The Good Assessment Handbook

[Introduction]  

This is a Research in Practice podcast, supporting evidence informed practice with children and families, young people and adults.

Georgina: Hello, and welcome to this Research in Practice podcast. My name is Georgina Chetwynd, and I'm a Research and Development Officer with Research in Practice. I'm delighted to be joined by Gerry Nosowska, and we're going to be talking today about the Good Assessment Handbook. So, this was first written by Gerry in 2014, and has been a really popular resource on our website, but she's recently made significant updates to it, and so we're going to be unpacking it for you today. It's written primarily for adult social care practitioners, who are completing assessments under the Care Act.

So, as well as writing the handbook, Gerry is the founder and director of Effective Practice, which supports organisations to improve social care. She was also the chair of the British Association of Social Workers, which is the professional association for social workers, from June 2018 to June 2022. As well as this, she was a service manager, team manager and social worker in community and integrated teams in England. So, really pleased to welcome you today, Gerry. Thanks so much for joining me.

Gerry: It's great to be here.

[The background to the handbook]  

Georgina: I was wondering if we could start off, perhaps, by hearing a little bit about the background of the handbook and how the project started, and how you got involved.

Gerry: Yes, so, the handbook, initially, as you said, it came out in, was created in 2014 to 2015, which was just at the time that the Care Act 2014 was coming into force. It started officially in 2015, and so the assessment handbook was part of the change project that partners asked us to do. A, kind of, action research project to support them with the implementation of the Care Act. One of the biggest things about the Care Act is, of course, the assessment of care and support for adults and carers, and so that was an area that they really wanted us to focus on, because the work that had been done to, kind of, lead to the Care Act or the policy work and the discussions with experts who were quite experienced in the research pointed to some issue around assessment and, under the previous law, the assessment was very much driven by needs and we're moving into looking at outcomes and looking at, kind of, strength based work. Much more self-directed work. So, there was a big shift happening and big legal and policy shift. So, it was a really good time to do the handbook, and it was-, although I wrote it, it was based entirely on other people's work to be completely honest.

So, there was a change project of partners who came together into a development group, seven local authorities, and they brought all of their expertise and their experience around assessment, and all of their, kind of, hopes and learned wishes about how assessment would work well. We had lots of input from research and voices from people with experience of assessment, and we also used other research around assessment. That development group met three times and we looked at what a good assessment is, what a good assessor looks like and what good support for assessment looks like. That formed the basis of the handbook. It's amazing, actually, to think that that was, kind of, six or seven years ago, now. So, it is really timely to review it, and to look at all the tools and resources that we put together and put in the handbook at that point, and to think about, you know, what's the most useful thing now. 

So, again, we had input from partners around that, and we did another look at the literature, look at the policy and the guidance, and brought in lots more examples of, really, how assessment works, now. At the time when we wrote it in the first place, it was all about how assessment might work. Now, it's about, you know, what's actually happening in practice.

[Updates to the handbook]  

Georgina: That's great. Thank you. I think you acknowledge at the beginning of the handbook that since it was first written in 2014 there have been really significant changes in adult social care. So, I was wondering, kind of, what some of the key themes are that you've updated in the new handbook?

Gerry: I mean, the major thing that's happened really is that the Care Act had been implemented and embedded. So, that has, I think, led to a shift in practice and also to lots of developments in the way that practice works. So, the major practice themes, now, are, you know, built on what was happening before, and, really, around co-production and around strength-based work. So, really focusing in on supporting people to have conversations about what's important to them and what matters to them, and to bring that into the assessment and to look at outcomes with them, and to look at what might support them, as a co-produced endeavour. So, I think that's been one of the things that, hopefully, comes through in the new edition.

The other things that are really at the forefront of social care, thinking at the moment are equality, diversity and inclusion. So, there's much more in here about that, and about the work that's been done in the sector to really try to be more inclusive and to be anti-oppressive. It's to really challenge racism, for example. There's been a lot of work happening, still is, with Research in Practice around intersectionality and thinking about people's identity and experiences in a real, kind of, rounded way.

