Lesson 1 - Preparing for and Structuring a Review
1. Introduction
A well-structured review is more than a general conversation about how somebody has been feeling. It is a purposeful clinical contact that allows the practitioner to understand what has changed, evaluate progress, identify emerging concerns and agree what should happen next.
Case workers may undertake reviews as part of psychologically informed care, structured clinical management or an agreed care plan. Although the case worker is not responsible for diagnosing mental illness or independently changing clinical treatment, they often have an important role in maintaining continuity between senior clinical reviews. Regular contact can help identify improvements, setbacks and changes in risk at an early stage.
Good reviews require preparation. Reading the relevant records, understanding the purpose of the appointment and knowing the limits of your role allow the conversation to remain focused without becoming rigid. Preparation also communicates respect: the person should not have to repeat information unnecessarily because the practitioner has not read the available notes.
This lesson considers how to prepare for a review, establish a collaborative agenda, explore progress systematically, assess safety, maintain professional boundaries, document the appointment and escalate concerns appropriately.
2. Learning Outcomes
By the end of this lesson, learners should be able to:
Explain the purpose of a mental health review and how it differs from an initial assessment.
Prepare effectively by reviewing the care plan, previous records, identified risks and agreed objectives.
Structure a review while remaining person-centred, flexible and psychologically informed.
Explore changes in mental health, functioning, treatment, physical health and risk.
Recognise information requiring discussion or escalation to a senior clinician.
Document the review clearly and agree an appropriate follow-up plan within their professional competence.
3. The Lecture
What Is a Review?
A review is a planned opportunity to consider what has happened since the previous clinical contact. It should answer several important questions:
What has changed?
What has improved?
What remains difficult?
Has anything new emerged?
Is the existing care plan being followed?
Is the care plan helping?
Have risks increased or decreased?
What needs to happen next?
A review is different from an initial assessment. During an initial assessment, the practitioner usually gathers a broad history and develops an understanding of the person’s needs. During a review, the emphasis is on change over time, progress towards agreed goals and whether the current plan remains appropriate.
However, a review should not be artificially restricted to previously identified difficulties. New symptoms, adverse experiences, safeguarding concerns or significant changes in circumstances may emerge. The practitioner must therefore combine structure with curiosity.
The Purpose of Structure
Structure helps ensure that important areas are not forgotten. It can make appointments feel more predictable and can help people who find open-ended conversations difficult.
Structure should support the conversation rather than control it. A review should not feel like a checklist being read aloud. The practitioner should listen to what appears most important to the person and adjust the order or emphasis of the review when appropriate.
A useful structure follows the sequence:
Prepare → Connect → Agree → Explore → Review safety → Plan → Summarise → Document and escalate
This sequence should not be treated as an inflexible script. For example, if somebody reveals an immediate safety concern at the beginning of the appointment, risk assessment and escalation take priority over the usual agenda.
Preparing Before the Appointment
Understand the purpose of the review
Before the appointment, establish why it has been arranged. The review may be intended to:
Monitor progress against a care plan.
Review emotional wellbeing or mental state.
Support engagement with agreed interventions.
Review practical or psychosocial difficulties.
Monitor coping strategies.
Identify barriers to progress.
Review safety or an existing risk-management plan.
Gather information for a senior clinician.
Support somebody between formal clinical appointments.
If the purpose is unclear, seek clarification from the supervising clinician before beginning. Do not create a new clinical purpose independently.
Review relevant records
Read the information necessary to conduct the review safely and effectively. This will usually include:
The most recent clinical note.
The current care plan.
Agreed goals or actions.
Relevant risk assessments and safety plans.
Recent communications from the person, family or other professionals.
Any safeguarding information relevant to the contact.
Instructions provided by the supervising clinician.
The date and purpose of the next senior clinical review.
You do not need to reread the entire clinical record before every appointment. Focus on the information that is relevant to the current review while remaining aware of major risks, communication needs and important contextual factors.
Reading the record does not mean making assumptions. Previous information provides context, but the person’s current experience must still be explored.
Review previous actions
Identify what was agreed at the last appointment. For example:
Was the person going to practise a particular coping strategy?
