Working together to improve outcomes for children and families Needs, thresholds and pathways Guidance for Camden s children s workforce
Universal, and Specialist Services: responding to the needs of Camden s children, young people and their families Introduction The purpose of this guide is to support practitioners in universal, targeted and specialist services to make decisions about how best to meet the additional needs of children, young people and their families. The Common Assessment Framework (CAF), Lead Professional and Team Around the Child (TAC) integrated working tools are used to facilitate joined up working across children s services in Camden to achieve improved outcomes. Service thresholds The assessed level of need is essential for deciding service involvement. Universal services have responsibilities for ensuring that children and young people have their basic needs met, such as health care and education. and specialist services can be accessed when children and young people have needs at higher levels. This guide provides details of services that may provide support at each level of need, although particular factors may restrict access, such as: specific service criteria related to the agency s specialist area of work previous interventions geographical location age limits time limited provision, e.g. only available during school term Continuum of Needs Camden has outlined four levels of need to inform decision making about service thresholds. These levels (Universal and Levels 1, 2 and 3) can be used to prioritise and develop a range of support and intervention strategies matched to a child or young person s needs and strengths. The basic needs of the majority of children can be met appropriately by their families and/or a range of universal services. Children with additional needs may require single agency or integrated targeted support. For more complex needs, support from specialist and/or statutory services is likely to be required. 2
Service involvement and the continuum of needs Service Level of need Universal (for upper level 1 needs) Universal: no additional needs Babies, children and young people who make good overall progress in all areas of development. Broadly, these children receive relevant universal services, such as health care, education, leisure and play facilities, housing, and voluntary sector services. Level 1: additional needs Babies, children & young people who would benefit from extra help from services to make the best of their life chances (CAF threshold). A single targeted service may be involved, but a team around the child and a Lead Professional may not be required. Level 2: babies, children, and young people with high level additional unmet needs These children and young people require integrated or targeted support, to achieve well-being This refers to the range, depth or significance of the needs. More than one service is likely to become involved, with a team around the child (TAC), and a Lead Professional. Social Work threshold would be met when there are significant indicators at level 2. These children may be eligible for a Child in Need service and may be at risk of moving to a high level of risk if they do not receive early intervention. When social workers are involved they will act as the Lead Professional. Also included at this level are children with significant health or mental health needs, or who are exhibiting serious anti-social behaviours. Level 3: babies, children and young people with complex additional unmet needs Specialist These are children and young people whose needs are complex and enduring and cross many domains and require specialist/statutory integrated support. More than one service is typically involved, with Team Around the Child (TAC), or Child in Need (CIN) review meetings, and a Lead Professional, commonly in a statutory role. Included at level 3 are children experiencing significant harm that requires statutory intervention such as child protection or legal intervention. These children may also need to be accommodated by the local authority, or may be involved in serious youth offending. Also included at this level are disabled children and young people with severe or profound levels of complex health needs and disability. 3
UNIVERSAL LEVEL: no additional needs, only requiring universal service support Service: Universal Key universal services that may provide support at this level: Education Children s Centres & Early Years visiting service School nursing GP Police Housing Voluntary & community sector Level of need indicators DEVELOPMENTAL NEEDS Good physical health with age appropriate developmental milestones Speech, language and communication Age-appropriate speech and language development Emotional, Social and Behavioural Development Good mental health and psychological well-being Good quality early attachments, confident in social situations Able to take age appropriate responsibility for own behaviour Responds appropriately to boundaries and constructive guidance Self-concept Age appropriate independent living skills Positive sense of self and abilities Positive relationships with siblings, carers and peers Learning Achieving key stages, with no barriers to learning Good attendance at school/college/training Enjoys and participates in learning activities Planned progression and aspirations beyond statutory education PARENTS & CARERS Care, safety and protection Parents able to provide care for child s needs Protection from danger or significant harm, in the home and elsewhere Emotional warmth, stability and family relationships Parents provide secure and caring parenting Guidance, boundaries and stimulation Parents provide guidance and boundaries to help child develop appropriate values Enables child/young person to experience success Child/young person accesses leisure facilities as appropriate to age and interests FAMILY & ENVIRONMENTAL FACTORS Family history, functioning (including wider family) Supportive family relationships Sense of larger familial network Good friendships outside of the family unit Housing, employment and finances Child fully supported financially Good quality, stable housing meeting family needs Community resources and social integration Good social and friendship networks exist Safe and secure environment Access to consistent and positive activities Assessment and pathways No Common Assessment is required. 4