The other thing, of course, is the changes in the context that we've had with adult social care. So, the research around the implementation of the Care Act is really clear that it's hampered by constraints and resources, and everyone working in adult social care is really aware of that in that in their, kind of, lived experience. We've had austerity and we've had cuts to local authority resources over the time-frame in which the Care Act has been operating. So, that's something that impacts, not only on assessment but also on assessors and the, kind of, support that they need. So, we've tried to really reflect that, and the other thing, I think, is, you know, the COVID pandemic has accelerated technological changes in practice. So, there's a section in the handbook about approaches to assessment which talks about the different, kind of, ways that you would have those conversations with adults and carers and we do a lot more work now, virtually, than we would have done even a few years ago.

Georgina: So, it sounds like there have been some really significant changes and updates. I'm particularly interested in hearing you talking about, you know, the focus on intersectionality and anti-oppressive practice, now. Also, the focus on co-production. 

Gerry: Yes, the other thing that we've done is we've brought in more sections around specialist considerations around assessment. So, the handbook applies to any assessment with any adult with any carer, but there are particular considerations around how you work with people who are experiencing particular situations, or who have particular, kind of, things going on in their lives. So, we've got sections around considerations about young carers for example, working with autistic adults, working with people with an acquired brain injury, people living with dementia, people in prison. So, it's, you know, just some of the examples. So, there's not great detail there, but what there is - there's a lot of signposting, and hopefully will enable people to think not just about not just about assessment in the round, but also the particular person in front of them, if they're experiencing something significant, where there's good research, or good evidence or good information from Research in Practice that they can go to, that they'd be able to use the handbook, also, as a, kind of, signposting resource.

[The structure of the handbook]  

Georgina: So, perhaps it's a good time to - it leads on nicely to thinking about how the handbook is structured. I'm very aware that some people who are listening to this might be, kind of, very used to using the handbooks, but some people might be new to using the handbook. I know that you mentioned at the beginning that it's structured around the three key themes: the good assessment, the good assessor and support for assessment. Have you got, kind of, top tips for people in terms of navigating the handbook and finding the information that they need?

Gerry: Yes, we tried to make the handbook really easy to dip into and to find useful information that you might want to. It's an electronic resource, of course you can use the search function, which does help you. There's also, hopefully, fairly clear heading and sub-headings that, kind of, help guide you to the right place, the place that you're at. There's a context section at the start, which gives a, kind of, overview of the law and the context to assessment. The, sort of, practice of assessment. So, that's quite a good place to start as an introduction.

The good assessment section has a lot around the, sort of, practice approach, and the ethics of assessment and then talks you through steps to doing a good assessment. So, there's building a relationship, gathering information, analysing the information and then acting on it. So, that's a way of, kind of, thinking through your assessment practice and where you might be in an assessment that you were doing. That's also where you'd find the, sort of, specific elements of assessment that need to be considered. So, I think that's quite a good place to start.

The Good Assessor section is much more about your professional development and the, kind of, capabilities that are needed, and again all that signposting to different sorts of resources that might help you. The good support for assessment is aimed both at assessors and organisations around the, kind of, conditions that help them do good assessments. That's working conditions, supervision, issues around work load; those kind of things. In terms of top tips, having a look through the contents and the introduction but which says, 'This is really what it covers and how you might use it, and who it's for.' That's quite a, kind of, useful, two page overview of the way that it works, but there's also, throughout the handbook, there's some highlighted main messages and reflective points, so that's things you could just, kind of, home in on. 

We've got exercises in that which have been created with people who work in assessment and with our partners so those are things that you could take out and use, either in an assessment or in learning and development, and there's also good practice suggestions and examples that, kind of, help you think about how other people are doing things and how organisations are working. I think probably one of the most useful things is the signposting, as well, through to other resources, so you can dig a bit more deeply into the things that you want to. So, hopefully people will use it both as a, kind of, reference point, either to support them to learn or to just reinforce the way that they're working. I think particularly for the law and the ethics it's a really useful reference guide. Also, as something that they can pull out a particular element of assessment or a capability and reflect on that themselves, or think about that in supervision or with colleagues. Or, you could absolutely use it as a learning resource.

[Who is it useful for?]  

Georgina: Well, Gerry, thank you so much for explaining that to us. It sounds like it's great that it can be used in such a, kind of, variety of different ways. It sounds like it can be a really useful resource for people at different stages of their career, too, from newly qualified social workers through to, kind of, managers.