Was the case worker going to provide information or contact another team member?
Was a family member going to support a new routine?
Was a concern due to be discussed in supervision?
Was a referral or senior clinical review expected?
Reviewing previous actions promotes accountability. It also prevents the person from feeling that each appointment begins again from the beginning.
If an action allocated to you has not been completed, acknowledge this honestly and take appropriate steps to resolve it. Do not imply that somebody else was responsible unless this is accurate.
Consider communication and accessibility needs
Think about what may help the person participate. This might include:
Using clear and concrete language.
Allowing additional processing time.
Avoiding multiple questions at once.
Offering breaks.
Providing written summaries.
Checking whether an interpreter is required.
Minimising sensory distractions.
Clarifying whether the person wants a family member or supporter present.
Considering whether part of the appointment should take place individually.
Do not assume that a diagnosis automatically determines somebody’s communication preferences. Ask the person what helps them.
Prepare the practical environment
For an in-person appointment, consider privacy, seating, noise, interruptions and access to assistance if a safety concern arises.
For a remote appointment, follow local procedures for confirming:
The person’s identity.
Their current location.
Whether they can speak privately.
Who else is present.
A suitable telephone number if the connection fails.
How emergency assistance could be contacted if required.
Remote appointments should not create a false sense of safety. If somebody is at immediate risk, knowing their location may be essential.
Beginning the Review
Welcome and orientate the person
Begin in a calm, professional and approachable manner. Introduce yourself if necessary and explain your role. Even when the person has met you before, it may be helpful to briefly remind them of the purpose of the session.
For example:
“Today is an opportunity to look at how things have been since we last met, what has helped, what remains difficult and whether there is anything we need to raise with the wider clinical team.”
This provides predictability and makes the purpose of the review transparent.
Confirm consent and confidentiality
Check that the person understands the nature of the appointment and is willing to participate. Explain confidentiality in proportionate language, including its limits.
For example:
“What you tell me will usually remain within the clinical team. If I become worried that you or somebody else may be at serious risk, or that a child or vulnerable person may not be safe, I may need to share that information with an appropriate senior clinician or service. I would usually try to explain this to you.”
Do not promise absolute confidentiality.
When working with children and young people, it may be helpful to hear separately from the young person and their parent or carer. This should be handled sensitively and in accordance with consent, competence, safeguarding requirements and the agreed clinical plan.
Begin with an open question
An open question allows the person to identify what matters most to them.
Examples include:
“How have things been since we last met?”
“What has been most important since our previous appointment?”
“What would you particularly like us to make sure we discuss today?”
“Has anything changed that you think the team needs to know about?”
Allow the person time to respond. The first answer may reveal the central issue for the appointment.
Agree the agenda
A collaborative agenda combines the person’s priorities with the areas the practitioner is required to review.
For example:
“You would like to talk about the difficulties at college. I would also like to review your mood, how the strategies we discussed have been working and whether there have been any safety concerns. Is there anything else we should add?”
If several issues are raised, prioritise them together. Be realistic about what can be covered in the available time.
Reviewing Progress Since the Previous Contact
Start with change
A review should focus on comparison. Asking only how somebody feels today may miss important patterns.
Useful questions include:
“Compared with when we last met, would you say things are better, worse or about the same?”
“What have you noticed changing?”
“When did that change begin?”
“Has it been consistent, or does it vary?”
“What do you think has contributed to the change?”
Explore both improvement and deterioration. Improvements provide information about strengths, effective strategies and protective factors.
Review agreed goals
Return to the goals established in the care plan. Goals should be meaningful to the person rather than based only on symptom reduction.
Examples might include:
Leaving the house more regularly.
Returning to education or employment.
Developing a more consistent sleep routine.
Responding differently during conflict.
Using coping strategies before distress escalates.
Attending appointments more consistently.
Reconnecting with supportive people.
Completing manageable daily activities.
Ask what has helped and what has made progress difficult. Avoid treating incomplete actions as evidence of laziness or lack of motivation. Barriers may include anxiety, executive functioning difficulties, low energy, family stress, financial pressures, misunderstanding, fear of failure or a plan that was not sufficiently realistic.
