The Skilled Conversation (Young Carers)

Under the Care Act, anyone with parental responsibility must be involved in the assessment because parental responsibility applies until the young carer is 18. This is the case whether the young carer consents to their involvement or not.

Sometimes the relationship that the young carer has with their parent (or the relationship that parents have with each other), may not ensure the involvement of the young carer in the assessment process. For example:

1. the young carer may become overly distracted by their presence;
2. the young carer may become distressed at their presence;
3. parents may be estranged and there is a high risk of conflict during meetings.

You have a duty to ensure the involvement of the young carer, so will need to consider any adjustments you need to make to the planned process.

Examples of adjustments could include:

1. holding separate meetings with each parent;
2. meeting with the young carer without the parent's presence;
3. involving a parent via consultation only; and
4. involving the parent in some aspects of the assessment but not others.

The young carer's parents have to be involved in the assessment. However, under the Care Act it is important that the young carer's needs are considered within the context of their whole family network wherever possible. This is what is meant by a whole family approach.

Taking a whole family approach enables the Local Authority to:

1. understand the role that family members have in supporting the young carer and the person with care and support needs; and
2. identify and support other carers (both these things are duties under the Care Act).

Taking a whole family approach also builds the resilience of families and increases the likelihood that a non-service led, self-sustainable method of supporting the young carer will be identified.

When taking a whole family approach, you should consider involving the following people in the assessment:

1. Adults living in the same household as the young carer;
2. Children living in the same household as the young carer;
3. Adults living elsewhere but who form part of the young carer's support network;
4. Children living elsewhere but who form part of the young carer's support network.

Specifically you need to understand:

1. how other family members are supporting the young carer and whether this is sustainable;
2. whether the role that other adults or children in the family have constitutes a caring role under either the Care Act 2014 or the Children and Families Act 2014;
3. where other family members are identified as having a caring role, whether they are being supported in this role and whether it is sustainable.

Where there is an appearance of need in any other family member you have identified as a carer, you have a duty to offer an assessment.

Any conversations with adult family members must give regard to the duty to provide good information and advice about adult care and support. This could be in relation to the likely needs of the person that the carer is supporting, or in relation to another adult that they support or are concerned about.

You must also consider whether any prevention service would be of benefit to any adult family member you speak to, either to support them as a carer or in their own right. Where they appear to have a need for a prevention service themselves, you should support them to access this service.

Where you take action to support another adult in the young carer's family via a whole family approach, you should make sure that you make appropriate and proportionate recordings for the action you have taken or the information and advice you have provided.

The duty to safeguard children

Children are protected under different legislation to adults. You must know your statutory responsibilities in relation to protecting children so that you can respond appropriately.

Things that you must consider in relation to all children living in the household:

1. Whether the child is taking part in any caring activities that may be inappropriate for their age, gender or that cause them physical difficulty or emotional distress;
2. Whether the cared for person presents with behaviours that place the child at risk of harm or abuse;
3. Whether the child is at risk of neglect because the cared for person also has caring responsibilities towards them that they cannot adequately meet as a result of their own needs;
4. Whether the child is at risk of neglect because the young carer has caring responsibilities towards them that they cannot adequately meet as a result of caring for the cared for person;
5. Whether the home environment or any caring role is having a negative impact on the child's well-being, education or development.

If you are concerned about the safety of a child, or that they are at risk of abuse and neglect, you must take action to protect them.

If you are concerned that a child is in imminent danger from abuse or neglect, or that a criminal act has taken place, you should contact the police by dialling 999.

Responsibilities to other young carers

The legal definition of a young carer under the Children and Families Act is:

"a person under 18 who provides or intends to provide care for another person (of any age, except where that care is provided for payment, pursuant to a contract or as voluntary work)".

There is a duty to meet the needs of other young carers under the Children and Families Act in the same way as there is a duty to meet the needs of the young carer being assessed. This means that if you become aware that another child or young person under the age of 18 is providing care you must take steps to ensure they are appropriately supported.

The first thing you should do is liaise with Children's Services to establish whether the child or young person is already being supported as a young carer.

If support is in place, you should provide Children's Services with any new information you may have about the impact of the cared for person's needs upon the child, but you will not need to provide any further support to the child.

If the young person is not already being supported by Children's Services, you should discuss and agree with your line manager and Children's Services who is best placed to assess them.