LEVEL 1: additional needs, requiring universal or universal & targeted services support Services: Universal & Key services at this level: Universal Education Children s Centres & Early Years Schools visiting service School nursing GP Police Housing Voluntary & community sector Welfare Psychology Family Support Services One Point of Access for Young Peoples Services related to ASB / Offending (IYSS) Primary Learning (PLSS) Speech & Language Voluntary & community services Level of need indicators DEVELOPMENTAL NEEDS Slow in reaching developmental milestones, Missing immunizations or checks Minor health problems which can be maintained in a mainstream school Minor concerns re diet, hygiene Dental care not sufficient Starting to default in health appointments Vulnerable to emotional problems, perhaps in response to life events Speech, language and communication Speech production difficulties Phonological difficulties Expressive and/or receptive language difficulties Emotional, Social and Behavioural Development Child can find managing change difficult Responds inappropriately to boundaries and constructive guidance Low level mental health or emotional issues requiring intervention from non mental health specialists e.g. GP (CAMHS tier 1 ) Early onset of offending behaviour or activity (10-14) Coming to notice of police through low level offending Early onset of sexual activity (13-14) Low level substance abuse Self-concept Lack of age appropriate independent living skills that increase vulnerability to social exclusion Some insecurities around identity expressed e.g. low self esteem Learning Occasional truanting or non attendance Not always engaged in play/learning, e.g. poor concentration, low motivation & Interest, no equipment School action or school action plus Reduced access to books, toys or educational materials Few or no qualifications; NEET PARENTS & CARERS Care, safety and protection Inconsistent basic care e.g. inappropriate child care arrangements or young inexperienced parent Emotional warmth, stability and family relationships Inconsistent parenting, but development not significantly impaired Guidance, boundaries and stimulation Lack of response to concerns raised regarding child FAMILY & ENVIRONMENTAL FACTORS Family history, functioning (including wider family) Parents/carers have relationship difficulties which may affect the child Parents request advice to manage their child s behaviour Children affected by difficult family relationships or bullying Housing, employment and finances Overcrowding Families affected by low income or unemployment Community resources and social integration Insufficient facilities to meet needs e.g. transport or access issues Family require advice regarding social exclusion e.g. hate crimes Assessment and pathways If professionals are concerned the child may have unmet needs, they should consider completing the Common Assessment Framework (CAF) to help determine needs. If proceeding with the Common Assessment Framework, the CAF should be completed with the child and family to identify strengths & needs. If their needs cannot be met by the agency completing the assessment, then the CAF can be used to access targeted support. 5
LEVEL 2: complex additional needs, requiring targeted services support Services: Key agencies providing support: Welfare Children s Centres & Early Years Family Services and Social Work Integrated Services for Disabled Children (MOSAIC) Integrated Youth Primary Learning (PLSS) SEN & psychology Services for families affected by domestic violence Camden Futures Speech & Language CAMHS Tiers 2 & 3 School Inclusion Team Voluntary & community services Plus universal services Level of need indicators DEVELOPMENTAL NEEDS Disability requiring specialist support to be maintained in mainstream setting Teenage pregnancy Child has some chronic/recurring health problems Missing routine and non-routine health appointments Concerns about developmental progress: e.g. overweight/underweight; enuresis Mental health issues emerging e.g. conduct disorder; ADHD; anxiety; depression; eating disorder; self-harming Speech, language and communication Dysarthria Verbal dyspraxia Significantly delayed or disordered language development Significant social communication difficulties Emotional, Social and Behavioural Development Underage sexual activity, criminal behaviour, substance misuse Child/young person appears regularly anxious, stressed or phobic Does not accept responsibility for own actions Starting to commit offences / re-offend Interacts negatively with peers in learning and play contexts Child/young person is withdrawn, isolated / unwilling to engage Self-concept Lack of age appropriate independent living skills, likely to impair development Child subject to persistent discrimination, e.g. racial, sexual or due to disabilities Demonstrates significantly low self-esteem/confidence in a range of situations Involved in conflicts with peers/siblings Child lacks a sense of safety and often puts him/herself in danger Learning Short term exclusions or at risk of permanent exclusion, persistent truanting No access to books, toys or educational materials Very limited progress towards benchmarks Identified significant learning needs and may have a statement of SEN Some fixed-term exclusions Limited participation of young person in education, employment or training PARENTS & CARERS Care, safety and protection Physical care or supervision of child is inadequate Parental learning disability, parental substance misuse or mental health Impacting on parent s ability to meet the needs of the child Parental noncompliance Pregnant women whose lifestyle may be affecting the development of the unborn child Emotional warmth, stability and family relationships Inconsistent parenting impairing emotional or behavioural development Guidance, boundaries