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We are going to look at all four of these communication tasks and how they may link together through the case of Kate Collier who was visited by a care manager Jane Standing.
The case of Mrs Collier is set in Adult Services, but the key learning points are transferable to all social work contexts and roles, including communication with other professionals.
Jane Standing is a care manager in Adult Services. An important part of her role is enabling frail older people to live as independently as possible in their own homes by assessing their needs and planning appropriate support.
Kate Collier was referred to Adult Services by her GP, Dr Jones. The letter described her as "an 83 year old widow with painful osteo-arthritis which restricts her mobility and makes it difficult for her to manage cleaning and personal care." Dr Jones requested an assessment of her need for support services. He also mentioned that she was lonely and interested in attending a day centre.
When Jane phoned, Kate said that she was looking forward to meeting Jane, as life had been very hard since her husband died 3 years ago.
Click 'next' to meet Jane Standing.
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Hello, I'm Jane Standing (It is important to give both names when you introduce yourself, so that people know your full name if they need to contact you or refer to you.) and I'm a care manager in Adult Services. An important part of my role is enabling frail older people to live as independently as possible in their own homes with support that they have chosen and that they control. I work with the older person to identify his or her needs through assessment and to plan appropriate support. Carers and other professionals often contribute to this process.
Social care is means-tested, so the amount that people pay for care depends on their income and other factors (The regulations here vary across the UK). Funding restrictions also mean that I have to tell some people that they are not eligible for help from Adult Services (Here too the regulations vary between the four countries of the UK). When this happens, I may suggest other sources of support and make a referral if appropriate.
The people I meet are facing crises and problems in their lives. They often have no experience of social services and find all the rules and procedures bewildering. Also as people age they are more likely to have a hearing loss, or other sensory or cognitive impairment. All this means that good communication skills are essential for my work.
Click 'next' to find out about Kate Collier.
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Mrs Collier was referred to Adult Services by her GP, Dr Jones. The letter described her as 'an 83 year old widow with painful osteo-arthritis which restricts her mobility and makes it difficult for her to manage cleaning and personal care'. Dr Jones requested an assessment of her need for support services. He also mentioned that she was lonely and interested in attending a day centre.
When I telephoned Mrs Collier to arrange a visit, she said she was looking forward to meeting me as life had been very hard since her husband died 3 years ago.
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Planning and Preparation. Write down your initial thoughts about how you'd prepare for meeting Kate Collier
- What are the priorities for your visit?
- Is important information missing from the referral?
- How might you plan the interview?
- What information might you take with you?
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Now match our suggestions below with your own.
What are the priorities for your visit?
- Mrs Collier's view of the support she needs.
- Her eligibility for help.
- Potential strategies for meeting her needs.
Is important information missing from the referral?
The referral letter didn't reveal whether Mrs Collier had any sensory loss, or any support from friends or family.
How might you plan the interview?
Before an interview I find it helpful to review the assessment forms and mark the areas I'm likely to focus on. My plan was to start by checking that Mrs Collier knew why her GP made the referral and to discover her view of her situation. Then I would explain the assessment process, to help her participate as confidently as possible.
What information might you take with you?
When I phoned Mrs Collier I got the impression that she was still grieving after her husband's death. Loss of a spouse is an important risk factor for depression in older people (Fiske & Jones, 2005), so I looked out information on counseling and local bereavement self-help groups. The referral letter didn't reveal whether Mrs Collier had any sensory loss, or any regular support. The GP had suggested that she was interested in going to a day centre, so I put leaflets about day care in my bag and information about my agency, potential support options and paying for care.
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When I visited Kate Collier (It is important not to make assumptions about what people like to be called, but to find out from the person concerned) she was very friendly and chatty. I had hardly sat down when she started to talk about her husband and everything that had happened in the final year of his life. I listened attentively, but time was passing and I was worried I would not achieve all I had set out to do in the limited time available.
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Kate Collier's story about her husband poses a real dilemma for Jane. Life story information provides vital clues to personality, wishes, needs and preoccupations (Richards, 2000). However, time is short and Jane is anxious to tell Kate about the assessment and to gather the key information she needs.
Jot down one or two ideas for what you might say or do at this point to get the interview back on track.
Click 'next' to discover how Jane approached this.
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It seemed really important for Kate to tell me about her husband. Abruptly switching to my agenda, which focused on the assessment process, could leave her feeling that I wasn't interested in what matters to her. So when she next paused, I said:
'It is good you telling me this. It helps me to understand what you have been through. After your long life together and all you did to care for your husband, it must be very difficult living alone. I hope I'll be able to help you one way or another. But to do that I need to get some specific information from you to give me a better picture of how you manage and where you may need help. How does that sound?'
In any dialogue it is difficult to predict the other person's response. I was hoping that my intervention would enable Kate to focus on the assessment process.
points to remember as you begin an initial interview are:
- It is important to check the information you have with the service user
- Enabling service users to tell you about themselves, in their own way, reveals their perspective and what is most important to them.
