Integrated Workingthrough Information

Sharing and Assessment

Welcome!

Group agreement

• Confidentiality• Respect• Ask questions• Mobile phones• Time keeping

• Handouts• Venue information

Programme outline

Day 1• Module 1 – Integrated Working and Information Sharing• Module 2 – the Common Assessment Framework, Part I

Day 2• Module 3 – the Common Assessment Framework, Part II• Module 4 – The Lead Professional

Why do we need an Integrated approach?

• Victoria Climbié

– Known to 3 Local Authorities– Unknown to any education dept.– Known to 12 different agencies– Died aged 8 as a result of extreme neglect– She had 128 injuries at the time of her death

• Lord Laming Inquiry - looked at why at least 12 chances to save Victoria's life were missed by local authorities, by doctors and the police.

• Lord Laming’s Inquiry- offered 108 recommendations.

Every Child Matters (ECM) Outcomes

1. Be healthy

2. Stay safe

3. Enjoy and achieve

4. Make a positive contribution

5. Achieve economic well being

Children Act 2004

Legal framework for Every Child Matters and Laming

Section 10 – Duty on the local authority promote co-operation with key partner agencies to promote the welfare of children in their area.

Section 11 – Statutory duty to safeguard & promote the welfare of children.

Section 12 – Establish an Index (ContactPoint) containing basic details about children and young people to enable better sharing of information – NB – ContactPoint was discontinued in June 2010

Section 53 –Children’s Social Care to take reasonable steps to find out children’s wishes and feelings when assessing a child ‘in need’ and a child at risk of ‘significant harm’.

This should also happen in Common Assessments

ECM: Change for Children

• Central government programme to safeguard and promote children’s welfare

• Includes ‘Integrated Working’• Three interdependent elements:

1. The Common Assessment Framework2. The Lead Professional3. Information Sharing

Benefits of Integrated Working

•Earlier holistic identification of needs

•Earlier more effective intervention

•Improved information sharing across agencies

•Faster delivery of service for the child

•Better service experience for children and their families

•Benefits for practitioners and organisations

Barriers to effective Integrated Working

• Lack of confidence about what, how and when to share information

• Lack of common guidance on information sharing across services

• Communication difficulties

• Not knowing who to contact for support on information sharing

• Professional ‘silos’

• Professional hierarchies

• Lack of understanding of different agency roles and responsibilities

• Competing or conflicting targets

Guiding principles for front-line staff

• Promoting the well-being and safeguarding children from harm is everyone’s business

• Be proactive – identify concerns as early as possible and initiate actions

• Follow LSCB procedures if concerned about significant harm

• Be holistic – think about the child in context• Consider all potential sources of support• Involve families in decisions that affect them• Information sharing

Information Sharing

Seven Golden Rules for Information Sharing

1. Remember that the Data Protection Act is not a barrier to sharing information

2. Be open and honest 

3. Seek advice if you are in any doubt

4. Share with consent where appropriate

5. Consider safety and well-being 

6. Necessary, proportionate, relevant, accurate, timely and secure

7. Keep a record of your decision

Who can give or refuse consent?

A person aged over 16

A child under 16 who has the capacity to understand and make their own decisions, may give (or refuse) consent to sharing information

We need to ask ourselves whether they are of sufficient age and understanding to make the decision

When weighing this up, we also need to consider what are the reasonably foreseeable consequences for the young person of deciding one way or another

Sharing information

• Evidence of, or reasonable cause to believe a child is suffering or at risk of suffering significant harm

• To prevent significant harm to children or serious harm to adults.

•Refer to or consult Children’s Services immediately if concerned about abuse

authorised by the person who provided it or to whom it relates

Confidential information can be shared - even if not authorised by the person - if justified in the public interest….

Confidential information can be shared if….

Information can generally be shared if….

it is not confidential

Consent

Consent:

• Must be informed

• Should normally be explicit but can be implied (written is preferable but can be verbal)

• Must be clear and not inferred from a non response

• Must be sought again if things change significantly

• Can be withdrawn – fully or partially

Practitioners must:

• Use clear accessible language

• Explain there are times when confidentiality can not be maintained

• Be aware of relevant legislation

• Follow local policies and protocols.

What is confidential information?

Confidential information is:

– information of some sensitivity;

– information which is not already lawfully in the public domain or readily available from another public source;

– information which has been shared in a relationship where the person giving the information understood that it would not be shared with others.