Identify strengths and successes
Reviews can become dominated by problems. Deliberately exploring strengths helps develop a balanced understanding and supports self-efficacy.
You might ask:
“What has gone slightly better?”
“What have you managed despite things being difficult?”
“Was there a time when you handled the situation differently?”
“Who or what has helped?”
“What does that tell us about what might be useful?”
Do not exaggerate small improvements or offer praise that feels patronising. Acknowledge effort accurately and respectfully.
Reviewing Mental Health and Wellbeing
The depth of questioning should be determined by the care plan, the person’s presentation and your level of competence. A case worker should not attempt to complete an unplanned diagnostic assessment.
Relevant areas may include:
Mood
Explore whether the person has experienced persistent sadness, reduced enjoyment, hopelessness, irritability or changes in motivation. Ask about duration, frequency, triggers and impact rather than relying on a single rating.
A numerical rating can be useful when it has an agreed meaning:
“You rated your mood as four out of ten last time. What number would you give it today, and what makes it that number?”
The number itself is less important than the explanation.
Anxiety and emotional distress
Ask about worries, physical symptoms of anxiety, panic, avoidance, overwhelm and situations that increase or reduce distress.
Explore the impact on everyday life:
Has the person stopped attending school, work or activities?
Are they avoiding leaving home?
Are they seeking repeated reassurance?
Is anxiety disrupting sleep, eating or relationships?
Emotional regulation
Explore episodes of becoming overwhelmed, shutting down, withdrawing, shouting, damaging property or acting impulsively.
Remain curious rather than judgemental:
“What tends to happen before things become overwhelming?”
“How do you notice that distress is building?”
“What happens next?”
“What helps the situation settle?”
“Has anybody been hurt or felt unsafe?”
Unusual or concerning experiences
If the person describes unusual beliefs, perceptual experiences, marked confusion, a major reduction in sleep with increased energy, or behaviour suggesting significant deterioration, gather sufficient information to identify the concern and escalate it.
Do not attempt to diagnose psychosis, mania or another disorder. Do not challenge unusual beliefs confrontationally. Record what the person describes and seek senior clinical advice promptly.
Sleep, appetite and daily routine
Changes in sleep and appetite can reflect mental distress, physical illness, medication effects or changes in routine. Ask about:
Sleep onset and waking.
Night-time waking.
Total sleep.
Daytime tiredness.
Changes in appetite.
Regularity of meals.
Daily structure.
Activity and time spent outside the home.
Significant or rapid changes may need clinical review.
Substance use
If relevant, explore alcohol, cannabis, illicit drugs, prescribed medication used outside its directions, nicotine, caffeine and energy drinks.
Use neutral language. The aim is to understand patterns and risk, not to catch somebody out.
Ask about what is used, how often, how much, in what situations and with what consequences. Escalate concerns in accordance with the care plan and local procedures.
Reviewing Functioning
Symptoms are only one part of a review. It is equally important to understand how the person is managing their everyday life.
Relevant areas may include:
Personal care.
Eating and preparing food.
Sleep and daily routine.
Household responsibilities.
Education or employment.
Relationships and family life.
Social contact.
Community activities.
Finances and housing.
Caring responsibilities.
Attendance at appointments.
Ability to manage agreed tasks.
Changes in functioning can provide valuable evidence of improvement or deterioration. Somebody may say that their mood is unchanged but may have stopped eating, attending school or responding to messages. Conversely, they may still experience symptoms but have become more able to pursue valued activities.
Reviewing Interventions and Coping Strategies
Explore what the person has tried since the previous appointment.
Useful questions include:
“Which strategies have you used?”
“When did you use them?”
“What effect did they have?”
“Was anything difficult about using them?”
“Would you use them again?”
“Does the strategy need to be simplified or adapted?”
Avoid presenting coping strategies as tests that the person has passed or failed. If a strategy has not helped, this is information that should shape the plan.
Case workers may reinforce previously agreed strategies within their competence. They should not independently introduce specialist psychological treatment or claim to be delivering a therapy for which they have not been trained and authorised.
