1. Website: csnat.org / Twitter @CSNAT_
The CSNAT Approach
Website: csnat.org /

2. Overview of the training session
1. The importance of identifying and addressing carers’ support needs
2. Reflections on existing approaches to identifying carers’ support needs
3. Background to the CSNAT
Development of the tool
Format and content
4. The 5 stages of The CSNAT Approach
5. How The CSNAT Approach differs from existing practice
6. Benefits of using The CSNAT Approach
7. Examples of using The CSNAT Approach in practice

3. Learning objectives
1. To provide an overview of the work you currently do with carers.
2. To gain a thorough understanding of The CSNAT Approach and how it differs from existing practice.

4. Discussion point 1: As an organisation, why is it important that we identify and address carers’ support needs?

5. Existing approaches
As you are going to use The CSNAT Approach in your practice, it will help to put this into context if you first consider:
how you currently become aware of carer support needs in your everyday practice (e.g. picking up on cues, speaking with the carer when making a patient assessment).
- the positives and limitations of your current approach.

6. Discussion Point 2: How do you currently become aware of carer support needs in your everyday practice?
Where do you tend to speak with a carer? e.g. at the end of a patient visit on the ‘door-step’ of the home, in the ‘corridor’ of a ward, alongside the patient, over the telephone.
Who initiates this process? (e.g. you, the patient, the carer)
How do you start a conversation with the carer about their support needs? e.g. pick up on their ‘cues’, asking ‘how are you?’
What type of support needs do you routinely discuss with carers?
Do you consider your existing practice to be a comprehensive assessment?
Is the carer aware that you are discussing their support needs as part of an assessment?
Does your current approach distinguish the carer’s needs as separate from the patient’s needs?
What support needs do you usually address? e.g. practical, emotional.

7. Discussion Point 3: What are the positives and limitations of your existing approach?

8. CSNAT Definitions Carer Support Needs Assessment Tool
We take the view that the carer becomes a ‘carer’ at the same time as the person they care for becomes the ‘patient’. We use the NICE definition of a carer as it acknowledges that many carers may not necessarily have a ‘hands-on’ role but nevertheless may still require support.
“Lay people in a close supportive role who share in the illness experience of the patient and who undertake vital care work and emotion management” (NICE 2004)
Support Needs
Anything the carer has identified as a support need to:
(i) enable them to provide care for the patient
(ii) support them directly to look after their own health and well-being
Assessment
An upfront and visible process of gathering carers’ views on their support needs to enable an action plan to be put in place to help address such needs.
Tool
A framework which provides structure for the assessment process, whilst retaining flexibility.

9. Why was the CSNAT developed?
27/02/2019
Why was the CSNAT developed?
There was a need for a straightforward ‘evidence based’ assessment tool which was easy to use in practice

10. How was the CSNAT developed?
The CSNAT team obtained the views of 75 bereaved carers on the support they needed when caring for someone towards the end-of-life (EOL) and found that carers’ support needs were not always being met by existing approaches.
Carers identified 14 key areas of support in end-of-life care (what we refer to as domains). These fell into two main groupings and formed the basis of the CSNAT:
- support to enable them to provide care to the patient (‘co-worker’ role)
- direct support for themselves to look after their own health and wellbeing (‘client’ role)

11. Carer Support Needs Assessment Tool (CSNAT): 14 Domains
Enabling carers to care
(co-worker role)
Knowing who to contact when concerned
Understanding the patient’s illness
Knowing what to expect in the future
Managing symptoms and giving medicine
Talking to the patient about their illness
Equipment to help care for the patient
Providing personal care for the patient
Direct support for carers
(client role)
Own physical health concerns
Dealing with their own feelings and worries
Beliefs or spiritual concerns
Practical help in the home
Financial, legal or work issues
Having time for them themselves in the day
Overnight break from caring
I will give a brief overview of the CSNAT-For more detailed info see csnat.org
The CSNAT tool itself was developed working with bereaved carers telling us what were key aspects of support when caring for someone in the last few months of life.
Then the tool that was developed was used by a large group of current carers to find out whether the areas covered by the tool were actually relevant to their caring situation- which they were
The key support areas identified fell into 2 groupings – those that enabled carers to care for the patient. And then more direct supports for themselves related to their health and well-being (I won’t read these out- usually agreement that there are no big surprises here)

12. How was the CSNAT validated?
225 adult carers of patients from six Hospice Home Care services completed a questionnaire booklet.
Interviews with 10 carers were also carried out to get feedback on the CSNAT.
Results showed that the CSNAT was a valid tool for uncovering carers’ support needs in everyday practice.

13. How do we know the CSNAT is comprehensive?
Scores of need for more support with the 14 CSNAT domains showed that the existing support domains comprehensively covered carer support needs.
Percentage of carers expressing need for more support with each Carer Support Needs Assessment Tool domain (N = 216–222)

14. What does the CSNAT look like in practice?

15. The CSNAT is only the beginning…

16. The CSNAT Approach: a person-centred approach to carer assessment and support

17. Stage 1 How do I introduce the CSNAT?
There are a number of different ways to introduce the CSNAT and this will very much depend on how you currently come into contact with carers.
It may be you introduce it:
During a patient visit/appointment (if the carer is present).
During a telephone conversation with the carer when arranging a home visit, so the carer is expecting to be given the CSNAT.
If the carer is not present, by explaining the CSNAT to the patient and leaving the tool/associated documents with them to pass on to the carer.
By posting the CSNAT/associated documents to the carer if it is expected there will be no opportunity for face-to-face contact e.g. due to the carer living a long distance away.