Gerry: Yes, absolutely, and that was one of the ideas behind it, when we were initially working with the development group to think about who the handbook was aimed at. We really wanted it to be something that assessors themselves could use, so that as any social care practitioner who might be carrying out an assessment, so there's just a real diverse group of people who do that. As you say, from people who are brand new into adult social care, through to very experienced practitioners, and also people with different professional backgrounds. So, the idea was that you could take it as a, kind of, foundational textbook, I suppose. A foundational handbook. You could also build on that and use it for reflection so that you could, kind of, identify your own development and where you wanted to strengthen your practice. You could also be signposted onto additional things. One of the things, just to mention is that there is a set of capabilities in the handbook around assessment, and there's also a learning needs analysis, and an action plan, so that you can be thinking about your own practice and where you want to extend your practice. So, for example, when I was writing it, I had quite a lot of professional experience of assessments, but one of the areas that I was particularly interested in was the ethics behind assessments and behind the law. So, if it had been me as a practitioner, I would probably have wanted to, kind of, use that as a focus for my professional development. So, I think, you know, one of the things we know in adult social care is that people are always learning, and practice is always evolving. So, it's really good to, you know, kind of, be thinking about where you are and where you want to go with your practice.

[Key themes in the handbook]  

Georgina: Yes, that's so true that practice is always evolving and the context is always evolving.

I was thinking about this podcast, Gerry - I was thinking about examples of people coming to the handbook. Kind of, questions that they might have. I was thinking about when I was a newly qualified social worker. So, I was a children's social worker, rather than an adult social worker, and thinking about, kind of, that very first home visit that I did where I needed to do an assessment. I was wondering, Gerry, if I could ask you if you take yourself back to when you were a newly qualified social worker, on the doorstep of your very first assessment, are there, kind of, top tips that have learned from doing the handbook that you'd like to tell your younger self?

Gerry: That's an interesting question, isn't it, and, amazingly, even though it's a really long time ago, I qualified twenty years ago, I still do remember those first assessments. Either, out in the community, or I was also a hospital social worker, so going into the ward to meet with people. There is-, and I think it's right that there is-, a, kind of, element of anxiety about that, because you're going into a new relationship with somebody in a situation that you don't know about. I think the things that this handbook and the work that I've done on it has really helped me reflect on are, you know, the emphasis on that relationship. I know that's a, kind of, truism that we talk about all the time in social care, but it is relationship based. When you're going to see someone and you know you've got to get, kind of, a job done, and you've only got a certain amount of time, the pressure is on you to move away from that relationship focus and to be focused on the task. The task only happens through the relationship. So, I hope that the handbook's, kind of, clarity around assessment starts through building a relationship, and that that's, kind of, the first step. Anything else that you want to do, the information, the analysis, the decisions, all of that follows, or comes from that relationship. I hope that that would be something that people would really take away, and that's really resonated with me.

I think the other things in the handbook, kind of, doing the work with partners and looking at the research and the lived experience around it - one of the things that, kind of, jumps out as well is the importance of seeing the experience through the eyes of the person that you're assessing, and what that feels like for them. So, there's an exercise around understanding responses to assessment. There's a section on ethics, as well, which I think really help to think through what that experience of assessment is like for the other person. Certainly, when I was a newly qualified practitioner, or new in a job, again, there's a tendency, isn't there, to kind of, be focused on your own experience, because it's quite a big deal to go and assess someone. So, having that, again, permission and encouragement and reflection around thinking about the other person and thinking about it through their eyes. Looking at their experience, I think, is a really positive thing.

I suppose, the final thing is, you know, assessment ultimately is underpinned by law. So, there's really good practice that has grown up around it. It draws on ethics and the law, of course, is underpinned by ethics as well. We do really need to have clarity and a really sound understanding of what the law actually says to keep our practice on the right track, but also to be able to be an advocate for the person that we're working with and to be able to say, 'These are your entitlements. This is how it looks. This is the kind of thing that we need to talk about, and this is why, and this is what we're hoping to get to, for you.' So, that advocacy role requires really sound legal knowledge. Again, in the handbook we've had support both from people working in the field, but also from people who've written about the law. So, there's stuff in there about legal literacy from Braye and Preston-Shoot. There's thing in there around the detail of the Care Act from Pete Feldon, and I think that's really helpful as well, because you've got to kind of, have that sound reference as well, back to 'What's my mandate here?' Again, for a new person coming to assessment, having that clarity about what your role is and why it's okay to go and have this conversation with this person, and just, kind of, I guess, in some ways push yourself into their life. You know, to have real clarity about what is the mandate for that? What is the legal, kind of, basis for that, I think, is really important.