Reviewing Medication Without Exceeding Your Role
Where medication forms part of the care plan, a case worker may be asked to gather information about the person’s experience. This might include:
Whether the medication is being taken as prescribed.
Whether doses are being missed.
Any practical barriers to taking it.
Perceived benefits.
Possible adverse effects.
Concerns or questions the person wants the prescriber to address.
Whether medication supplies are running low.
The case worker should not advise the person to start, stop or alter medication unless carrying out a specific authorised instruction within their professional competence.
Potentially serious adverse effects, medication errors, deliberate overdose, significant non-adherence or an intention to stop essential treatment should be escalated promptly. Immediate physical symptoms may require urgent medical attention rather than a routine message to the prescriber.
Reviewing Physical Health
Mental and physical health should not be separated unnecessarily. Ask about relevant changes in physical wellbeing, especially where they may affect mental health or treatment.
This may include:
New physical symptoms.
Pain.
Significant changes in weight or appetite.
Fainting, chest pain or palpitations.
Sleep problems.
Reduced mobility.
Pregnancy or possible pregnancy where clinically relevant.
Difficulties accessing medical care.
Concerns about medication monitoring.
A case worker should not diagnose a physical condition. Concerning symptoms should be escalated to the appropriate clinician or emergency service according to urgency.
Reviewing Risk and Safety
Risk should be reviewed, not assumed
A previous risk assessment does not establish that risk remains unchanged. Risk can alter in response to loss, conflict, medication changes, substance use, physical illness, social isolation, access to means and other events.
Equally, asking about risk should not be reduced to a mechanical list of questions. A psychologically informed review explores the person’s experience, context, protective factors and ability to remain safe.
Relevant areas
Depending on the person and care plan, consider:
Thoughts of death or suicide.
Thoughts or acts of self-harm.
Plans, intent, preparation and access to means.
Recent attempts or near misses.
Risk from impulsive behaviour.
Risk to other people.
Domestic abuse or exploitation.
Abuse, neglect or safeguarding concerns.
Aggression or serious conflict.
Substance-related risk.
Self-neglect.
Vulnerability in the community.
Ability to care safely for children or dependants.
Protective factors and reasons for staying safe.
Ask directly, calmly and without judgement. Asking about suicide does not place the idea into somebody’s mind.
Avoid false reassurance from risk labels
Terms such as “low”, “medium” and “high” can create false certainty when used without explanation. The record should describe the relevant thoughts, behaviours, circumstances, protective factors and actions taken.
Risk assessment is not a prediction of the future. It is a process of understanding current concerns and deciding what action is required.
Responding to concerns
Use the familiar sequence:
Recognise → Record → Report → Escalate
If there is an immediate threat to life or serious safety concern, follow the emergency procedure without waiting for routine supervision. This may include contacting 999, seeking urgent clinical support or activating the organisation’s safeguarding procedure.
If the concern is important but not immediately life-threatening, discuss it with the supervising clinician, Registered Manager or other designated senior clinician within the timescale required by local policy.
Do not agree to keep serious risk or safeguarding information secret. Wherever possible, explain what information needs to be shared, with whom and why.
Working with Parents, Carers and Supporters
Parents, carers and supporters can provide valuable information and may play a central part in implementing the care plan. Their contribution should be welcomed while maintaining the person’s dignity and voice.
Where appropriate:
Speak directly to the person rather than only about them.
Clarify what information may be shared.
Explore differences in perspective respectfully.
Avoid deciding automatically that either account is more accurate.
Consider whether individual time would support disclosure.
Record relevant differences between accounts.
Escalate concerns about consent, capacity, competence or safeguarding.
For children and young people, use developmentally appropriate language and involve them meaningfully in decisions. Their wishes should not be ignored simply because a parent or carer is present.
Managing Common Challenges During a Review
The person says that everything is “fine”
Do not immediately assume either that there are no concerns or that the person is concealing something.
Use gentle, specific questions:
“What has an ordinary day looked like?”
“How has school or work been?”
“How have things been at home?”
