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DEVELOPMENT OF TOOLS TO MEASURE SERVICE USER AND CARER SATISFACTION WITH SINGLE SHARED ASSESSMENT
CHAPTER FIVE PRACTITIONERS' WORKSHOPS
5.1 Practitioners from health, local authorities and the voluntary sector were invited to 2 workshops during the course of the project. Those who were able to attend contributed valuable insights from their experience of planning, implementing or monitoring the SSA and of managing and training operational staff who were or would be using it. Their reports added up to date detail to the information which had been gathered through the survey and, essentially, helped us to ensure that in designing the Toolkit we took account of key features of the SSA and of operational challenges. They also provided the kind of guidance and information in the Toolkit which would enable practitioners to use it in the longer term and, in the first instance, potentially to assist with piloting it.
Workshop 1
5.2 The first workshop was held in October 2003. Of 20 people invited, 11 were able to attend. Participants came from a fairly wide spread of geographical areas including the Highlands and Islands, Aberdeen and Ayrshire as well the central belt.
5.3 In designing the programme for the workshop we aimed to:
provide participants with an introduction to the project;
explore operational and practice issues identified through the survey and literature search within the context of participants' own experience; and
develop pointers to assist in the development of methodologies and evaluation questions.
5.4 The outcomes we anticipated were that
the experience of practitioners would directly inform the Toolkit and the operational perspective would be built into its development
discussion between participants from different areas and Joint Future Partnerships would help to generate ideas and suggestions as well as exchange of information
practitioners' familiarity with the Toolkit and involvement in its development would help to support its future use
we would gain more detailed information from different areas
we would be able to test out ideas for questions, approaches and explanations
potential sites for piloting the toolkit might be identified
we would extend our contacts and connections for the project
Selected key points from the discussion
5.5 The key points highlighted here are a mixture of individual and shared views expressed at the workshop and were not necessarily held by all participants.
This is still
very early in the development and implementation of the Single Shared Assessment; people are unsure of the process and there are a lot of obstacles still to be overcome and systems to be develop and put in place
Evaluation at this stage feels premature
Assessment is difficult to evaluate; service users generally don't know they've been assessed; it's frequently not a transparent process; assessments can be experienced by service users as a test - with hoops to jump through; outcomes are the priority of people who use services; it is difficult to make a distinction between the assessment process and provision of services
For practitioners the emphasis is now on recording which means increased paper work. Does this detract from values and good practice? Assessment is often related to what resources are available and does not always reflect a service user's real needs; direct access to resources for practitioners is critical.
There are differences in assessment practice between health and social work
There is inconsistency in information sharing across Scotland
Training for assessment and SSA is essential
Good practice indicators include: assessment - "with" people, not "to " them; good information to be provided before the visit; explanations given; build relationships; include aspirations, move away from a deficit model - to a person centred approach
The Toolkit needs to be jargon free and straightforward to use; include guidance on when/whether carers are approached as well as or instead of the service user; assume the right to take part, don't exclude because of e.g. communication or cognitive issues; helpful for service users to do the evaluation as people may find it easier to speak honestly to someone with a shared experience; include guidance/help on how to establish SSA as the focus as this is very difficult; service users must be able to speak freely - without fear of services being taken away.
Workshop 2
5.6 The second workshop was held at the end of February. By this stage the Local Development Groups had completed their work and there were a number of 'outputs' and draft Toolkit resources available for discussion with participants. Invitations were sent to people who had attended or who had hoped to attend the first workshop and to a small number of new contacts. We also received some requests for places from practitioners who had heard about the workshop through a colleague - and from some who believed (and hoped) it was an information day about the single shared assessment. Places were allocated to approximately 25 people; 11 attended on the day. Of the participants, 3 had also attended the first workshop.
