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service development : children and families

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Moving towards a common approach

 

Developments with common assessment frameworks

 

Learning from the work of other local authorities

 

I am going to start by looking at the background to the development of one common assessment framework – The National Framework for the Assessment of Children in Need and their Families.  I will then go on to look in detail at one example of steps towards a common approach taken by Bolton in their Child Concern Model, as well as  looking briefly at examples from other authorities.

 

Background to the Framework for the Assessment of Children in Need and their Families

The Children Act 1989, implemented in 1991, introduced the threshold of children ‘in need’.  The Act places a duty on local authorities to:

 

‘safeguard and promote the welfare of children within their area who are in need and, so far as is consistent with that duty, to promote the upbringing of such children by their families, by providing a range and level of services appropriate to those children’s needs.’ (section 17(1))

 

A child shall be taken to be in need if:

 

S/he is unlikely to achieve or maintain or have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision of services by a local authority

 

His/her health or development is likely to be significantly impaired or further impaired, without the provision of such services

 

S/he is disabled

(section 17 (10)).

 

There are some important issues to bear in mind in relation to this definition of ‘in need’ and in relation to the duties placed on a local authority in section 17 of the Act:

 

To sum up: the Act provides a very broad definition of need linked to children’s health and development.  It encourages a corporate approach by a local authority – social services, education, housing, youth and community services, leisure, planning etc – to the identification of, and response to, children and families in need. Guidance issued with the Act and a subsequent amendment to the legislation have emphasised that such a corporate approach should include close working with health services, police, probation and the voluntary sector and consultation with users of services.

 

What happened

 

In the two years between the passing of the Children Act in 1989 and its implementation in 1991 the issue of what methods would be used by Local Authorities to assess whether or not a child was in need was discussed regularly at conferences, training events and seminars.  Twelve volumes of guidance were issued by the Government to accompany the Act but these did not include guidance on assessments of need.

 

There was at that time already detailed government guidance on the operation of child protection procedures.  This was updated to reflect changes in legislation and practice.  This was the one area where there was already inter-agency co-operation and communication and local procedures developed in line with government guidance.

 

No similar systems for the assessment of children in need were developed nor were there any locally agreed procedures in relation to an inter-agency response to such cases.

 

The Government commissioned research to look at the working and impact of the legislation and continued to collect information from local authorities through inspections and other forms of monitoring.  Key publications were:

 

·     Children Act Report 1993.  Department of Health and Welsh Office. 1994. HMSO (information from regular monitoring of the implementation of the Act)

 

·     Seen But Not Heard. Co-ordinating Community Child Health and Social Services for Children in Need.  Audit Commission , 1994, HMSO (A review of health and social services response to children under eight)

 

·     Child Protection: Messages from Research.  Department of Health.  1995, HMSO (A review of 20 research studies looking at the operation of the child protection system and its impact on children and families).

 

·     Responding to Families in Need.  Social Services Inspectorate.  1998.  Stationery Office. (A review of a range of inspections).

 

The findings from monitoring, inspections and research were:

 

·     Local Authorities were not taking a corporate approach to identifying and meeting needs of children in need and their families

 

·     There was no inter-agency co-operation in relation to the assessment of individual children and families and little co-ordination in relation to delivering services to them

 

·     Local and health authorities had not developed systems for identifying the extent of need in their areas

 

·     There was little corporate and inter-agency co-operation in relation to the strategic planning of services and very little joint –commissioning of services.

 

·     Social services departments were tending to focus their resources on cases which took the child protection route

 

·     Child protection processes, however, were encouraging professionals to focus on whether or not there had been an incident or incidents of maltreatment, rather than looking at the wider needs of children and their families.  Where wider needs were identified and met, outcomes were better for children.

 

·     Children and families who had high needs were not receiving services because the child’s name had not been placed on the child protection register.

 

·     Although there was evidence of good inter-agency co-operation during child protection enquiries there was little evidence of this continuing in relation to planning and delivering services post registration.

 

·     Social services departments were providing services to children in need but there was no consistency in the way in which they assessed children and families or responded to their needs.

 

·     There was no real attempt to operationalise the definition of children in need.  Many Local Authorities, although Camden was not among them, re-designed their existing eligibility criteria with the definition of need in mind, but the division of cases into low, medium and high need on the basis of fairly crude indicators, effectively meant that many children who would have come within the definition of ‘in need’ were denied access to services.