“What has been easiest and what has been hardest?”
“What would somebody close to you have noticed?”
Respect the person’s right not to discuss something while considering whether this limits the safety or usefulness of the review.
The conversation becomes unfocused
Acknowledge what the person is saying and gently return to the agreed agenda:
“It sounds as though several difficult things have happened. I want to make sure we also have time to discuss how safe you have been feeling and agree what happens next.”
Redirection should not communicate that the person’s concerns are unimportant.
A major new problem emerges
Pause the original agenda and clarify the new concern. Determine whether immediate action is required and contact a senior clinician when necessary.
Do not attempt to manage a complex new presentation outside your competence simply because it arose during your appointment.
The person becomes distressed
Slow the pace, acknowledge the distress and offer appropriate choices. This might include a brief pause, grounding, changing the subject temporarily or involving an agreed supporter.
Do not rush to stop all emotion. Becoming tearful does not necessarily mean that the conversation is harmful. The important questions are whether the person remains able and willing to continue and whether the appointment remains safe.
There is disagreement
Explore the difference rather than trying to win the argument:
“We seem to be understanding this differently. Can we slow down and look at what each of us has noticed?”
If disagreement concerns diagnosis, medication or a significant treatment decision, record the person’s view and refer the matter to the responsible clinician.
Agreeing the Plan
The plan should follow logically from the review. It should be collaborative, realistic and within the authority of those involved.
A useful plan identifies:
What the person will do.
What the case worker will do.
What family members or supporters have agreed to do.
What will be discussed with a senior clinician.
Any safety actions.
Who will be contacted if the situation worsens.
When the next contact will occur.
Which issues remain unresolved.
Avoid vague plans such as “continue to monitor” without specifying what will be monitored, by whom and when.
Do not promise a particular clinical decision on behalf of another professional. For example, say:
“I will share your concerns about the medication with the prescriber.”
Do not say:
“The doctor will increase your medication.”
Ending the Review
Summarise
Give a concise summary of what you have understood:
The main changes.
Progress or strengths.
Continuing difficulties.
Safety information.
Agreed actions.
The follow-up arrangement.
Check accuracy:
“Have I understood that correctly?”
This gives the person an opportunity to correct misunderstandings.
Check unanswered questions
Ask whether the person has any questions or whether something important has been missed. If you do not know the answer, say so and agree how it will be clarified.
Confirm what happens next
The person should leave knowing:
What has been agreed.
Who is responsible for each action.
When they will next be contacted.
How to seek help if their mental health or safety deteriorates.
Documenting the Review
Documentation should be completed promptly and should provide a clear account for another member of the team.
The record should normally include:
The date, time and format of the contact.
Who attended.
The purpose of the review.
The person’s account of changes since the previous contact.
Relevant mental health symptoms and functioning.
Progress towards agreed goals.
Interventions or strategies discussed.
Medication information where relevant.
Risk and safeguarding information.
Protective factors.
Advice provided.
Information escalated and to whom.
The agreed plan and responsibilities.
Follow-up arrangements.
Distinguish between:
What the person reported.
What another person reported.
What you directly observed.
Your professional actions.
Use respectful, factual language. Avoid judgemental terms such as “attention-seeking”, “manipulative”, “non-compliant” or “difficult”. Describe the behaviour and context instead.
For example, rather than writing “He was uncooperative”, write:
“He answered briefly and stated that he did not want to discuss his anxiety today.”
Do not retrospectively alter records to make the appointment appear more complete than it was. If an error is identified, follow the organisation’s procedure for making a transparent correction or addendum.
Following Up After the Appointment
The work is not complete when the conversation ends. Complete all agreed actions, including:
Escalating clinical concerns.
Sharing safeguarding information.
Updating the supervising clinician.
Sending agreed resources.
Arranging the next contact.
Recording tasks on the appropriate system.
Checking that urgent communications have been received.
If you have escalated an urgent concern electronically, do not assume that sending a message means it has been received and acted upon. Follow the appropriate procedure to obtain confirmation.