Information sharing

• Not all information about families is confidential

• At the time of collecting a person’s information, inform them about:

– Why you require it.– Whether it may be shared with other departments and

external organisations.– What information is to be shared.– How it may be held e.g. electronic system/ paper

records.– Who has access to it.

Key points about Info Sharing - 1

• Explain openly and honestly at the outset what information will or could be shared and why

• Seek agreement• The child’s safety and welfare must be the

overriding consideration• Respect the wishes of children or families who

do not consent to share confidential information – unless there is sufficient need to override this

• Seek advice if in doubt

Key points about Info Sharing - 2

• Ensure information is accurate, up to date, and relevant to the purpose

• Share only with those who need to see it and shared securely

• Check whether the recipient intends to pass the information on

• Always record the reasons for your decision• Confidentiality is never a reason for not sharing

information if this is in the child’s interests

Information Sharing and the Law

• Common law duty of confidence• Human Rights Act 1998 (articles 8.1 & 8.2)• Data Protection Act 1998• Crime and Disorder Act 1998 (s115)

• NB none of the above creates an absolute right to privacy. Information will need to be shared if a child or adult is at risk of significant harm or impairment.

Parental Responsibility• All Birth Mothers• Birth Fathers if…

– Married to the child’s mother (before or after child’s birth)– Parental Responsibility Agreement– Named on birth certificate - children born after 1st Dec 2003– Residence (s.8 CA 1989) or PR Order (s.2 CA 1989)

• Step parents by written agreement with birth parents (if married/civil partnership with a birth parent)

• Adopters• Others - through court application, e.g. Residence and Special

Guardianship Orders - Members of extended family, step parents (if application opposed) and foster carers

• Local Authorities - through Emergency Protection, Interim Care and Care Orders

Guidelines for access to files

• A parent with parental responsibility can request access to their child’s information

• This is not an automatic right and may need to be weighed against potential risks to a child or adult

• ‘Gillick competent’ children under 16 may consent to or veto parental access to their information

• In cases of intimate partner violence:– Has a court ordered disclosure/non disclosure of information?

– Would disclosure escalate domestic abuse?

• Always record your reasons for sharing or not sharing information

Key principles underlying a decision to share information

Is there a legitimate purpose for sharing information?

Is the information confidential?

Is there a statutory obligation or court order to share?

Have you properly recorded your decision and action taken?

Is there sufficient public interest to share?

If you share, is it the right information in the right way?

Do you have consent to share?

Does the information enable a person to be identified?

The Common Assessment Framework(CAF) – Part I

What is the Common Assessment Framework (CAF)?

• A key part of the Every Child Matters: Change for Children Programme

• A Standard national approach to identifying need at the earliest opportunity

• Used across the entire children’s workforce

• It should ensure that EVERY child/young person receives any additional services they need at the earliest opportunity

What is the Common Assessment Framework? continued…

• A simple pre-assessment checklist to help practitioners identify children/young people who would benefit from a common assessment;

• A process for undertaking a common assessment, to help practitioners gather and understand information about the needs and strengths of the child and family

• A standard form to help practitioners record, and, where appropriate, to share with others, the findings from the assessment

Level 1 - Universal Services

Level 2 - Targeted Services

Level 3 - Specialist Services

Dev

elop

men

t of C

hild

Family & EnvironmentalParents and C

arers

HealthEmotional and social

development Behavioural

developmentIdentity

Family and social relationships

Self-care skills and independence

Learning

Basic care, ensuring safety and

protection Emotional warmth

and stabilityGuidance,

boundaries and stimulation

Family history, functioning and well-beingWider family

Housing, employment and financialSocial & community elements and

resources, including education

Basic principles of an effective common assessment

Assessment should be:

• Child/young person centred• Non-discriminatory• Collaborative – work with the C/YP/family• Continuous – ongoing process rather than a one-off

event• Progressive• Transparent – be clear, open and honest• Consensual • Current – valid and reliable• Sufficient and informative• Grounded in evidence• Consider strengths as well as needs

Fast track through levels when serious injury/allegation or high level of concern from any agency.

I = Identification and actionT = TransitionN = Needs met

Level 2

Level 3Level 1

Lead Professional from this point

Lead Professional Consultation Group

Continuum of Needs and Services – A Common Model For All Agencies

Information sharing, Common Assessment Framework (CAF) and lead professional support across the continuum:

Statutory or specialist assessments from this point

What are additional needs?