Georgina: Thanks. So, yes, that's three really, really important points. The importance of relationship building and, kind of, everything else flowing from that. The importance of being able to see things from the other person's perspective and the, kind of, legal mandate for the work that we're doing, are really crucial.

I think just reflecting on what you were saying about the importance of relationship building, and there are definitely certain themes within the handbook that resonated with me-, thinking particularly about strength-based practice, and what you were saying in terms of when, you know, I was feeling under pressure with lots to do. It was much harder to focus on that, and easier to focus on, kind of, just the needs and the presenting problems, but I think you talk about ways to support social workers in a strength-based practice in terms of supervisory support, being able to take a step back and think about the bigger picture and draw out the strengths within the families themselves. Are there any other, kind of, key themes in the handbook that have deeply resonated with you?

Gerry: My favourite section is the ethics of assessment section, and the themes within that, I mean, they're huge themes around, as you say, building on people's strengths, bringing out the, kind of, individuality and then the person-centred approach. But also, kind of, reference in there to anti-oppressive practice, ethics of care, big ideas around how we relate to people. I mean, that's one of the things that excites me about social care, is that the capabilities are skills and knowledge and ethics, so there's a real strong element to all of our work about not just how to do it well but why are we doing it at all? What is the framework in which this sits? As I said, you know, there's a legal framework and that is underpinned by human rights ethics, and the practice frameworks, whatever guidance we're following, whether we're using this handbook or other resources to think about what guides our practice. They are underpinned also by the values that we hold, again, the why. Why are we doing this? What is it that we're really hoping to achieve? It's really important to think about that, but it's also really fascinating, because it all comes back to how humans want to relate to one another in a society. So, why would a practitioner be spending time talking to an adult about how their life should be, or how they want their life to be? It's because we have a shared understanding of what a good life looks like, and what thriving looks like, and that's then built into law and practice that we undertake. So, kind of, going back to that, I think, is really important and really interesting.

The other thing, just in terms of what, kind of, resonates with me in the handbook, there's a section in there now, as I said, about virtual working. Again, that draws on some other work that I was doing with Research in Practice around virtual conversations, and that's been a really fascinating development in practice. Again, goes back to, you know, not just how we can work with adults and carers and the range of options from texting through to video conferencing through to phone calls to face-to-face visits, and the blending of that, but again, probably more interestingly and more importantly, why? Why would we use different methods, what's the best approach to having the conversation that that adult or carer needs to have with us, and getting to the place that we need to through that relational work. So, that's been, I think, something that's developed through quickly through the Covid-19 pandemic, but has, kind of, tapped back into that fundamental question of why do we work in the way that we work? And given us reason to, kind of, question that and think about the different approaches that we could have to that conversation. And again, all of that helps you reflect on why we have this conversation in the first place. So, yes, it's that underpinning why that is most interesting to me.

Georgina: That's so interesting, thank you. Yes, it's really important, really helpful for us to be able to take time, take a step back and think, 'Well, why? Why are we doing this? Why are we working in this way? Are there better ways of working?' And what do we hope to achieve through doing this? And I guess that takes us right back to the well-being principle of the Care Act and wanting to see other people thrive.

You were also talking about, kind of, the context of austerity and time pressures and resource pressures, and perhaps, thinking about social workers who listen to this and are feeling - well I could definitely see myself in this position sometimes, of feeling I really want to be able to take a bit of a step back, to practise more reflectively, but there's so many situations going on, I'm needing to be in crisis mode all the time. Are there any, kind of, areas of the handbook that you could point them to, to help them be able to take a step back and practise more reflectively?

