Applying Just Enough Support in Support Planning and Reviews
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Just enough support cannot be achieved through initial assessment alone. It must be actively embedded into support planning and review processes, with clear mechanisms for adjusting support as needs, skills and risks change. Without this, services drift into over-support or unmanaged risk.
This article builds on wider person-centred planning frameworks within the Knowledge Hub, including Support Planning & Reviews and Recording & Evidencing Person-Centred Care.
Embedding Least Restrictive Practice at Planning Stage
Support plans should clearly distinguish between what a person can do independently, what they can do with support, and where full assistance remains necessary. This avoids blanket approaches and creates a baseline for future reduction.
Effective plans include:
- Outcome-led goals linked to independence
- Specific descriptions of how support will fade over time
- Clear indicators for increasing support if risk escalates
Operational Example: Graduated Support in Meal Preparation
A provider supporting an adult with acquired brain injury structured meal preparation into stages: planning, cooking and safety checks. Initial hands-on support reduced to observation as skills improved, with progress reviewed fortnightly.
The plan explicitly recorded why continued observation remained necessary for hot surfaces, demonstrating proportionate restriction rather than blanket control.
Review Cycles and Dynamic Adjustment
Regular reviews are essential. Least restrictive practice relies on timely reassessment, not annual reviews alone. Providers should use a mix of formal reviews and informal monitoring to capture progress.
Commissioners increasingly expect evidence that reviews lead to real change, not simply confirmation of existing arrangements.
Operational Example: Reducing Support Following Health Improvement
Following stabilisation of epilepsy medication, a provider reduced overnight checks from hourly to three-hourly, supported by risk assessment updates and sleep monitoring data. This reduced restriction while maintaining safety.
Inspector Expectations
CQC inspectors often ask how providers know support levels remain appropriate. Strong answers reference:
- Documented review outcomes
- Evidence of trial reductions
- Management oversight of changes
Governance and Quality Assurance
Providers should audit support plans for restrictive elements and ensure reviews actively consider whether restrictions remain necessary. This demonstrates a culture of enablement rather than risk avoidance.
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