- It is important to develop and sustain shared purpose. So, if you have to assert your agenda, it is essential that you negotiate this carefully with the service user and address their concerns. Otherwise the service user is likely to feel marginalised and powerless.
Click on 'next' to find out.
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Instead of responding to my question, Kate had one for me:
How much will I have to pay to have someone in to help me?
This threw me for a moment as I couldn't really answer this question without assessing her needs, her eligibility for services and her financial circumstances. I had to work out something to say that would be helpful to Mrs Collier but not delay matters further.
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Decide which of the options below would be the most helpful response to Kate's query about how much she will have to pay for help. Click on each one to see Jane's thoughts.
This response has obvious advantages. Discussing financial issues at this point could be time wasting, especially if it turns out that Kate is not eligible for help from Adult Services because her needs do not meet the eligibility threshold. The discussion may also tire Kate so she is less able to participate in the interview. But avoiding Kate's question is risky. With only token reassurance, her anxiety about money may prevent her from fully engaging with the process of identifying and exploring her needs.
Like the first option, this response tries to postpone financial discussions to a more appropriate point but with information added to reassure Kate. But Kate may not find this reassuring, as it contains complex concepts and assumptions about her concerns that may not be accurate. For example, Kate may have financial worries but not have a low income, as officially defined. She may welcome someone checking her entitlement to benefits or see this as intrusive and stigmatising.
This response acknowledges that Kate is worried about paying for help but also signals that I am willing to address her concern, even though it is difficult to tackle at this point. I would hope that once she has had some information about what she may need to pay, Kate will feel ready to participate fully in the assessment process.
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Providing Information and Explaining
Jane has agreed to give Kate some information in answer to her question, but she must decide
- what information will be most useful for Kate - unnecessary information tends to confuse
- how to explain it so that Kate understands the essential points
Click on 'next' for a way of thinking about the process of explanation that you may find helpful as you consider how Jane might proceed.
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Explanation is a process which can be broken down into 3 distinct tasks:
- Identifying and specifying the problem that requires explanation
- Determining a process for explanation - involving linked statements each of which is understood by the person receiving the explanation
- Checking that the explanation has been understood
(Brown and Atkins (1997))
Click on 'next' to see how Jane responded to Kate's question.
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I started by trying to narrow down the problem. I asked Kate if she had particular concerns about paying for help I might be able to tackle now, even though I couldn't answer her question fully. She revealed that her friend in a neighbouring authority was 'paying through the nose' for help from Adult Services. So I explained that individuals may pay very different amounts as what people are charged depends on:
- the amount of help they get
- the hourly rate for care set by the authority
- their income level and savings.
I said that there are other options for arranging help, but it would be easier to discuss these when I've got a better understanding of her needs and can give her appropriate information.
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Before moving on Jane needs to check that Kate has understood this explanation. There are many ways she could do this. Click on the option below that you think Jane should choose.
The correct answer is b
The first option could be problematic as Kate might say yes so as not to appear stupid.
The third option is an effective way of testing how much Kate has understood, but it would be an unnecessary and time consuming diversion at this point.
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Kate didn't need to understand all the details I had given her, only that her friend's experience may not be relevant to her and that there are various options for arranging and paying for help. She was happy to move on and then able to focus on the questions I posed, so I felt that my explanation was sufficient for now.
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When Jane has completed the assessment, she may need to return to Kate's query about how much she will have to pay for help. This time she may need to provide a more detailed explanation to ensure that Kate has all the information she needs.
What sources of information might help Jane with this task? Note down your thoughts. Click 'next' to see examples of sources Jane might use and to see what she chose.
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- Fair Access to Care Services (Department of Health, 2003)
- Fairer Charging Policies for Home Care (Department of Health, 2001/3)
- Wanless Review (2006)
- Information from the local authority on: charges for home care services; Direct Payments and Individual Budgets; the process for assessing an individual’s financial contribution for services received
- Information on costs of local private cleaning and domiciliary care agencies
- Paying for Care and Support at Home (Age Concern, 2007)
What Jane chose
I took information that is most likely to be useful and relevant to Kate and family members.
- the local authority information leaflets
- Information on costs of local private cleaning and domiciliary care agencies
- Paying for Care and Support at Home (Age Concern, 2007)
If Kate or her family have access to the Internet I can tell them where to access additional information on-line. If they are keen to know a lot more about Government policy on paying for care, I can point them to information (For example Fairer Charging Policies for Home Care 2001/3) on the Department of Health website or to independent policy reports, for example the Wanless Review (2006).
Description: Social Work is the premier journal of the social work profession. Widely read by practitioners, faculty, and students, it is the official journal of NASW and is provided to all members as a membership benefit. Social Work is dedicated to improving practice and advancing knowledge in social work and social welfare. Its articles yield new insights into established practices, evaluate new techniques and research, examine current social problems, and bring serious critical analysis to bear on problems in the profession. Major emphasis is placed on social policy and the solutions to serious human problems.
Coverage: 1956-2012 (Vol. 1, No. 1 - Vol. 57, No. 4)
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Subjects: Social Sciences, Social Work
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