Wellbeing is the single most important concept of the Care Act and is a primary factor used to determine whether needs are eligible.

The duty to promote individual wellbeing applies at all times; in every single process, conversation or decision that is made and you must be able to demonstrate that you have done so during the transition process, which includes when carrying out the young carer's assessment.

It is vital that you understand your duties in relation to promoting individual wellbeing. See: Promoting individual wellbeing

In order to promote individual wellbeing, you must first understand what wellbeing means to the young carer. The Care Act sets out nine domains of wellbeing that you must consider. See: Wellbeing domains

As part of any process to establish needs you must understand:

1. which areas of wellbeing are most important to the young carer at that moment in time;
2. which areas of wellbeing are least important to them at that time;
3. whether there are other areas of the young carer's life important to them but not listed as a domain (the domains under the Act are not definitive as wellbeing is personal);
4. which areas of wellbeing are causing the young carer concern or worry;
5. what impact any concern or worry is having (or could have) across the wellbeing domains (is there a destabilising effect?); and
6. how the young carer thinks any support needs interact and impact on wellbeing.

It is important to remember that, under the Care Act, the wellbeing domains are all as important as each other. Any hierarchy can only be determined or described by the young carer whose wellbeing it is.

1. A sense of wellbeing is extremely personal and will be different for every young carer;
2. Never make assumptions about what is important and what is not important to a young carer;
3. The young carer is the expert in relation to their own wellbeing;
4. If a young carer tells you they have no worries in a particular area, this does not mean the area is not important to them; and
5. Conversations about wellbeing should be 'genuine' person centred conversations, not process led.

Often the key to an effective conversation about wellbeing is preparation, and you should take whatever steps are available to ensure that the young carer is as prepared as possible for the conversation:

1. provide information that will support the young carer (and their parents) to understand the concept of wellbeing and why it is important;
2. offer advice about the things that a young carer may want to think about before having a conversation about wellbeing;
3. make sure that anybody who will be supporting the young carer understands wellbeing and is confident and appropriate to support the young carer to prepare for and have the conversation; and
4. consider whether any tools may be helpful to support the young carer (and their parents) to think about wellbeing.

A conversation about wellbeing can be a very difficult conversation for a young carer (and their parents) to have. Not everyone will feel happy, confident or able to share with you how they are feeling about the different areas of their life. For many young carers, this will be the first time they have been asked or given an opportunity to think about their own wellbeing in this way, and they are also doing so whilst preparing for a significant change in their life.

Any questions that are used to support a young carer to think about wellbeing must:

1. be proportionate to the level of information required;
2. be appropriate, taking into account the young carer's specific needs around communication and their specific circumstances;
3. be realistic in respect of the young carer's ability to be able to answer the question; and
4. be asked in a manner that is accessible to the young carer.

Powerful questions

A powerful question is a specific type of open question that:

1. encourages a young carer to reflect;
2. is thought-provoking;
3. supports an exploration of options; and
4. helps the young carer to gain a greater insight into their situation.

Powerful questions should be framed in a positive way to promote engagement of the young carer and promote a strengths-based approach.

Appreciative enquiry

An appreciative enquiry is a conversation that is led by the young carer and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.

The listener should invite the young carer to:

1. talk about a time or times when something has been working well in their life;
2. explore what it was that worked well and supported them at that time;
3. think about how that experience could support them now in making a plan for the future.

Some key questions to support an appreciative enquiry approach include:

1. Tell me about a time when things were going well for you.
2. What did you learn about your strengths at that time?
3. If you had a magic wand, what would the future look like?
4. What is it that you value most in your life now?
5. What small changes would make the most difference?

The use of tools

A tool can be helpful to shape and focus a conversation about wellbeing, making sure that you consider everything that needs to be considered from a statutory perspective. Tools are also useful because they:

1. can be completed with the young carer (and their parents) as part of any conversation you have with them; or
2. the young carer can complete them in their own time as part of their preparation for the conversation (either independently or with support).

See: Tools and practice guidance to establish needs

Because wellbeing is extremely personal, different people are likely to have different perspectives about the same domains. The young carer is more likely to have a subjective view about their wellbeing which may be dominated by worries or concerns they have about their presenting situation (for example, if they are going to be leaving school), whereas someone who is emotionally removed may see things more objectively.