5.7 This workshop had a very practical focus. The majority of the time was used to discuss parts of the draft Toolkit and get practitioners' feedback. A draft contents list had been sent out beforehand together with a copy of the service users' guidelines on assessment. On the day, copies were provided of the draft Questionnaire/interview schedule, Guided Discussion schedule and explanatory information and letters and the guidance notes on selection, consent and ' serious concerns' procedure. Participants were asked not to circulate any of the draft documents at this stage and, in fact, left their copies with us at the end of the workshop.
5.8 An update on progress in the project was provided at the beginning of the workshop. We then worked in 2 groups and finally came back together in a plenary session, considering and discussing the draft Toolkit sections.
5.9 The outcomes we anticipated were that:
practitioners would have direct input to the final stage of production of the draft Toolkit
we would further check out and test the evaluation questions and approaches and practitioners would help to provide a reality/feasibility check
practitioners coming from different settings and giving their views would contribute to the validation process
some participants might be able and willing to involve their authority in the pilot
Selected key points from the discussion
5.10 The key points highlighted here are a mixture of individual and shared views expressed at the workshop and were not necessarily held by all participants.
Evaluation
5.11 It seems very early to be evaluating as we are still in the planning and implementation phase- this means trying to measure at the same time as getting the basics of SSA implemented.
5.12 Careful consideration has to be given to
when the evaluation takes place.
The Toolkit
5.13 It would be useful to include small group discussions as one of the evaluation methods; the Guided Discussion schedule would provide a good basis for a topic guide/group interview schedule.
5.14 The evaluator should be independent - not a member of staff from the service provider authority. In practice this may be very difficult to adhere to. There may be interest in exchange arrangements e.g. between different Joint Future Partnerships.
5.15 There are no specific questions, in the questionnaire/interview schedule, about the difference that SSA makes, e.g. in relation to Community Care Assessments, or whether it is meeting its aims.
5.16 There were mixed views about the 'serious concerns' form and process and about whether staff would agree to a photo of the assessor being sent to people in advance of an evaluation interview to remind them and help them identify the SSA.
5.17 The evaluation questions feel like a test for the practitioner!
5.18 Will ethical approval be required?
5.19 These questions - produced by service users and carers - help the culture shift, away from a service led towards a person centred approach. This is good practice.
Assessment - practice issues
5.20 Again, tensions were recognised, between an emphasis on the form and a focus on the assessment as a process.
5.21 The range of terms used in different Joint Future Partnership area for single shared assessment was noted.
5.22 The different timescales for assessment depending on urgency/priority were highlighted. It's not possible to get information out to people before a high priority/ emergency assessment. However, the principle should still be that the assessment is carefully explained, even if this is done just before the assessment starts. This is about good practice.
5.23 There was a difference of views about whether other aspects of the service user guidelines were practical: for example, a choice of gender/age of assessor. There was recognition of the importance of these aspects of choice for some people.
5.24 Differences in practice were noted regarding whether service user is asked to sign the SSA or not and the correct practice where information is all handled electronically so there is no paper form to sign.
Outcomes
5.25 The practitioners' workshops broadly met the objectives which we had set for them.
5.26 Participants provided many valuable insights into the practicalities of operating the SSA and suggested changes and additions to sections of the toolkit.
5.27 They debated the tension between a person centred approach and the demands of service provision and despite the constraints which they described, strongly supported the approach taken in the Toolkit. The guidelines for assessors developed by service users and carers were regarded as a statement of good practice and particularly useful in training assessors and in developing assessment practice.
5.28 A number of practitioners kept in contact with the project and were able to help with enlisting the assistance of their authorities in testing the Toolkit.
Summary
5.29 Key themes from the Practitioners' Workshops were:
Single shared assessment is not yet the universally used term, even among professionals
Staff in Joint Future Partnerships are still preoccupied with implementing the basics of single shared assessment and feel that evaluation at this stage may be somewhat premature
There was significant congruence between the views of service users and carers and practitioners: e.g. practitioners regarded the Guidelines for Assessors as a statement of good practice
Participants in the workshops provided many valuable insights into the practicalities of operating the SSA and suggested changes and additions to sections of the toolkit.
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