will it be on a daily basis? Weekly? As required? Put specific details into the support package about times, frequency and location of support, then think about the face-to-face delivery. A great care-plan only works if the service user engages with it and this is down to your therapeutic rapport.
  8. Monitor and follow up
    Ensure you record all relevant information as and when it happens and sign and date all entries. Accurate and up-to-date records mean progress can be measured, potential hazards can be spotted and best practice can be shared. Be aware of any other professionals you need to share information with but also bear in mind the limitations put on information sharing due to confidentiality and the service users own wishes.

Take your time and work through each Step in order.