Gerry: One of the things I hope comes through clearly in the handbook and certainly came through clearly from the development group when we were putting it together is that assessment isn't, kind of, a solo activity. You're assessing in context, and that's why there's the sections around understanding what good assessment is, and understanding what a good assessor is. But also, what's the support? What does good support for assessment look like? So, that section on good support for assessment, that's, I hope, a place that people can find some strategies, organisationally and individually, to support the work that they're doing. And the fact that this is really pressured time for this kind of work. I think the responsibility primarily lies with the organisation to support people who are going out and doing this work with adults and carers, however, what we wanted to do as well is give people who are in that mix things to ask for. The point is to-, the things that they need, the supervision, you know, being able to talk to their manager about their workload, having learning and development opportunities. Because, although we know those things, you know, it's very well documented and researched, isn't it, that support for people working in adult social care is absolutely crucial, and what good support can look like in pressured environments. Some of that disappears, and people don't prioritise challenging for that and asking for that and ensuring that that's in place. I think that's partly because we've got a very altruistic workforce who prioritise going out and doing the practice work above their own support. 

I think it's also because organisations are under pressure to meet their statutory expectations and that makes it very hard for them then to prioritise the supervision and the professional development and the other things that are needed, and to manage the workload. That said, you know, again, I hope the handbook is just another voice in that discussion that's saying, 'We have to prioritise support,' because everything else depends on it. You know, people can't do good, ethical practice work without having that support in place. So, that's one of the things. I think also, having something to refer to that, kind of, gives you some confidence that the kind of practice you're doing is actually on the right lines. That can be really reassuring, because of course, when you're busy and pressured, you can start to lose confidence in your capabilities. The other thing that I hope is in there is something that will support the best use of the time that you have. So, you know, we do know the context at the moment and the expectations around the context are that it's going to be maybe potentially even more difficult because of the cost of living crisis. You know, we know that, within that, practitioners are going to be really constrained for time and resource with people. So, there's an element of that which is about advocating nationally for the right, sort of, conditions to do good social care, but there's also an important element around making the best possible use of the time that you have, which is why there's such a focus in the handbook on relationship building. And also hopefully tools and reflections that will support you to ask the kinds of questions, and gather the information and do the, kind of, analysis that will help you make the best possible decision within the constraints that you have. So, you know, if you're going out to see someone and you only have a limited time, for example, in the handbook, there's top tips from people with lived experience about what they hope their assessor would do, what sorts of things they'd ask them, the sorts of ways that they would approach it, which will maybe help with building the relationship so that, you know, you can get onto a sound footing at the start. 

And then there's reflective points in there about thinking again about that person's experience, the kinds of questions you would ask them that would actually get to the bottom of what their strengths are, what the barriers are that they're facing that would really, kind of, tap you into what are the human rights elements of this work that we're trying to do? Then, you know, hopefully the steps around assessment with help with that ordering of information and analysis so that you can come to a good judgement. Because what we're talking about, in a pressured environment, is people using the time they've got as appropriately and, kind of, proportionately as possible, in order to get the best information they can for the best decision they can make in that circumstance.

One of the decisions that's important in assessment is, do I know enough to make a decision that is going to be helpful to this person? You know, that's a discussion that hopefully people have with their supervisor, maybe with their colleagues, but it's not, have I done everything possible? Because everything possible is-, the constraints around assessment mean that you can't do everything possible, you have to be thinking about what's reasonable, what's enough, what's the best that I can do in this circumstance? So, again, hopefully the handbook can help with that kind of discussion. It's a very real dilemma, isn't it, have I got enough to make a good judgement in this situation, because I know I need to move onto the next thing. I think having, again, a reference to support you with that, and that real emphasis in here about, assessors need to be able to make those kinds of judgements with the support of their organisation and with good supervision. Hopefully, that will help provide some scaffolding around the work that people are doing.

[Assessment as an intervention]  

Georgina: A point that you made in the handbook that really, kind of, stood out to me was the importance of social work is recognising that a social work assessment is an intervention in itself, and through building a relationship through an assessment, kind of, the power of the change that can happen through that, is important not to-, yes, really important not to forget.

