1. Introduction

It is essential that workers in adult social care and partner agencies include the needs of all family members when carrying out assessments and developing plans, when working with an adult who has care and support needs.

There are four steps to the whole-family approach:

  • Step one: think family;
  • Step two: get the whole picture;
  • Step three: make a plan that works for everyone;
  • Step four: check it is working for the whole family.

This chapter is taken from The Care Act and Whole-Family Approaches (Local Government Association et al) and provides guidance about using the whole-family approach in daily practice. Whilst the guidance is written for local authority workers, it is relevant for everyone working with an adult and their family who are receiving care and support services.

2. Step 1: Think Family – Early Intervention and Prevention

The Care Act 2014 states that a whole system, whole council, whole-family approach must be taken which organises services and support around the adult and their family. It also means that everyone working with the adult and their family must think about the impact of the care needs of each member of the family, including any children.

The principle of wellbeing is at the heart of this approach (see Promoting Wellbeing chapter). A vital part of an adult’s wellbeing is the situation they live in, who they live with and their family relationships. It is important to achieve a balance between their wellbeing and that of any family or friends caring for them.

A whole-family approach to promoting wellbeing and preventing need for care and support may include helping the adult and their family to think about what may happen in the future, and plan for those possible changes, when the adult needs more care or if a carer becomes unwell for example (see Reducing, Preventing or Delaying Needs chapter).

The needs of young carers, for example a teenager who has to look after their mother because she is disabled, are included in both the Care Act 2014 and in the Children and Families Act 2014. This is to make sure tall workers involved take a whole-family approach to assessing and supporting the adult and their young carer and delivers support in a coordinated, organised way. See Annex A of The Care Act and Whole-Family Approaches (Local Government Association et al).

In organisations that thinks family:

  • There should be senior leadership and commitment to a whole-family approach with protocols in place so that services can be coordinated.
  • Staff training ensuring the skills and referral arrangements are in place so that service protocols are operating ‘on the ground’.
  • Family-related questions are embedded in processes at first contact and subsequently, such as:
    • Who else lives in your house?
    • Who helps with your support and who else is important in your life?
    • Is there anyone that you provide support or care for?
    • Is there a child in the family (including stepchildren, children of partners or extended family)
    • Does any parent need support in their parenting role?
  • There is an active approach to establishing if there are any significant potential changes in families’ lives and working with them to plan for these.
  • Families and carers are an integral part of the design, delivery and evaluation of services and support. (Adapted from the LGA guidance, p. 3)

3. Step Two: Get the Whole Picture – Whole Family Assessment

Getting the whole picture means seeing each person as an individual, as well as recognising the part they play in their family and community. Everyone has something to contribute in addressing the adult’s needs. The whole-family approach builds on everyone’s strengths and develops their resilience. It also promotes working together with carers as partners, as well as the adult and other members of the family and friends where appropriate.

Understanding the needs of the whole family and getting them to think about the outcomes they want to achieve individually, as well as a family is vital. It means the worker can then provide the right guidance, information or services.

Assessment is an important part of the process for everyone. During the assessment,  the worker can give guidance and information to help the family understand the situation, their needs and strengths. This can help to reduce or delay any increase in the adult’s needs and make sure that they have support when they need it. The aim of assessment is to get a full picture of the person and their needs and goals, so any carers must be consulted. Carers are recognised in the Care Act, in the same way as those they care for.

In an organisation that gets the whole picture:

  • Information on assessments and care plans that family members are having from other organisations is routinely identified and shared between partner agencies as appropriate. Where possible and appropriate, assessments are coordinated or combined.
  • Proportionate assessments are undertaken in a way that is most appropriate to each family.
  • People providing care and support are identified and involved in assessments to provide their expertise and knowledge and views of what works and what does not.
  • Risks to carers of sustaining their caring role are always considered.
  • Carers’ willingness to continue caring is always established.
  • Where they wish to have one, carers are provided with an assessment carried out by their local council. In such circumstances, the council consider the carers’ eligibility for support in their own right is always considered.
  • In all instances, even when a person can achieve an outcome independently, consideration is given to any impact on others and whether they might be adversely impacting on the health or safety of others, particularly family members and including children.
  • At assessment, all of a person’s needs are identified regardless of whether such needs are being met by any carer.
  • Consideration of the ability to maintain family or other significant relationships, including with any children, and the impact of these not being maintained on the adult’s wellbeing is always considered. This applies to both the person in need of care and support and their carer.
  • When a child may be a young carer, consideration is always given as to whether to undertake a young carer’s needs assessment under section 17 of the Children Act 1989.
  • Assessments of an adult identify any potential child in need who does not have any caring responsibilities. (Adapted from the LGA guidance p. 4)

Where an assessment does identify a potential child in need, the worker should contact their line manager to discuss the situation and a referral should be made to children’s services as appropriate (see the local Safeguarding Children Partnership procedures).

