Providing Direct Support

Direct support refers to the range of ways that an Occupational Therapy practitioner works directly with a person or a carer to ensure safe and effective use of equipment, aids or an adaptation.

Direct support includes:

1. Training of informal and paid carers in the safe and proper use of equipment; and
2. Supporting the person to safely and confidently use equipment or adapt to their environment after an adaptation.

Direct support:

1. Builds the person's confidence to use equipment and access their adapted environment;
2. Builds the confidence of any carers to use the equipment;
3. Ensures that people using the equipment are suitably skilled to do so;
4. Ensures that people using the equipment know when it may be faulty;
5. Reduces the risk of unsafe use of the equipment;
6. Reduces the risk of injury from unsafe or improper use of the equipment;
7. Maximises the effective use of the equipment or adapted environments to promote independence or prevent, reduce and delay needs.

You should consider providing direct support whenever:

1. New equipment has been provided;
2. An adaptation to the person's home has been carried out (major or minor adaptations);
3. The person or a carer requests support to use equipment;
4. A service provider requests support to use the equipment;
5. The Registered Manager of a care home requests support to use equipment provided by the Local Authority.

With consent (or in the best interests of a person who lacks capacity), direct support should be arranged in any of the following circumstances:

1. There is evidence that the person or any carer (informal or paid) will not be able to safely use the equipment without support;
2. There is evidence that the person may not use the equipment or access an adapted area of their home (either regularly or at all) without a period of direct support;
3. The equipment is complex and requires direct support to understand how it works;
4. There is a doubt about the effectiveness of the equipment to meet the person's identified need (and thus there is a need to 'test out' the equipment).

Direct support can be provided whenever:

1. The person consents to it;
2. The person lacks capacity to consent but a decision is made under best interests to this effect;
3. The carer consents (when support is to be provided to the carer).

Direct support can be provided in:

1. The person's home;
2. A care home;
3. Another environment where equipment is used and direct support would be beneficial (for example a day service).

Direct support arrangements should be made with:

1. The person (or their representative if they lack capacity);
2. Any carer;
3. Any service provider or care home who will be receiving direct support.

You will need to agree appropriate and proportionate arrangements as follows:

1. When direct support needs to start (this must be timely to reduce risk and maximise the benefit of support to promote independence);
2. The purpose and desired outcome of direct support;
3. The frequency that direct support will be provided;
4. The duration of each episode of direct support;
5. Who will provide the direct support;
6. Who will require direct support;
7. How long it is anticipated that direct support will last; and
8. How the progress of, and need for direct support will be monitored.

When deciding the arrangements for direct support you should consider:

1. The level of risk associated with improper use of equipment (risk of harm and to independence);
2. Whether equipment is in situ or not yet provided;
3. The complexity of the person's needs;
4. The person's ability to 'carry over' learning from one day to the next;
5. How often the equipment will be used/is used;
6. The time of day that direct support will be most beneficial (you should try and provide direct support in line with normal the routines of the person);
7. How many carers will need direct support;
8. The specific skills required of the person providing direct support; and
9. The current skills and abilities of carers to meet the person's needs.

A proportionate record of the direct support arrangements agreed should be made and, where deemed appropriate a written copy provided to the person.

Where you are making arrangements for another practitioner to provide direct support (rather than providing it yourself) you must make sure that you have recorded this in a way that will ensure the right person provides direct support at the agreed time.

Direct support should be provided in the manner agreed unless there is evidence to confirm that the arrangements are no longer appropriate or proportionate.

Proportionate records should be made each time that direct support is provided. Records should include:

1. The nature of the support provided (including which equipment and who direct support has been provided to);
2. Progress made towards safe and proper use of equipment;
3. Whether direct support is still required (including the views of the person and any carer about this);
4. Whether direct support arrangements are still appropriate; and
5. Any actions agreed (for example to arrange support for a carer who has not yet engaged with direct support).