It is important that you recognise when a young carer's views about their wellbeing may not be holistic and take steps to try and support them to gain insight or broaden their thinking. One way of doing this is to seek the views of family members and others involved in their life. This supports a whole family approach to assessment but can also lead to a shared understanding and solution from within informal networks of support. You can seek the views of others:

1. when the young carer consents to this; or
2. when the views of parents are being sought; or
3. when the views of any other person with parental responsibility are being sought.

Even with the involvement and perspective of others, certain factors affecting wellbeing may still be difficult for people to recognise, acknowledge or explore. If it is your view that these things are having an impact on wellbeing, then you must raise them for the purposes of:

1. supporting the young carer (and their parents) to gain insight into their situation;
2. developing the young carer's resilience (and the resilience of their parents) through talking about difficult situations and exploring options to find a solution;
3. providing information and advice;
4. preventing, reducing or delaying the need for support from the age of 18.

You may also find the tool Six tips to help you have difficult conversations useful.

You should also make effective use of supervision to explore and develop skills that will support you to have difficult and sensitive conversations with people in a positive way.

A young carer's wellbeing is always affected by what is happening in their life at that time. It changes as their situation changes, and sometimes the changes in wellbeing that take place can be quite dramatic. It is, therefore, important to understand a young carer's wellbeing in the context of their current situation, but to monitor and review wellbeing as things change.

When you have understood a young carer's individual wellbeing you have a duty to promote it. To do this you must understand:

1. the things that they want to achieve;
2. the things they want to change; and
3. the things that they want to stay the same.

These things are known as the young carer's outcomes. In order to promote wellbeing, you should explore with the young carer, during the assessment, the steps that they can take to achieve their outcomes, as the two things are intrinsically linked.

NHS Choices have an online resource: 5 steps to mental wellbeing.

If, following assessment, the Local Authority meets any eligible needs that the carer has you will need to explore not only what steps the carer can take to achieve their outcomes, but also how the support/services provided can help them to do so too.

You have a duty to promote a young carer's individual wellbeing but this is not a duty at the detriment of others. The wellbeing of others must be taken into account and may determine the action that you then do or do not take to promote a young carer's wellbeing.

For example, if promoting the young carer's wellbeing will put a vulnerable adult or a child at risk then you must not do so unless risks can be mitigated. The duty to protect people from abuse or neglect overrides the duty to promote individual wellbeing.

The purpose of a young carer's assessment is to understand both the needs that the young carer has now, and the needs that they are likely to have from the age of 18. This can only be done by talking about needs.

A young carer's needs also often directly impact on their wellbeing, which you have a duty to promote. Therefore, understanding needs will also support you to fulfil the duty to promote wellbeing.

The Care Act sets out 8 areas of need that must be assessed whenever it appears that they exist:

• Carry out caring responsibilities for a child;
• Provide Care and Support to other adults;
• Maintain a habitable home environment in their own home;
• Manage and maintain nutrition;
• Develop/maintain family and other personal relationships;
• Engage in work, training, education or volunteering;
• Make use of community services;
• Engage in recreational activities.

Unlike a conversation about individual wellbeing, there is not a requirement to talk about all of the areas of need described in the Care Act, regardless of whether they appear to be present or not. Instead, the conversation about needs must be proportionate and appropriate to each young carer's situation and you should be mindful to make the best use of available information from existing assessments and plans.

Often the key to an effective conversation about need is preparation, and you should take whatever steps are available to ensure that the young carer (and their parents) is as prepared as possible for the conversation:

1. Provide information that will support the young carer (and their parents) to understand the areas of need described in the Care Act and why establishing needs is important;
2. Offer advice about the things that a young carer may want to think about before having a conversation about needs;
3. Make sure that anybody who will be supporting the young carer understands needs and is confident and appropriate to support the young carer to prepare for and have the conversation; and
4. Consider whether any tools may be helpful to support the young carer (and their parents) to think about needs.

A conversation about needs can be a very difficult conversation for a young carer to have. Not everyone will feel happy, confident, or able to talk about their needs. Some young carers may lack insight into their needs, particularly if they are still going through a period of adjustment to their caring role.