4. Clinical Perspective
Clinical Pearl: Preparation Creates Space for Listening
Preparation is not about deciding in advance what the person will say. It prevents the practitioner from spending the appointment searching through records or asking the person to repeat information unnecessarily. Knowing the background allows more attention to be given to the present conversation.
Clinical Pearl: Begin Broadly, Then Become Specific
An open question reveals the person’s priorities. Specific questions ensure that essential areas are covered. Using only open questions may leave important gaps, while using only closed questions can make the review feel interrogative.
Clinical Pearl: Always Look for Change and Impact
A statement such as “I still feel anxious” is incomplete. Explore whether the anxiety is more or less intense, how often it occurs, what triggers it and what effect it has on everyday functioning.
Clinical Pearl: Improvement Does Not Mean Risk Has Disappeared
Some people continue to experience suicidal thoughts even when their mood or functioning has improved. Risk should be reviewed directly when clinically relevant rather than inferred from the general tone of the appointment.
Clinical Pearl: Risk Questions Should Be Calm and Clear
Indirect or apologetic questioning can suggest that suicide and self-harm are subjects that cannot be discussed openly. Clear questions are usually kinder and clinically safer.
Clinical Pearl: Silence Can Be Useful
Do not fill every pause. People may need time to remember, process or decide how to explain something. A brief silence can support disclosure.
Practical Tip: Keep an Eye on Time Without Rushing
Mentally divide the appointment into an opening, main review and closing period. Leave enough time to review safety, agree a plan and summarise. Do not introduce a complex new subject in the final minute unless it relates to immediate safety.
Practical Tip: Use the Previous Plan as an Anchor
Beginning with previous actions provides continuity. It also helps distinguish a structured review from a general supportive conversation.
Practical Tip: Record Escalation Precisely
Document what was escalated, to whom, when, how and what response was received. Writing only “discussed with senior” may not provide an adequate clinical record.
Common Pitfall: Turning the Review into a Checklist
A checklist can support consistency, but it cannot replace listening or clinical curiosity. Follow up meaningful answers rather than moving immediately to the next question.
Common Pitfall: Giving Advice Too Quickly
Practitioners may move into problem-solving before fully understanding the difficulty. Explore what is happening, what the person has already tried and what outcome they want before suggesting an agreed strategy.
Common Pitfall: Working Beyond Competence
A case worker should not diagnose a new disorder, alter medication, provide specialist therapy without appropriate training or independently manage significant risk. The correct action is often to gather relevant information and seek senior clinical input.
Common Pitfall: Treating Missed Goals as Failure
If the person has not completed an agreed action, explore the barriers. The goal may have been too ambitious, poorly understood, insufficiently supported or no longer relevant.
Common Pitfall: Allowing the Parent or Carer to Dominate
Parents and carers may have important information, but the person receiving care should remain meaningfully involved. Speak to them directly and create opportunities for their perspective to be heard.
When Senior Clinical Advice Is Required
Seek advice or escalate when:
There has been significant deterioration in mental state or functioning.
Suicidal thinking, self-harm or another serious safety concern has emerged or increased.
There is concern about harm to another person.
A safeguarding concern is identified.
The person describes possible psychotic or manic symptoms.
There are significant adverse effects or medication concerns.
The person wants to stop or substantially change prescribed treatment.
There is severe substance-related risk.
The current care plan appears ineffective or unsuitable.
The person’s needs exceed the remit of the service.
Consent, capacity, competence or confidentiality is unclear.
You are uncertain about the appropriate response.
Uncertainty is itself a valid reason to seek supervision. Escalating appropriately is not a failure of competence; it is an essential part of safe practice.
5. Summary
A mental health review should establish what has changed, what has helped, what remains difficult and what needs to happen next.
Effective reviews begin before the appointment. The practitioner should understand the purpose of the contact, read relevant records, review previous actions and consider communication, accessibility and safety needs.
The appointment should begin with a clear explanation of its purpose, appropriate discussion of confidentiality and a collaboratively agreed agenda. The review can then explore mental health, functioning, goals, coping strategies, physical health, treatment and safety.
Structure should guide the conversation without making it rigid. Practitioners should remain responsive to the person’s priorities and to any new clinical or safeguarding concerns.