 

 

One response to these findings was the development and implementation of the National Framework for the Assessment of Children in Need and their Families.  The Framework requires professionals to consider the child’s developmental needs, issues of parenting capacity and parents’ needs, and environmental factors when carrying out an assessment of children.  It was designed to take us back to that wide definition of need in the Children Act and, in particular, to get social services departments to think about the wider needs of children and families even when the response to those needs would more appropriately come from another agency.

 

The Framework is guidance issued jointly by the Department of Health, the DFEE and the Home Office.  It is issued under section 7 of the Local Authority Social Services Act 1970.  It came into effect in April 2000.  The forward to the Framework states ‘Delivering services to children in need in our communities is a corporate responsibility.  It falls on all local authority departments, health authorities and community services.’   In the preface the guidance states: ‘Effective collaborative work between staff of different disciplines and agencies assessing children in need and their families requires a common language to understand the needs of children, shared values about what is in children’s best interests and a joint commitment to improving outcomes for children.  The framework for assessment provides that common language based on explicit values about children, knowledge about what children need to ensure their successful development, and the factors in their lives which may positively or negatively influence their upbringing.’ It goes on to add that this will increase the likelihood of a consistent response to children and families.

 

Despite this emphasis on collaboration, consistency and a common language the assessment framework identifies social services departments as having the lead responsibility to assess children in need. It is social services departments who have taken the lead in ensuring that their colleagues in other agencies are aware of the framework and have been leading attempts to develop multi-agency referral forms.  Despite considerable activity around this, it remains the case that many professionals in other agencies are unaware of the framework.  It is a matter for regret that the government were not prepared to go further in requiring all agencies working with children to adopt this framework for assessment.

 

Many local authorities have retained their eligibility criteria post implementation of the Assessment Framework although it is difficult to see how this can be justified.  Eligibility criteria encourage a focus on the presenting problem or reason for referral and there is always a risk that additional needs and problems are overlooked, or that the impact of a combination of needs is underestimated.  In the majority of cases it would seem that the Framework would require an Initial Assessment at the very least to check out whether other needs exist. As Lord Laming points out in the Summary and Recommendations of the Victoria Climbie Inquiry : ‘The use of eligibility criteria to restrict access to services is not found in either legislation or in guidance……Only after a child and his or her home circumstances have been assessed can such criteria be justified in determining the suitability of a referral, the degree of risk, and the urgency of the response.’(p.13).

 

Despite the references in the Assessment Framework to the importance of a corporate approach to identifying and meeting needs, collaboration and a common language there is still a failure to do this from government level down.  The range of different new initiatives designed to encourage a common approach come from different government departments, have different lead agencies and are aiming to achieve different outcomes. 

 

In relation to a common language, the assessment framework itself confuses the issue by making a distinction between vulnerable children and children in need, although it is difficult to understand why a vulnerable child would not also be a child in need.  IRT talks about children at risk of exclusion, who would also, it seems come within the definition of children in need.  Within other agencies and professions other terms are used such as children with special needs or children with special educational needs.  Other terms also need clarification, so for example, we may well have different understandings within this room about what we mean by prevention and how that differs from early intervention.

 

We have heard from a range of different agencies represented here today describing the different assessment frameworks and tools used for assessment.  These range from the low key approach of Sure Start, through to the more complex assessments used by social services (Assessment Framework), YOT (ASSET), Connexions (APIR), Behaviour Improvement Teams (EPS/BSS), and CAMHS.

 

Despite this plethora of different frameworks and tools the majority of them actually have a lot in common in the things they are looking at in terms of the child’s development, parenting and environmental factors and it would seem quite possible to base a simple common assessment tool on the Assessment Framework triangle, which captures all of these features.

 

This leads me on to the Child Concern Model developed in Bolton.

 

Bolton Child Concern Model

 

Following the publication of Child Protection: Messages from Research (1995 and see above) social services departments were encouraged to ‘re-focus’ by looking at how they could better respond to the wider needs of children and families.  Attempts by Bolton social services department to divert children, in appropriate cases, away from the child protection system and to focus more on responding to need caused concerns and anxiety among other agencies, particularly the police and health professionals.