and stimulation Parent provides inconsistent boundaries or responses FAMILY & ENVIRONMENTAL FACTORS Family history, functioning (including wider family) History of domestic violence Risk of relationship breakdown with parent or carer and the child Young carers, Privately fostered, children of prisoners Child appears to have undifferentiated attachments Housing, employment and finances Severe overcrowding, temporary accommodation, homeless, unemployment Community resources and social integration Family require support services as a result of social exclusion e.g. hate crimes parents socially excluded, no access to local facilities Assessment and pathways A common assessment should be completed with the child and family to identify their strengths & needs if appropriate, and to access targeted support. Other assessments may include FSSW initial or core assessment; EPS and SALT specialist assessments; ONSET; SEND statutory assessments. A common assessment must not replace a specialist assessment. If more than one agency is involved a Lead Professional should be agreed and a Team Around the Child formed. 6
Specialist & Statutory Key agencies providing support: Family Services and Social Work Integrated Services for Disabled Children (MOSAIC) Integrated Youth Police (Child Abuse Investigation Team) Primary Learning (PLSS) School Inclusion Team SEN & psychology Services for families affected by domestic violence CAMHS Tiers 3 & 4 Plus universal & targeted services LEVEL 3: complex needs, requiring specialist services support Level of need indicators DEVELOPMENTAL NEEDS High level disability which cannot be maintained in mainstream setting Severe / profound physical disability and / or complex health needs, including sensory Complex mental health issues requiring specialist interventions Self-harming Non-accidental injury Acute mental health problems e.g. severe depression; threat of suicide; psychotic episode Speech, language and communication Expressive / receptive language disorder Semantic and / or Pragmatic disorder Severe verbal / non-verbal language impairment Severe / profound social and communication difficulties Emotional, Social and Behavioural Development Challenging behaviour resulting in serious risk to the child and others Failure or rejection to address serious (re) offending behaviour Known to be a part of a gang or post code derived collective In sexually exploitative relationship Under 13 engaged in sexual activity / Teenage parent under 16 Frequently missing from home for long periods Experiencing harm through substance abuse Self-concept Severe lack of age appropriate independent living skills likely to result in significant harm e.g. bullying, isolation Socially isolated and lacking appropriate role models Distorted self-image Learning Chronic non-attendance, truanting Permanently excluded, frequent exclusions or no education provision No parental support for education Young child with few if any achievements Has no access to leisure activities Not in education, employment, or training (post 16) Severe / profound learning disability PARENTS & CARERS Care, safety and protection Parent or carer is unable to meet child s needs without support Children suspected of be being trafficked or involved in commercial exploitation Children subject of emergency protection orders or who are in police protection Where a pre-birth assessment has shown the unborn child to be at serious risk of significant harm Emotional warmth, stability and family relationships Parents unable to manage and risk of family breakdown Family life chaotic Child/young person beyond parental/carers control Guidance, boundaries and stimulation Parent does not offer good role model e.g. condones antisocial behaviour Multiple carers with no consistency No relevant stimulation or inappropriate for age No constructive leisure time activities or guided play FAMILY & ENVIRONMENTAL FACTORS Family history, functioning (including wider family) Children living with high levels of domestic violence that places them at risk Children suspected of being physically, emotionally or sexually abuse or neglected Parents are unable to care for the child Children who need to be looked after outside of their own family Child is main carer for family member Housing, employment and finances No fixed abode or homeless Family unable to gain employment or extreme poverty Housing dangerous or seriously threatening to health Community resources and social integration Child or family need immediate support and protection due to harassment or discrimination No access to community resources Assessment and pathways Universal service practitioners should complete a CAF to access specialist support. service practitioners can request the involvement of other services via specialist reports, except when referring to FSSW when a CAF needs to be completed. Assessments at this level include FSSW initial or core assessment; ASSET; CAMHS, EPS, and MOSAIC specialist assessments; SEN statutory assessments. A Lead Professional in a specialist role is required. 7
Family Information Service 020 7974 1679 option 2 fis@camden.gov.uk CONTACT DETAILS: CORE SERVICES Child and Adolescent Mental Service (CAMHS) CAMHS Joint Intake 020 8938 2638 http://www.camden.nhs.uk/childandadolescentmentalhealthservice Family Services and Social Work Family Service (including Families in Focus & Family Intervention Project) 020 7974 1960 Children in Need South 020 7974 4094 Children in Need North 020 7974 6600 Integrated Early Years & Children s Centres Crowndale Centre 020 7974 1603 Integrated Youth (IYSS) One Point of Access for Young Peoples Services related to ASB / Offending Crowndale Centre 020 7974 6181 Primary Learning (PLSS) Stanhope Street 020 7974 8027 SEN & Psychology Service Crowndale Centre 020 7974 6500 Education.psychology@camden.gov.uk CINDEX www.camden.gov.uk/cindex INTEGRATED WORKING RESOURCES AND SUPPORT Practitioner, ecaf support and general enquiries: www.camden.gov.uk/ecaf-support-guide 020 7974 6687 Camden Integrated Working Website: www.camden.gov.uk/iw Training Information: www.camdentds.co.uk 020 7974 2821 8