Case workers must remain within their competence. Their role may include gathering information, supporting agreed strategies and identifying changes, but not independently diagnosing conditions, changing medication or managing serious risk.
Every review should end with a clear summary, an agreed plan and follow-up arrangements. Documentation and escalation should be prompt, factual and sufficiently detailed to support safe continuity of care.
6. Further Reading
NICE NG197: Shared decision making — guidance on involving people in decisions and supporting meaningful, informed participation.
NICE CG136: Service user experience in adult mental health services — principles of person-centred communication, relationships, information-sharing and involvement in care.
NICE NG204: Babies, children and young people’s experience of healthcare — guidance on communication, involvement, consent, privacy and developmentally appropriate care.
NICE NG225: Self-harm: assessment, management and preventing recurrence — guidance on compassionate assessment, psychosocial assessment, safety planning and aftercare following self-harm.
NICE NG10: Violence and aggression — guidance on prevention, communication, de-escalation and responding safely to distressed or aggressive behaviour.
NHS England: Mental health personalised care framework — national principles for personalised care, collaborative planning, coordination and review.
The Skilled Helper by Gerard Egan and Robert Reese — a practical model for purposeful helping conversations and collaborative action planning.
Motivational Interviewing: Helping People Change and Grow by William R. Miller and Stephen Rollnick — guidance on collaborative conversations that strengthen motivation and autonomy.
7. Knowledge Check
Question 1
What is the primary purpose of a planned mental health review?
A. To repeat the entire initial assessment
B. To determine what has changed and whether the current plan remains appropriate
C. To establish a new diagnosis at every appointment
D. To allow the practitioner to give general advice
Correct answer: B
Explanation:
A is incorrect: Some information may need clarification, but routinely repeating the entire initial assessment is unnecessary and can feel frustrating.
B is correct: A review considers change over time, progress, continuing needs, safety and whether the current care plan remains suitable.
C is incorrect: Diagnosis is not the purpose of every review and is outside the independent remit of a case worker.
D is incorrect: Advice may form part of an agreed plan, but a review should involve assessment, collaboration and follow-up rather than simply giving advice.
Question 2
What is the most appropriate preparation for a routine review?
A. Reading every entry in the person’s record from the beginning
B. Waiting to hear what the person says before looking at any records
C. Reviewing the recent notes, current care plan, identified risks and previous actions
D. Preparing a new treatment plan before meeting the person
Correct answer: C
Explanation:
A is incorrect: Reading the entire record before every review is rarely proportionate. Preparation should focus on relevant information.
B is incorrect: Failing to review available information may lead to missed risks, repetition and poor continuity.
C is correct: These documents establish the purpose, context, previous agreements and known safety concerns.
D is incorrect: The plan should be informed by the review and agreed collaboratively. It should not be decided in advance without the person’s contribution.
Question 3
A young person begins the review by saying that conflict at home is the only issue they want to discuss. You also need to review their mood and safety. What should you do?
A. Ignore the home situation and follow the review form
B. Discuss only the issue chosen by the young person
C. Agree an agenda that includes their concern and the essential clinical areas
D. End the appointment because the planned agenda has changed
Correct answer: C
Explanation:
A is incorrect: Ignoring the young person’s priority would not be collaborative and could damage engagement.
B is incorrect: Their concern should be explored, but essential areas such as safety cannot automatically be omitted.
C is correct: A collaborative agenda combines the person’s priorities with clinically necessary aspects of the review.
D is incorrect: Reviews should be flexible. A change in emphasis does not usually require the appointment to end.
Question 4
A person says that they did not complete an agreed activity because they “could not face it”. What is the best initial response?
A. Remind them that they agreed to complete it
B. Record that they are non-compliant
C. Explore what made the activity difficult and whether the plan needs adapting
D. Remove all goals from the care plan
Correct answer: C
Explanation:
A is incorrect: A reminder alone does not identify the barrier and may feel critical.
B is incorrect: “Non-compliant” is judgemental and provides little clinically useful information.