4. Step Three: Make a Plan that Works for Everyone – Developing the Care and Support Plan

Adopting a whole-family approach to developing care and support plans and other plans with the local council and with other agencies can result in new ways of achieving the best outcomes for the whole family. Sometimes a plan can unintentionally affect other members of the family, particularly carers, but often small changes can make a plan produce better results for everyone.

It can also make better use of resources. Sometimes plans are needed for more than one member of the family and from different organisations, for example the Care Programme Approach if mental health services are involved. Plans should not be developed in isolation from one another but should be developed together. If everyone involved agrees, including the practitioners, plans for different family members can be combined to form a single plan in which there may be parts for individual family members as well as the family as a whole. This can be particularly important in making sure that everyone’s wellbeing is being considered and it can also be helpful in addressing any areas of conflict that arise and agreeing a way forward so that everyone achieves what they need, as far as possible.

In an organisation that makes plans that work for everyone:

  • Planning takes into account the wellbeing of all the family and the impact of any services and support on other family members. This includes identifying and responding to situations such as mutual caring, and carers living at a distance or outside of the local area.
  • Planning always involves any carer and consideration is given to the involvement of other family members.
  • Planning considers how carers can be supported to look after their own health and have a life alongside caring.
  • Plans include consideration of support to ensure a carer is able to fulfill any parenting role.
  • Consideration is given to how a person’s circle of support can be developed, where this might benefit them.
  • Plans from different organisations for any family members are identified and consideration given as to whether these can be aligned, coordinated or integrated into a single plan (where all involved agree).
  • Where plans are integrated, a lead organisation is established to undertake monitoring and assurance and it is clear about when the plan will be reviewed and by whom. (Adapted from the LGA guidance p. 5)

5. Step Four: Check it is Working for the Whole Family – Review of Plans

As with assessment and care planning, wherever possible a whole-family approach to review should be taken. It should concentrate on the results that are being achieved by the adult and their family. Workers should consider giving others permission to conduct the review; this could be the person themselves, a carer or someone else.

Workers need to oversee the process and sign off all reviews. Sometimes a ‘light touch’ approach can be helpful early on, which might include a telephone call or asking the adult or another family member to carry out a self-review to check that things are working satisfactorily. Whatever approach is used, it should always include consider any impact of the plan on other family members.

Where the review identifies things that have changed, the plan may need to be updated to include these. Again the adult, their carer and anyone else they want included should be involved. The whole-family approach should make sure that everyone’s (including any children) needs and wellbeing are considered, there are no consequences for anyone that had not been seen in advance and that everyone agrees with the plan.

In an organisation that knows its approach is working for the whole family:

  • The impact of the plan and results being achieved are reviewed in relation to both the individual and the whole family. This includes consideration of any unintended consequences for other members of the family.
  • Consideration is given to any changes that can be made to maximise the benefit to the whole family.
  • Carers’ (including young carers’) needs are routinely reviewed and the support they are willing and able to provide, as well as the outcomes they want to achieve, is re-established.
  • Any anticipated changes in the family that may impact on needs and support are identified and considered in any revised plan.
  • The plan is checked to see that it is providing adequate support to ensure children are not expected to offer inappropriate or excessive levels of care. (Adapted from the LGA guidance p. 6)

6. Tools to use with the Whole-Family Approach

Annex C of The Care Act and Whole-Family Approaches (Local Government Association et al) 

includes some practical tools for working with families which can be adapted and developed for local use. These include:

  • questions to consider including in conversations at initial contact, assessment and care planning stages;
  • whole-family care planning discussion questions;
  • a genogram
  • identifying support networks;
  • an emergency crisis plan.

Annex D also provides a checklist of key practice points.