Why scaffolding a conversation is so important

Under the Mental Capacity Act 2005 (MCA), professionals must take “all practicable steps” to support a person’s decision-making before deciding they lack. This includes helping with memory recall during assessments.

One of the ways we can do this is by something known as ‘scaffolding’ and it’s a way of structuring and supporting the conversation to ease memory demands.

Why Scaffolding Memory Matters

Memory difficulties (from dementia, brain injury, etc.) can hinder a person’s ability to retain and recall information, which as we know, is one of four things we look for when assessing mental capacity (understanding, retention, ability to weigh and use and ability to communicate).

By not helping to support someone’s memory, we risk unfairly deeming someone to lack capacity. When it comes to having capacity, case law is clear that a person doesn’t have to remember everything – just the relevant, or salient, information (see my blog on salient information here.)

By scaffolding the conversation and helping to reduce memory load, we can differentiate between a lack of capacity and the need for additional support.

Practical Techniques to help scaffold a conversation

These simple techniques can support memory and understanding during assessments:

• Chunk Information: Break down complex information into smaller, digestible chunks. Present one point at a time rather than a lengthy monologue. After each chunk, pause and check understanding. This not only helps the person understand and recall information but it also provides evidence that you’ve tried to support the person’s decision- making.

  
  

• Use Visual Aids and Memory Cues: Research tells us that visual cues and familiar examples make it easier for the person to grasp and remember the salient facts. Support verbal information with visual information. Written notes, cue cards, calendars or timelines, even simple diagrams (I love my ‘stick- man’ drawings by the way!) can all serve as additional memory aids.

  
  

  For example, you might write down the main options or use a timeline of events to help the person recall context.

  
  

  A practical tip is to relate information to the person’s daily routines or familiar reference points – this anchors new information to something they readily remember (e.g. linking a medication schedule to meal times). Research tells us that visual cues and familiar examples make it easier for the person to grasp and remember the salient facts.

  
  

• Repetition and Reinforcement: Don’t hesitate to repeat important information in a patient, matter-of-fact way. Key details may need to be stated a number of times (in slightly different words) throughout the conversation. Each repetition gives the person another chance to encode the information.

  
  

  I will often recap ‘the conversation so far’, after each ‘chunked’ piece of information. It might take slightly longer but it helps provide a clear and structured format and builds or ‘scaffolds’ the key elements of the conversation, making it easier for the person to understand and recall what has been said.

  
  

  By periodically summarising what’s been discussed, it helps keep the person oriented and reduce the memory burden of holding onto earlier points.

  
  

• Encourage them to paraphrase it back to you: “Could you tell me in your own words what the options are, just to make sure we’re on the same page?”.

  
  

  This not only reinforces their memory but also lets you check and correct any misunderstandings on the spot.

  
  
  
  

  Supporting memory and understanding is not just good practice; it should be a fundamental part of our assessments. Remember, part of our role as an assessor is to give each person the greatest possible chance to be the best that they can be, before we ever reach a decision about their capacity.

  
  

  One of the most effective ways we can do this is by ‘scaffolding a conversation’ and helping the individual to understand, retain, weigh and use and communicate relevant information.