C is correct: The difficulty may relate to anxiety, low energy, executive functioning, misunderstanding or an unrealistic goal.
D is incorrect: One incomplete action does not mean that collaborative goals should be abandoned.
Question 5
During a medication review, a person asks whether they should double their dose because it does not seem effective. What should a case worker say?
A. “Yes, if the current dose is not helping.”
B. “Try it for one week and reduce it if you experience side effects.”
C. “I cannot advise you to change the dose, but I will share your concern with the prescriber.”
D. “Medication cannot be discussed during a case-worker appointment.”
Correct answer: C
Explanation:
A is incorrect: Independently recommending an increased dose is outside the case worker’s role and may be unsafe.
B is incorrect: This is also unauthorised medication advice.
C is correct: The case worker can gather relevant information and ensure that the responsible prescriber considers it.
D is incorrect: Medication experience can be discussed when relevant. The boundary concerns making prescribing decisions, not listening to or recording concerns.
Question 6
A person reports suicidal thoughts and says that they have obtained the means to act on a plan later that day. What should the case worker do?
A. Complete the usual review before deciding what to do
B. Ask them to promise that they will not act on the thoughts
C. Follow the urgent risk and emergency procedure immediately
D. Arrange to discuss the case during the next routine supervision session
Correct answer: C
Explanation:
A is incorrect: The standard agenda should be paused because immediate safety takes priority.
B is incorrect: A promise does not provide an adequate assessment or safety response.
C is correct: Suicidal intent, a plan and access to means require immediate action under the organisation’s emergency procedure.
D is incorrect: Routine supervision would create an unsafe delay.
Question 7
Which is the best example of objective documentation?
A. “He was difficult and manipulative throughout.”
B. “He refused to cooperate.”
C. “He gave brief answers and stated that he did not want to discuss his anxiety today.”
D. “He was clearly hiding something.”
Correct answer: C
Explanation:
A is incorrect: “Difficult” and “manipulative” are subjective and potentially stigmatising labels.
B is incorrect: This does not describe what occurred or acknowledge the person’s stated choice.
C is correct: It records observable behaviour and the person’s own explanation without making an unsupported judgement.
D is incorrect: This attributes a motive without evidence.
Question 8
A parent answers every question directed to a 15-year-old. What is the most appropriate response?
A. Continue speaking only to the parent
B. Tell the parent to leave immediately
C. Respectfully create opportunities for the young person to answer and consider offering individual time
D. Assume that the parent’s account is more reliable
Correct answer: C
Explanation:
A is incorrect: This excludes the young person from their own care.
B is incorrect: Abruptly excluding the parent may damage trust and may not be necessary or appropriate.
C is correct: The practitioner should involve the young person meaningfully while considering consent, safeguarding and the agreed clinical plan.
D is incorrect: Different accounts should be explored and documented rather than one being automatically preferred.
Question 9
Which plan is most useful at the end of a review?
A. “Continue to monitor.”
B. “The case worker will telephone on Thursday, the person will use the agreed safety plan, and medication concerns will be discussed with the prescriber today.”
C. “The doctor will probably change the medication.”
D. “The person should try harder to maintain a routine.”
Correct answer: B
Explanation:
A is incorrect: It does not identify what will be monitored, by whom or when.
B is correct: It specifies actions, responsibilities, timescales and escalation.
C is incorrect: It promises or predicts a decision that belongs to the prescriber.
D is incorrect: This is judgemental and does not provide a practical or collaborative action.
Question 10
After sending an urgent electronic message to a senior clinician, what should the case worker do?
A. Assume that sending the message completes the escalation
B. Delete the message once it has been sent
C. Follow the relevant procedure to confirm that the concern has been received and acted upon
D. Wait until the next appointment to see whether the situation improves
Correct answer: C
Explanation:
A is incorrect: Electronic messages may not be read immediately. Sending is not the same as achieving effective escalation.
B is incorrect: The communication may form part of the clinical and governance record.
C is correct: Urgent escalation requires appropriate confirmation and documentation of the response.
D is incorrect: Waiting may expose the person to avoidable harm when an urgent concern has already been identified.