Examples of Indicators of Additional Needs and Complex Needs

Children with additional needs (Level 2) might include:

• Disruptive or anti-social behaviour• Overt parental conflict or lack of

parental support/boundaries• Involvement in or risk of offending• Poor school attendance/exclusion• Experiencing bullying• Special educational needs• Disabilities• Disengagement post-16• Poor nutrition• Ill-health• Substance misuse• Anxiety or depression• Housing issues• Pregnancy and parenthood

Children with complex needs (Level 3) include:

• When there is a child protection plan• Children in care• Care leavers• Severe and complex educational

needs• Children with complex disabilities or

complex health needs• Diagnosed with significant mental

health problems• Young offenders involved with youth

justice services( community and custodial)

• Children/young people in need and/or at risk of significant harm(s17 and 47 Children Act 1989)

• Children/Young people for whom adoption is the plan

Aims and principles of the CAF

A standard national approach

A standard national approach

Assessment to support earlier intervention

Assessment to support earlier intervention

A process supported by a standard form

A process supported by a standard form

HolisticHolistic

CAF cannot guarantee service provision

CAF cannot guarantee service provision

Empowering and a joint process

Empowering and a joint process

Simple and practical Simple and practical

Focuses on needs and strengths

Focuses on needs and strengths

Improve joint working and communication

Improve joint working and communication

Rationalise assessmentsRationalise assessments

Support the sharing of information

Support the sharing of information

Support better referrals, where appropriate

Support better referrals, where appropriate

Principles Aims

Who will use the CAF?Every practitioner should:

•Be able to recognise and respond to key signs of need•Know the CAF basics•Know how to have a CAF completed or how to complete one

Every agency will train some staff to complete common assessments

Where more than one practitioner is involved, one will take the lead(the Lead Professional)

Agencies (statutory, community or voluntary) include:

HealthChildren’s Services ConnexionsChildren’s CentresEarly YearsSchoolsPolice and Youth JusticeHousingAdult Services

When to undertake a common assessment

You could undertake a common assessment when it will help a child to achieve one or more of the five priority outcomes.

Follow Local Safeguarding Children Board (LSCB) procedures where appropriate

Likely to be of help when:• There are concerns about

progress• Needs are unclear• Needs cannot be met by a

universal service alone e.g. the School or the GP

Need not be done when:• Progress is good• Needs are identified and being

met successfully by the universal service alone

• Needs are already being met through an existing CAF or specialist provision

Steps of the CAF process

• Preparation:

– Identify whether the child or young person may have additional needs

– Contact the ISA Team to see if a common assessment already exists

– With the child/parent, decide if a common assessment would be helpful (or needs updating if it already exists)

– Note: The pre assessment checklist can support professional judgement in making this decision

– If a common assessment would be helpful, seek the consent of the child/parent to proceed

Steps of the CAF process• CAF discussion

– Undertake the assessment together in a child centred way

– Work together to understand issues and develop solutions

– Focus on strength as well as need – Consider the needs of the individual child

• Delivery and Review

– Determine and deliver interventions to meet identified needs

– Appoint a Lead Professional if relevant– Review on an ongoing basis

Step1Preparation

Identify whetherthe child may have additional needs,

possibly by using the CAF Checklist

Step 2Discussion

Gather and analyse information on

strengths and needs using the CAF

Step 3Delivery

Decide on action plan to meet identified

needs. Share information.

Appoint a LP if relevant.

Needs met?Close involvement

Needs not met?Return to stage 2 or consider alternative

approaches

Child and family

Step 4Ongoing monitoringand review by those

involved

The Common Assessment Framework(CAF) Part II

Dev

elop

men

t of C

hild

Family & EnvironmentalParents and C

arers

HealthEmotional and social

development Behavioural

developmentIdentity

Family and social relationships

Self-care skills and independence

Learning

Basic care, ensuring safety and

protection Emotional warmth

and stabilityGuidance,

boundaries and stimulation

Family history, functioning and well-beingWider family

Housing, employment and financialSocial & community elements and

resources, including education

CAF and specialist assessments

CAF must be registered

Threshold cannot be crossed without CAF

(except emergency CP)

Structure of Children’s Servicesin Barking and Dagenham

Critical thinking in assessment

• What are the unmet needs?• What am I basing this view on?• Have I used a framework to think about the needs?• Have I checked out my concerns with others (and

do they share these?)• Could my own biases have had an influence?• How does the family see the problem?• What are the child’s wishes and feelings?

A Child ‘In Need’

(a) 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...