Any questions that are used to support a young carer (and their parents) to think about needs must:

1. be proportionate to the level of information required;
2. be appropriate, taking into account the young carer's specific needs around communication and their specific circumstances;
3. be realistic in respect of the young carer's ability to be able to answer the question; and
4. be asked in a manner that is accessible to the young carer (and their parents).

Powerful questions

A powerful question is a specific type of open question that:

1. encourages a young carer to reflect;
2. is thought-provoking;
3. supports an exploration of options; and
4. helps the young carer to gain a greater insight into their situation.

Powerful questions should be framed in a positive way to promote engagement of the young carer and promote a strengths-based approach.

Appreciative enquiry

An appreciative enquiry is a conversation that is led by the young carer and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.

The listener should invite the young carer to:

1. talk about a time or times when something has been working well in their life;
2. explore what it was that worked well and supported them at that time;
3. think about how that experience could support them now in making a plan for the future.

Some key questions to support an appreciative enquiry approach include:

1. tell me about a time when things were going well for you.
2. what did you learn about your strengths at that time?
3. if you had a magic wand, what would the future look like?
4. what is it that you value most in your life now?
5. what small changes would make the most difference?

The use of tools

A tool can be helpful to shape and focus a conversation about need, making sure that you consider everything that needs to be considered from a statutory perspective. Tools are also useful because they:

1. can be completed with the young carer (and their parents) as part of any conversation you have with them; or
2. the young carer can complete them in their own time as part of their preparation for the conversation (either independently or with support).

See: Tools and practice guidance to establish needs

To ensure an accurate assessment of need, it is important that you identify whether a young carer has needs that fluctuate (change over time).

Fluctuating needs are needs that:

1. may not be apparent at the time of the assessment; but
2. have been an issue in the past; and
3. are likely to arise again in the future.

A simple question to ask a young carer to establish whether their needs fluctuate is 'How do your needs change over time?'

Every young carer with fluctuating needs will experience fluctuations differently. For example:

1. some young carers’ needs fluctuate in line with the needs of the person they care for (becoming more intensive when the person's needs increase);
2. some young carers will have periods of stability that could last several weeks or months with no fluctuation (for example, fluctuations may occur when a person that supports a carer to sustain their role goes on holiday);
3. some young carers’ fluctuations are related to their own physical or mental health condition (for example, having arthritis that affects their ability to carry out the caring role when the weather is bad).

Because of the variance in fluctuation possible, it is not appropriate to simply assess a young carer as having 'fluctuating' needs. Neither should you make a judgement about need based solely on either a 'worse case' or a 'best case' scenario. Doing so would not provide a true representation of the young carer's whole needs and it would be likely that any support the Local Authority did subsequently provide would be inappropriate or disproportionate (too much or not enough) to cover periods of fluctuation.

You need to be able to effectively demonstrate:

1. how often the young carer experiences a fluctuation in needs;
2. the type of fluctuations that are experienced and the impact on other needs and wellbeing;
3. what the potential causes or triggers are for fluctuations; and
4. what measures are effective in managing periods of fluctuation or reducing the risk that they will occur.

The kind of questions you could ask a young carer (and their parents) to help understand their fluctuating needs includes:

1. how long has it been since you had a good/bad day?
2. what does a good/bad day look like?
3. what changes in support do you have on a bad day?
4. how often do your needs change on a bad day?
5. which areas change the most on a bad day?

The length of extension to an assessment process to ensure that fluctuating needs are understood should be based on the individual needs and circumstances of the young carer.

It may also be appropriate to pause an assessment to enable the young carer to access support that may then prevent or reduce the number of fluctuations occurring (for example, to allow a new medication to take effect or to allow time for the person they care for to access a health service)

Different people involved with the young carer are likely to have different views about need. For example, the young carer is likely to have a subjective view about their needs, which may be dominated by worries or concerns they have about their presenting situation (for example, the potential impact of a serious health diagnosis or the prospect of leaving school), whereas someone who is emotionally removed from the situation may see things more objectively.

It is important that you recognise when a young carer's views about their needs may not be holistic and take steps to try and support them to gain insight or broaden their thinking. One way of doing this is to seek the views of family members and others involved in their life. You can seek the views of others:

1. when the young carer consents to this; or
2. when the views of parents are being sought; or
3. when the views of any other person with parental responsibility are being sought.

