Executive Function: What the Snapshot Misses

Stage 1 of 6

CASE FILE

Meet Leah

Leah is 34, autistic and lives alone in a housing-association flat. She has asked for a Care Act assessment after a period of increasing difficulty managing everyday life.

CommunicationSpeaks fluently and can describe ideas well, but needs time to process broad or unexpected questions.

Current supportHer mum texts most mornings with reminders and visits weekly to help reset the flat, organise food and sort paperwork.

ChangeLeah recently lost a part-time job. The loss of routine has made everyday tasks harder to start and sustain.

Plasticine illustration of Leah overwhelmed at her kitchen table by paperwork, household tasks, reminders and unfinished jobs.

The referral note says…

“Leah appears independent. She can cook, wash, use a phone and travel on public transport. She presents as articulate and has no physical care needs.”

Your job: test whether that snapshot tells you enough about her ability to achieve Care Act outcomes reliably in everyday life.

LOOK BENEATH THE SURFACE

What might executive functioning look like in Leah’s day?

Select the information that should make an assessor curious about executive functioning rather than simply labelling Leah as “unmotivated” or “choosing not to”.

Illustrated executive-function wheel showing areas such as working memory, planning, impulse control, organisation, task initiation, emotional control and flexible thinking. — Use the executive-function framework as a lens for the case, not as a checklist or diagnosis.

Buys ingredients, but cannot reliably start cooking before food spoils. Can explain a bus route, but misses appointments when the route changes or a connection is disrupted. Completes tasks when her mum is present, but struggles to begin or sequence them alone. Leaves letters unopened because deciding which action comes first feels overwhelming. Can shower, but may lose track of time and realise late in the day she has not washed, eaten or dressed. Prefers the colour purple.

THE NATIONAL ELIGIBILITY THRESHOLD

Apply the three-gate test

For this fictional exercise, make a provisional group judgement using the information you have. An actual eligibility decision would require a full person-centred assessment.

Gate 1 — Do Leah’s care and support needs arise from or relate to a physical or mental impairment or illness? Yes No Need more evidence

Gate 2 — As a result of those needs, is Leah unable to achieve two or more specified outcomes? Yes No Need more evidence

Gate 3 — Is there, or is there likely to be, a significant impact on Leah’s wellbeing as a consequence? Yes No Need more evidence

MAKE THE ASSESSMENT ACCESSIBLE

How would you strengthen the assessment?

Select the approaches you would want in the assessment plan.

Use concrete questions about real recent days, not just broad “can you…?” questions. Ask what prompting, supervision, planning or recovery support sits behind an apparently completed task. Offer written questions or an agenda in advance and allow processing time. With Leah’s consent, involve someone who knows her everyday functioning well. Explore variation across good days, disrupted routines and periods of stress. Treat articulate speech or good performance in the meeting as proof of independent daily functioning.

FINAL REFLECTION

One practice change

When a person can physically perform a task, what will you now do differently to explore whether executive functioning affects their ability to achieve it in everyday life?

One or two sentences is enough.

Group discussion summary

Practice anchor

Care Act eligibility is not diagnosis-led. The national threshold considers whether needs arise from or relate to an impairment or illness, whether the person is unable to achieve two or more specified outcomes, and whether this causes or risks a significant impact on wellbeing.

Read the Care and support statutory guidance · Care and Support (Eligibility Criteria) Regulations 2015