(b) his health or development is likely to be significantly impaired, or further impaired, without the provision for him of such services; or

(c) he is disabled.(Children Act 1989, section 17.1)

‘Development’ means physical, intellectual, emotional, social or behavioural development; and “health” means physical or mental health.

Some pointers on significant harm

1. Is the child at risk of harm?2. Is it significant? The OED describes significant as

‘considerable, note worthy, or of importance’.3. Think about severity, intent and chronic effects4. Is the harm attributable to:

• Parental care not being what it would be reasonable for a parent to provide for this child?

• Child beyond parental control• Impairment caused by seeing or hearing the ill-treatment of

another

Some stages in an interview

• Introductions

• Rapport building

• Open questions

• Focused questions

• Closure

Language used for the CAF should be:

• Plain simple English

• Understandable by the child and/or their parent

• Understandable by all other practitioners

• Free from jargon and with any acronyms explained

• Emphasising that common assessment is undertaken with the child/parent at the centre of the process

• Supportive and encouraging

• Focused on strengths as well as needs

• Based around the language used in the CAF guidance

Common language for the CAF

Partnership

• What are nine things we can do to demonstrate to a parent that we are working in partnership with them

• Note a word or short phrase (5 words max) in each box on the worksheet

What helps in developing partnership - 1

• Families want to be shown respect, trust and to have their point of view acknowledged

• Co operation between workers and families should be developed at the outset

• An emphasis should be placed on building the strengths of the family.

Turnell and Edwards 1999

What helps in developing partnership - 2

• Families need to know:– Why we are there– What we want them to change– Why we want them to change– How we will measure change– What powers we have– What (if anything) will happen if things don’t change

Source: Ivanoff et al, 1995

What children want - 1

• Introduce yourself. Tell us who you are. What your job is. • Give us as much information as you can. • Tell us what is wrong with our mum or dad. • Tell us what is going to happen next. • Talk to us and listen to us. Remember it is not hard to

speak to us. We are not aliens. • Ask us what we know, and what we think. We live with

our mum or dad. We know how they have been behaving.

Barnardo’s 2007 (study in Merseyside of

young carers of parents with mental illnesses)

What children want - 2

• Tell us it is not our fault. We can feel really guilty if our mum or dad is ill. We need to know we are not to blame.

• Please don’t ignore us. Remember we are part of the family and we live there too!

• Keep on talking to us and keeping us informed. We need to know what is happening.

• Tell us if there is anyone we can talk to. MAYBE IT COULD BE YOU.

Barnardo’s 2007 (study in Merseyside of

young carers of parents with mental illnesses)

Coordinating Delivery

The Team Alongside the Family (TAF) andthe role of the Lead Professional (LP)

Step1Preparation

Identify whetherthe child may have additional needs,

possibly by using the CAF Checklist

Step 2Discussion

Gather and analyse information on

strengths and needs using the CAF

Step 3Delivery

Determine and deliver interventions to meet

identified needs. Appoint a LP if

relevant.

Needs met?Close involvement

Needs not met?Return to stage 2 or consider alternative

approaches

Child and family

Step 4Review process

The CAF key steps – Service delivery

• Likely common assessment outcomes:- Concern resolved or- Actions agreed for single agency with child/parent or- Actions require multi-agency response or- Level Three needs are identified

• If more than one agency needs to be involved:- Assessor arranges meeting with relevant professionals- Team comes together with the family and appoints a LP- Agree a multi-agency plan (and record on the CAF form)- Make referrals or broker access to other services if needed (use the

CAF form as evidence of need)• Monitor and review progress

3: Service delivery2: Discussion1: Preparation

Multi-agency working: The Team Alongside the Family (TAF)

Effective multi- agency working and the Lead Professional are key elements of improving outcomes for children, young people and their families

Team Alongside the Family (TAF) is a framework for multi- agency working with children with additional needs

The TAF brings together relevant practitioners with the child/young person and/or their family to address any unmet needs

The team works together to plan coordinated support from agencies

Team Alongside the Family (TAF)

• The TAF framework aims to achieve the following for the child/family:

– They are fully involved in all decisions regarding the help and support they receive

– Parents/carers, and where appropriate, the child are equally valued members of the TAF

– Coordinated, seamless support is provided to the family

– Practice is child-centred and focussed on solutions– Empowers child / family

Key to the TAF approach is the role of the Lead Professional (LP)

The rationale for a Lead Professional

• The Lead Professional is central to the effective delivery of integrated services to children who require support from a number of practitioners.