 

It was then decided to work closely with other agencies and the voluntary sector to come to a joint agreement and approach in identifying and responding to need, including children’s needs for protection where those arose. 

 

The model was launched and implemented in May 1998.  It was reviewed and revised in 1999 and reviewed and revised again to comply with the Assessment Framework in October 2000.  Initial concerns that the emphasis placed on social services as the lead agency for assessments of children in need in the Assessment Framework would undermine the model have not been borne out in practice.  Bolton is one of the pilot IRT areas and will thus be reviewing the model yet again within this framework.

 

The Audit Commission and Department of Health Joint Review in 2001 was very positive about the model and stated: ‘the Child Concern Model, acknowledged as excellent in achieving safe support for families, has clarified the threshold for services with all agencies’.

 

The model started from the definition of need in the Children Act 1989.  From this were developed three levels of vulnerability as follows:

 

Level 1:

This level links with the first part of the definition of ‘in need’ – children who would not achieve a reasonable standard of health or development without the provision of services, but it could be argued that it is even wider than that because it is looking at children whose health or development  MAY be adversely affected.  This may explain why the term ‘levels of vulnerability’ was used rather than levels of need.

 

Level 2:

This clearly links with the first part of the definition of ‘in need’.

 

Level 3:

This links with the second part of the definition of need – significant impairment of health of development.

 

Each level has a check list of possible indicators attached  to assist practitioners in deciding on the level of the case.    For example Level one indicators include: ‘children of parents involved in substance misuse; children of parents where there has been some domestic violence’.  At Level two similar indicators are: ‘children in families where parents have substance dependency; children in families where there has been one serious incident of domestic violence or several lesser incidents.’

 

The model sets out the type of response to be expected depending on the level of vulnerability identified.  It is recognised that there will be some cases where it is not immediately clear whether it is Level 1 or 2 or Level 2 or 3.

 

At Level 1 there is a single agency response, with a brief and early assessment and then appropriate advice and/or intervention or referral on to another agency.

 

Where services have been provided but have not met the child or family’s needs or where it is not clear what the level of vulnerability is because there are a range of needs (Level 1or 2) consultation with another agency may help and/or referral on to another agency.

 

At Level 2 there should be a multi-agency assessment, a child in need meeting should be called, at which an action plan will be drawn up and arrangements made to implement and review the plan.

 

If needs are not met and concerns persist either because the child and family are not linked up to services, or are not benefiting from services being provided, this will be a Level 2/3 case which should be referred to social services who will co-ordinate an  initial and/or core assessment  and at this point the timescales of the Assessment Framework will apply.

 

Level 3 cases will be s.47 child protection enquiries and a core assessment led by social services.

 

Points to note

A single multi-agency referral and assessment form has been developed based on the Assessment Framework triangle.  The form has two parts, the first of which is basic factual information and referral details and this is all that is needed for Level 1 cases.  The second part of the form is similar to an Initial Assessment form but slightly briefer and this is used for Level 2 cases.  If the case is subsequently referred onto social services then all of this information will be incorporated into the Initial or Core Assessment.

 

The protocol for dealing with cases and the form has been signed up to by all child welfare agencies.

 

A key element of the model is consultation.  This should be available to any worker from any of the relevant agencies.  It is not a way of transferring the problem on to another agency but is a way of accessing additional knowledge and expertise.  There is clear guidance on seeking and giving consultation plus a form for recording the discussion and the action agreed on.  It is the responsibility of the consulted professional to complete this form.

 

There are clear criteria for children in need meetings: the family should be fully involved; only relevant professionals should be invited; it should be chaired by the agency calling the meeting; minutes should be taken and an action plan agreed; a co-ordinator of the plan should be identified and a date for review set. 

 

Bolton also make use of Family Group Conferences.

 

The threshold for referral into social services is:

Children whose health or development is being impaired or there is a high risk of impairment and child/family are not appropriately linked to services and/or are not benefiting from the help provided

 

Process and other issues

 

·     Involve managers, practitioners and users in developing a common approach.  Bolton have recognised that they did not do enough to involve service users in the development of the model.

 

·     Multi-disciplinary task groups were set up to work on different aspects of the model.

 

·     The model took 18 months to develop

 

·     Importance of allies in key positions in a range of agencies – it would not have been possible to develop and implement the model without this.