Even with the involvement and perspective of others, certain needs may still be difficult for people to recognise, acknowledge or explore. If it is your view that these needs exist and are having an impact on the young carer, then you must raise them for the purposes of:

1. supporting the young carer (and their parents) to gain insight into their needs and situation;
2. developing the young carer's resilience through talking about difficult situations and exploring options to find a solution;
3. providing information and advice;
4. preventing, reducing or delaying the need for support.

You may also find the tool Six tips to help you have difficult conversations useful.

You should also make effective use of supervision to explore and develop skills that will support you to have difficult and sensitive conversations with people in a positive way.

If the young carer has needs that you know are likely to change in the near future, and may not be present when they become 18, you should understand these needs as they exist now, so that any current need for support can be identified, but you should not record the needs as likely future needs. For example:

1. when a young carer or the person they provide care to is expected to make a full recovery from a health related condition;
2. when the person the young carer provides care to has temporary needs only (e.g. needs that will be resolved through upcoming surgery or treatment); or
3. when a young carer's needs are related to their circumstances and these circumstances are going to change (for example, the person that they care for is going to move into residential care).

The young carer's assessment should not be carried out in times of crisis. If a crisis occurs during the assessment process, you should provide any support under the Children Act 1989 or the Children and Families Act 2014 using the procedures available to do so outside of this site.

The young carer's assessment should be paused and rescheduled or recommenced at a time when the crisis is resolved and carrying out the assessment would be of 'significant' benefit.

During the assessment, it will be necessary to:

1. ensure that current methods of meeting needs are effective; and
2. if not, take steps under relevant children's legislation to meet needs; and
3. establish whether there are any needs likely from the age of 18; and
4. if so, explore broadly how these needs could possibly be met by Adult Care and Support.

Any decisions about meeting needs will be made at a time when the needs established through the young carer's assessment are confirmed and deemed eligible by Adult Care and Support.

Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.

The aim of any conversation about risk is to maximise the benefits and reduce the likelihood of harm.

When you have a conversation about promoting wellbeing, meeting needs or ways to achieve an outcome, there will at some point be a need to talk about risk and doing so at an early stage can support the young carer (and their parents) to:

1. explore and understand the benefits of taking the risk;
2. explore and understand the potential harmful consequences of taking the risk;
3. think about the measures they can take to reduce the likelihood of a negative consequence; and
4. make an informed decision about whether to take the risk.

The process of talking about risk can be very empowering for a young carer and can build resilience, confidence and independence.

Examples of risk you may need to talk about when establishing need can include:

1. risk associated with the carer’s own impairment or disability (e.g. falls when carrying out caring related tasks);
2. risk of accidental injury (e.g. from manual handling and supporting the cared for person to mobilise);
3. risks to the carer from the person they care for (e.g. from verbal or physical abuse or from behaviour relating to the use of drugs or alcohol);
4. risks to the carer's emotional health as a result of the caring role;
5. risks to the carer’s work or family life as a result of their caring role; and
6. risks to the carer's own network of support (e.g. is it sustainable and how likely is it to break down).

Depending on the level of risk, a formal risk assessment may need to be carried out in addition to any other assessment process. See: Risk Assessment

If, as part of any conversation you have with a young carer or their family, you become concerned that a vulnerable adult or a child is experiencing, or is at risk of abuse or neglect, you must respond appropriately.

See Safeguarding Adults, which also includes information about how to raise a concern about a person under the age of 18.

If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place, you should contact the police by dialling 999.

Where the safeguarding is in respect of the young carer whose needs are being established, a decision will need to be made about the need to pause the assessment process to allow a safeguarding enquiry to take place.

There are three possible options:

1. The young carer's assessment process continues alongside any safeguarding process;
2. The young carer's assessment is paused with no ongoing intervention by the person carrying out the assessment, whilst a safeguarding process takes place; or
3. The young carer's assessment is paused but urgent interim support is arranged to ensure current needs are met, whilst a safeguarding process takes place.

Any decision should involve the person carrying out the needs assessment, the person who will be carrying out any safeguarding process, the young carer, their parents, and anyone with parental responsibility.

You must consider any appropriate action required to authorise deprivations of liberty whenever:

1. the person being cared for lacks capacity to make decisions about the care and support provided to them; and
2. you feel that the level of restriction being imposed on them now is depriving them of their liberty.

See: Recognising and responding to Deprivations of Liberty