• It helps to overcome some of the frustrations traditionally experienced by service users with a range of needs, e.g.:

– numerous lengthy meetings;

– lack of co-ordination;

– conflicting and confusing advice;

– not knowing who to speak to;

– the right support not being available at the right time.

• It can also help alleviate the frustrations often felt by practitioners in accessing other services.

Vision and functions of the Lead Professional

3 Core Functions

Vision: All children and young people with additional needs who require support from more than one

practitioner should experience a seamless and effective service in which one practitioner takes a lead role to ensure that services are co-ordinated, coherent and

achieving intended outcomes

Reduce overlap and

inconsistency in the services

received

Act as a single point of contact for the child or

family

Co-ordinate the delivery of

actions agreed by the

practitioners involved

Fast track through levels when serious injury/allegation or high level of concern from any agency.

I = Identification and actionT = TransitionN = Needs met

Level 2

Level 3Level 1

Lead Professional from this point

Lead Professional Consultation Group

Information sharing, Common Assessment Framework (CAF) and lead professional support across the continuum:

Statutory or specialist assessments from this point

Continuum of Needs and Services – A Common Model For All Agencies

Selecting a lead professional

• Could be drawn from any of the people currently involved

• Practitioner who is most relevant to the child or young person’s action plan and who has the most appropriate skills.

• Not necessarily the first person to be involved nor the practitioner who carries out the common assessment.

• Deciding on lead professional can be done most effectively as part of the assessment and planning process

Key Accountabilities of a LP

• Each lead professional is accountable to their home agency for delivery of:– their part of the action plan; and – the lead professional functions (as defined previously).

• The lead professional is not responsible or accountable for services delivered by other services.

• The LP will be responsible for gathering people together to review progress, but it is up to the individuals to deliver on their agreed actions.

• A clear line of accountability for LPs runs from the practitioner, through their management structure to the children’s trust arrangements and the Director of Children’s Services.

Useful skills for LP functions

Empower child/family to make

decisions and challenge when appropriate

Establish a successful and

trusting relationship with child/family

Strongcommunication skills; diplomacy; sensitivity

Work effectively with practitioners from

a range of services

Knowledge of local and regional

services for childrenand families

Convene meetings and initiate

discussions with relevant practitioners

Understand boundaries of own

skills and knowledge

Support and enable child / family

to achieve their potential

Understand implications of the

child’s assessment, for example in relation to risks and protective

factors

Support in developing skills and confidence

The following ideas were offered by practitioners to help develop skills and confidence to undertake the LP role:

• Provision of regular area support network meetings for LPs to discuss issues and good practice

• Appoint a person(s) with additional responsibilities around the LP, to provide advice/support

• Set up a structure to enable LP professional peer mentoring • Use a newsletter to share ideas and practice tips• Shadow another LP• Telephone /email support from nominated experienced lead

professionals• Conference for LPs• Training needs analysis carried out to determine need

Managing workload implications

Time taken up by lead professional functions will vary. Experience suggests that:

– Being the lead professional can mean greater involvement with a particular child. However, practitioners can save time on cases where they are not the lead professional

– Communication is particularly important where staff may be working part-time in a multi-agency setting and part-time in their home agency

– Managers must ensure:

• lead professional responsibilities are taken into account when allocating workload

• performance in delivering the lead professional functions is recognised and recorded.

Lines of accountability

Director of Children’s Services

Coordinated arrangements in the Children’s Trust

Line management in home agency

Practitioner

Operational level management arrangements

Strategic level management

structures

Process for communicating and resolving

disputes

Transfers and endings

• Being a LP is not a permanent thing:

– Needs change (in their level, extent and focus)– Situations and relationships change– Practitioners change– Children and young people get older

• Transfers and endings of the LP functions, where appropriate, need to be carefully planned and managed

Tips for Lead Professionals

• Always ensure the C/YP/F and relevant practitioners have your contact details and make sure you have theirs

• Set a review date at the first TAF meeting

• Plan your contacts with the C/YP/F so they know you will be actively involved and check back with them at regular intervals

• Remember you are part of a team working collaboratively with the family – you are not expected to do everything!

• Be prepared to reconvene a meeting if things are not going according to the agreed plan

• If another practitioner/agency is not carrying out their contribution as agreed, raise this with them and find out the reason

• If it continues, raise it with your line manager and/or the ISA team

• If you are no longer the person best placed to be the LP or you move on, plan your handover