Working with each family requires an individualised approach as the system appears to require a flexible problem solving approach each time the plan is reviewed. Keeping track of how past plans have been provided and what was asked for versus what was provided and the impact of this is extremely important to document. Family are spending significant quantities of time every year in preparation for the review which is causing significant distress. Individuals within the family may or may not be extensively aware of the conversations and the required time allocation being different in their routines. Managing expectations is important to be upfront with the level of experience as well as possible outcomes based on clinical judgement. The meetings themselves have been extremely challenging for families and outcomes which do not provide the full services that have been asked for and clinically justified have resulted in repeat reviews and shorter term periods of funding e.g. every 6 months.