18. Stage 2
The next stage is to give the carer time to consider their support needs in relation to each domain. The length of time needed will vary, according to the individual.
Carers may wish to consider their needs:
When the CSNAT is first introduced, e.g. by looking at the CSNAT while you are with the patient.
Following on from the visit/appointment when the CSNAT was first introduced, for example they may
- Reflect on their support needs on their own during a quiet moment (using the CSNAT as a prompt).
- Chat about their support needs with family members/friends (using the CSNAT as a point of reference).
- Discuss their individual support needs with the person they are caring for.

19. How will I know what are the most important support needs for the carer?

20. Stage 3
The domains prioritised by the carer in Stage 2 will be the focus of the assessment conversation.
You therefore do not need to discuss all 14 CSNAT domains with them.
Opportunities for initiating an assessment conversation depend on the nature of your service e.g. visiting patterns and include:
When the CSNAT is first introduced to the carer.
At a follow up visit/appointment by you or a colleague.
During a visit by a support practitioner (e.g. Health Care Assistants).
Via a telephone call, e.g. situations where the carer does not live with the patient, or is not usually present at the patient visit/appointment).
Alternatively, the carer may make a phone-call to you or a colleague once they’ve had the chance to consider their needs. They may prefer the privacy this option allows.

21. Stage 3
This stage is also vital for unpicking the type of support required in relation to a given domain; the support required for one carer in relation to a domain may be very different to what another carer requires.
Understanding your relative’s illness…
Knowing what symptoms to expect
Being given a full explanation of the stage of the illness when requested
Explanations about the disease and its likely effects on the patient
Examples of carers’ support needs in relation to this domain
CSNAT domain

22. Stage 4
Before making a shared action plan it is important to find out what the carer feels would help them, before highlighting what is available.
What forms of supportive input could I provide?
You could help the carer to identify sources of support they may wish to access themselves (self-help) or via family members or friends (facilitating family help).
You might directly deliver some very simple support yourself. This could be ‘active listening’, providing reassurance, giving information, offering advice or providing some educational input.
You could signpost the carer towards sources of support, but leave the carer to access the supportive input themselves.
You could refer the carer to a service which can provide further support (with their consent).
The supportive input that carers need may be different (and simpler) to what you expect

23. Providing personal care for your relative…
Stage 4 example of supportive input
CSNAT domain
This may simply be a warning to carers of their future needs, for example, it may not have occurred to them that the handy bathroom next door may as well be Timbuktu for a weak patient.
Providing personal care for your relative…

24. Stage 5
There may be certain critical moments at which a full reassessment of the carer’s support needs would be beneficial (e.g. a change in the patient’s condition): prompt for a review can come from you or from the carer.
How can you help to facilitate a shared review with a carer?
Ensure they are aware they may raise their support needs at any time.
Ensure they know how to initiate contact e.g. contact person/number.
Leave a ‘blank’ CSNAT and self-addressed envelope with the carer which they can then forward to/discuss with you if their support needs have changed.
Be aware of events that might act as a trigger for a change in support needs and initiate a review e.g. a deterioration in the patient’s condition, or a change in the patient’s care plan.
You may wish to take a more proactive approach and agree a plan for review of the assessment with the carer rather than wait for a problem to arise e.g. you may record a date for when a review will take place.

25. Discussion Point 4: How could you follow each stage of The CSNAT Approach within your practice?

26. What's the same? What's different?
Measures are taken to identify the carer's support needs.
Personality of practitioner/style of interaction/use of professional judgement.
Issues relating to confidentiality of information and consent.
What's different?
The assessment process is facilitated by the practitioner, but carer led.
The assessment is more comprehensive and structured and visible.
The carer prioritises their support needs, therefore any support measures provided are tailored to the carer's individual needs.
The details of the carer assessment and supportive input are recorded.

27. Discussion Point 5: Discussion Point 5 How do you feel The CSNAT Approach differs from your existing practice? - Do carers currently know they are being assessed? - Are they able to reflect on what their needs are at that particular moment in time? - Do you create a shared action plan of how to address their support needs? - Do you review how their support needs change over time?

28. Comprehensive: it gathers all of the carer’s concerns in relation
Structured: the format of the CSNAT ensures all carers have a clear opportunity to consider their support needs in relation to each domain prior to discussing these
with a practitioner.
Flexible: it is responsive to the individual needs of the carer, it can be used in a way which matches the practitioner’s way of working, and in a way which meets the needs of a particular service
The CSNAT Approach to carer assessment and support is:
Comprehensive: it gathers all of the carer’s concerns in relation
to each domain prior to
focusing on the priorities
for the carer at a particular point in time.
Person-centred: it gives importance to the carer as a person with their own needs and enables them to say what is most important to them, at that moment in time, and what they feel would help support them.

29. your service/organisation
Discussion Point 5: What do you feel the benefits of The CSNAT Approach are for:
you as practitioners
carers
patients
your service/organisation

30. Benefits of The CSNAT Approach
For the Carer
- Makes the process of assessment visible.
- Legitimises support for the carer.
- Engages carers in the assessment process, tailoring support to their individual needs.
For the patient
- A carer who is well supported is more likely to be able to support the patient.
- It reassures the patient that their carer is being supported.
- It may help facilitate the patient’s preferred place of care.
Benefits of
The CSNAT Approach
For the practitioner
- Comprehensive and timely assessment.
- Reduced likelihood of ‘crisis management’.
- Helps with ‘expectation management’ about what support is and is not available.
For the organisation
- Provides a clear record of activity in relation to carer assessment and support; useful for auditing and/or commissioning purposes.
- Demonstrates the organisation’s commitment to carers.

31. Examples of using The CSNAT Approach in practice

32. Any questions?