 

·     Difficulty in retrieving information from diverse systems across many agencies was a feature that continued after implementation of the model and became evident in the reviews of the model carried out already.

 

·     Difficulties in ensuring all professionals aware of models existence – they experienced problems in communicating information about the model to all relevant professionals as well as problems in ensuring that everyone felt fully involved in the process of consultation and development.  This is despite six days per year set aside for multi-agency training on the model, which covers information about the model itself, the forms to be used, services that are available to meet the needs and training on assessment skills.

 

·     Some agencies felt model imposed

 

·     Guidance important plus clarity about thresholds – the guidance on the model was revised following each review of the process.  It is now contained in a clear and accessible handbook.

 

·     The implementation of the model is subject to a yearly audit

 

Other approaches in other local authorities

 

North Lincolnshire has adopted a model similar to the Bolton Child Concern Model but adapted for their own particular circumstances.

 

Hertfordshire have amalgamated their Children and Families social services department and Education Department.  All referrals to both education and social services go to a call centre where a client services team collect basic data and  make up an electronic file.  They collect the minimum information necessary to decide on the most appropriate action to take and respond to the referral within 24 hours. 

 

If the referral is accepted it is passed on to one of four multi-professional intake teams.  These teams, which all include at least one or more qualified social workers,  carry out an initial assessment.  Each case has a co-ordinator.  The assessments comply with the assessment framework timescales.  A common referral and assessment form has been developed and a common system for reviews.A data base is in the process of being developed.

 

The new system was implemented in April 2001, following two years of consultation and development.  An evaluation carried out very soon after implementation indicated that the new system was an important development addressing long-standing problems to do with the co-ordination of services.  It was proving a difficult cultural change for some.  The autonomy of schools and the pressures on them to meet specific government targets was one of main threats to the new model.

 

The new department is beginning to develop closer links with health and the voluntary sector.

 

Concluding comments

Some of the issues raised by children and families and professionals as part of the consultation carried out for the Best Value review of Children’s Services highlight the need for better co-ordination between agencies in the planning and delivery of services to children and families:

 

·     There is a lack of information re local services and eligibility criteria for them for both families and professionals.
 

·     Different professionals assess the same children and families using the same information, but with different forms, processes, timescales.
 

·     Relevant information is not shared between the different professionals working with a family.
 

·     The Assessment Framework has not been fully implemented across the different services and the use of a common language has not yet developed.
 

·     Delays and waiting lists to access services are common
 

·     There is a need for improved co-ordination between adult mental health services and children’s services.
 

·     There is difficulty in accessing appropriate mental health services for children and families
 

·     There is poor communication between agencies and lack of co-ordination in providing services.

 

Whether or not Camden was a pilot for the IRT project there is clear evidence of the need for work to be done to develop a common approach to assessment, intervention, service delivery and service planning and to ensure that practitioners at different levels, service planners and commissioners and families are able to understand each other when they talk about needs, thresholds, outcomes, risk and protective factors, prevention, early intervention and so on.

 

In terms of learning from other local authorities, the Hertfordshire model is an example of organisational change to encourage a common approach between education and social services. It is limited in that it applies only to those two providers of services to children and families, it does not address the issue of thresholds and how best to co-ordinate a response to those children and families where there are lower level, but complex, needs.

 

The Bolton model has the advantage of attempting to develop a common approach without major organisational change but in a way that takes account of the different levels of response required for different levels of need.  It encourages a co-ordinated and common approach from very low level needs onwards ensuring that service planners, commissioners and politicians take account of the full spectrum or continuum of needs when considering strategic planning and service development.

 

What both models show is the importance of continuous consultation with and involvement of all the relevant professionals and service users in the development of a common approach.  It is very helpful to have discussions based on actual cases in which people then describe what they see as they needs, the risks and protective factors, the seriousness of the needs and how those could best be responded to.  Such discussions should take place within single agencies between different levels of practitioners and managers, within multi-agency groups, and with service users, both children and parents.  Such discussions increase understanding about what each agency or group actually does as well as being a step towards the development of a common approach and common language.

 

A common approach to the identification of needs and to the recording of needs across the continuum of low level vulnerability through to high risk cases should also improve our knowledge of where the gaps in service provision and intervention exist.                                                                    Mary Ryan January 2003


 

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