Gerry: Yes, I think there's a couple of really important elements to that. So, the theory and research around the benefits of the relationship in its own right, the therapeutic element of assessment. So, we build a relationship, partly as a means to an end, because it's through the relationship that you come to understand the person and the outcomes and, you know, you can actually follow what the Care Act expects of you, that you would understand the needs that someone has and the outcomes they want to achieve, and the sorts of things that would help them achieve those outcomes. But the other aspect of it is the, kind of, relationship being an end in itself, that that is of benefit to people to have the chance to have those conversations and have that encounter with you as a practitioner, and what you can show them through that encounter. It's interesting, I have a colleague who works in children's services, Jo Fox, and we talk about this quite a lot, the heart of what you're doing is modelling things to them. So, in the case of children's services, where she works, you might be modelling a, kind of, really healthy relationship to somebody who's had lots of experiences of relationships that have been quite dysfunctional. In the adult world, it might be a bit different, you might be doing that, but you might also be modelling how to navigate law and policy, or how to understand your entitlements and to obtain them. So, you might be doing quite a bit of that work, but you're also modelling it to the person so that they can start to maybe do more of that themselves as well. So, that's, kind of, an interesting benefit of the relationship, the role modelling. 

The other thing that you mentioned about social work being a service in its own right, it's something that, there was some research recently around the implementation of the Care Act, that was one of the things that social workers themselves didn't necessarily remember, because we're busy doing the work and coordinating and, kind of, pulling in other people, but actually, social work, because of its professional background, can offer a therapeutic service, and does, in a very, kind of, evident way in some fields. So, for example, in end-of-life care, palliative care, social workers, one of the things that would be in the care and support plan would very likely be the social worker, you know, social work, time with a social worker, that therapeutic element. I think our colleagues in occupational therapy are much more aware of this, that they're not just there to, kind of, understand things and bring in different things, but also to do work themselves, and to be a resource in their own right. So, I think it's something that's worth remembering, but as I say, for all social care practitioners, whatever our background, the fact that we're spending time with an adult or a carer is an opportunity, isn't it? It's an opportunity for change making for helping that person understand things, helping that person develop their own skills in some sense, role modelling things, and being a therapeutic support to them in that moment.

Georgina: Yes, thanks Gerry, really, kind of, important things to think about in terms of social work as an intervention in itself in terms of the therapeutic benefits of relationship building. Interesting that you're saying about the, kind of, possibilities to model things for people using services.

We're coming to the end of our time together. Is there anything that you'd like to add about the handbook that I haven't asked you?

Gerry: I suppose the other thing just to say about it is there's lots in there, and there is for a really good reason, because even though this handbook is just looking at one aspect of the Care Act and one kind of assessment, it's a really rich activity. One of the things I really hope is that the handbook, kind of, demonstrates that this is complex work. You know, it's really skilled work. It's not a question of just anyone could have a conversation, you know, with someone about their life and follow a process of some sort to achieve the aspirations of the Care Act which is to promote that person's well-being. There's so much that goes into it, and people who do this work, assessors who've gained that, kind of, experience and expertise, I would hope would really recognise that it's something profound that they're doing, something really important, and that ought to be recognised as a really significantly expert activity. So, I think that message does come through. 

The other thing that I hope the handbook, kind of, recognises or helps to show is the constraints around assessment that lay outside of what the assessor or the organisation is trying to do. Because it is really important that we bear that in mind. There are great things that can come from assessment, it's a really positive entitlement for adults and carers and it can lead to really significant changes in that person's situation, that person's life. So, there's loads of potential and loads of reasons to be, kind of, really optimistic in engaging in this activity, but there are these definite constraints around it that are not necessarily located with the person doing the work. I think it's quite healthy for assessors to remember, not only are they doing something that is complex, but also they are doing something that is constrained. So, absolutely hold onto the aspiration and the optimism about what that can achieve, but also don't be too hard on yourselves that you're not able to do absolutely everything that you might hope to do. And, you know, keep going, keep doing it, because it is such a positive opportunity for good.

Georgina: Thanks Gerry, that's a really lovely note to end on. Recognition of the impact that assessments can have on the lives of service users, but also the reminder for social workers and social care practitioners not to be too hard on themselves as well. Thank you very much for talking with me today, it's been a real pleasure to have this conversation.

Gerry: Thank you, it's a great topic, great opportunity to talk.