INTEGRATED ASSESSMENT FRAMEWORK INTRODUCTION AND OVERVIEW November 2012 1 Integrated Assessment Framework Evidenced Based Assessment Introduction This evidence based multi-agency assessment framework has been influenced, developed and updated taking account of the Department of Health Framework, (2000), Scottish Executive guidance, Getting it Right for Every Child (GIRFEC) and work already undertaken by Dundee City Council and partner agencies. There are four parts to the framework and this overview provides details of the overarching principles and components of assessment and Getting it Right for Every Child. The framework and associated tools and appendices can be accessed on the Integrated Children's Website. An Overview The framework highlights the importance of assessment in identifying the needs of children, young people and their families and provides a structure for undertaking assessments. The framework provides some detailed information on particular tasks that require to be undertaken. It should provide an insight into the roles and responsibilities for staff in all agencies that work with children, young people and parents. Cross reference to appendices is made in this guidance. The tools and appendices cover a range of areas that will inform thinking and help staff focus on the main tasks to assist them to identify children's needs and undertake assessments and intervention with children, young people and their families. It is recognised that some agencies will undertake their own specialist assessment. For example, the NHS Tayside Family Needs Assessment Framework (FHNA), or psychiatric assessments that are undertaken by Child and Mental Health psychiatric services. The FHNA is a framework for public health nurses, health visitors, midwives and school health nurses to assess the needs of children and families they work with and to develop a Care Plan using the FHNA. The FHNA includes information about what programme the child may be placed on in relation to support, but also indicates where the assessment should be extended to other agencies. The integrated assessment framework does not replace other assessments of this nature, but where there is multi agency involvement, individual agency assessments are shared to inform an integrated assessment and child's plan. 2 Assessment and Early Intervention Assessment and early intervention are likely to be the most effective in prevention. All assessments should identify strengths as well as weaknesses (or areas for improvement). Assessment is a dynamic process and should be about working with families not doing to them. Any assessment of a child or young person and his or her family that aims to understand what is happening to a child has to take account of a child’s developmental needs, the capacity of parents to respond to those needs, and wider family and environmental factors. Together these have a direct impact on the current and long-term well being of a child. They constitute a framework for assessment to assist workers to understand what is happening to a child or young person (See Figure 1 Assessment Triangle, page 7). Getting it Right for Every Child (GIRFEC) Getting it Right for Every Child is a national programme that is changing the way adults and organisations think and act to help all children, young people and their families grow, develop and reach their full potential. GIRFEC is about all children – not just children ‘in need’, those ‘looked after, those ‘at risk’ or with the most acute or complex needs. For the purposes of this framework our involvement will start with children in need, but not precluding universal services and the role these services play in information sharing, assessment and early intervention. For further detail refer to Integrated Children's Services Website (GIRFEC model for Dundee). Definition of Children in Need The Children (Scotland) Act 1995, Regulations and Guidance, provides a list that is indicative rather than exclusive. Family conditions, such as family breakdown or poverty and deprivation may be factors underlying the needs of children and young people. The statutory definition of a 'child in need' is wide and can include: Children and young people who are looked after Children and young people in need of protection Children and young people who are no longer looked after by the local authority Young parents Children and young people who have disabilities /special needs (e.g. physical, or learning disabilities, sensory impairment) Children and young people who are carers for relatives and who are in households affected by disability Young carers Children and young people who have been adopted (and those who are in the process of adoption) Children and young people who misuse alcohol/drugs Children and young people who are effected by HIV/Aids Children and young people who are homeless Children and young people in poor housing Children and young people who live in violent environments 3 Children and young people whose parents suffer from mental illness Children and young people whose parents misuse substances /alcohol Children and young people whose health and development is suffering Children and young people whose educational development is suffering (including those excluded form school) Children and young people who have emotional, behavioural and mental heath problems Children and young people who are in conflict with the law because of offending behaviour (including those who offend against other children) Children who are unlikely to achieve or maintain a reasonable standard of health or development Children whose health and development is likely to be significantly impaired or further impaired Culture Change, System Change and Practice Change The GIRFEC programme aims to remove obstacles which are rooted in the differences in cultures, systems and practice that have emerged through single agency thinking and delivery. Traditionally, agencies have been seen helping a child or young person only in terms of the part of the child's life that is the concern or responsibility of their agency. GIRFEC asks all practitioners to think about a child's needs and difficulties not only from their agencies' perspective but also to see needs and risks in the context of the whole child's life (Assessing and Managing Risk, Jane Aldgate and Wendy Rose 2008). (Appendix 1) The GIRFEC framework represents a way of trying to capture the complexity of the child's world and provides an approach to collecting and analysing information about the child. This includes common values and principles which apply across all aspects of working with children and young people. The values and principles are: Promoting the well-being of individual children and young people Keeping children and young people safe Putting the child at the centre Taking a whole child approach Building on strengths and promoting resilience Promoting opportunities and valuing diversity Providing additional help that is appropriate, proportionate and timely Supporting informed choice Working in partnership with families Respecting confidentiality and sharing information Promoting the same values across all working relationships Making the most of bringing together each workers' expertise Co-coordinating help Building a competent workforce to promote children and young people's well - being 4 Getting it right is founded on the following 10 core components which can be applied in any setting and in any circumstances (Scottish Government 2008). The core components, my world assessment triangle, resilience matrix and the well being indicators provide the basis when considering assessments. The 10 Core Components: 1. A focus on improving outcomes for children, young people and their families based on a shared understanding of wellbeing 2. A common approach to gaining consent and to sharing information where appropriate 3. An integral role for children, young people and their families in assessment, planning and intervention 4. A co-ordinated and unified approach to identifying concerns, assessing needs, agreeing actions and outcomes based on the well being indicators 5. Streamlined planning, assessment and decision making processes that lead to the right help at the right time for children and young people 6. Consistent high standards of co-operation, joint working and communication where more than one agency needs to be involved, locally and across Scotland 7. A lead professional to co-ordinate and monitor multi agency activity where necessary 8. Maximise the skilled workforce within universal services to address concerns at the earliest possible time 9. A confident and competent workforce across all services for children, young people and their families 10. The capacity to share demographic, assessment and planning information electronically within and across agency boundaries through the national e-Care programme where appropriate The Getting it Right for Every Child practice model consists of three main elements: Eight Well being Indicators The My World Triangle The Resilience Matrix Well being Indicators The eight wellbeing indicators have been identified as areas in which children and young people need to progress in order to do well and in the future. The indicators allow practitioners to structure information which may identify needs and concerns and to structure planning for the child or young person. The eight well-being indicators are: safe, healthy, active, achieving nurtured respected responsible and included, (SHANARRI Appendix 2). The My World Triangle (figure 2, page 7) The My World Triangle introduces a mental map that helps practitioners understand a child or young person's whole world. It can be used to explore 5 their experience at every stage, recognising there are connections between the different parts of their world and, in assessment, can be used to explore needs and risks. The Resilience Matrix (Appendix 3) The Resilience Matrix can be used in a single or multi agency environment. It supports practitioners to analyse the more complex information they have gathered, using my World Triangle and other sources to so that the balance between vulnerability and resilience and adversity and protective factors can be weighed. Overall the GIRFEC practice model (figure 1, page 7) consists of six parts. Practitioners will combine some or all of these parts most appropriate to the needs of the child when undertaking assessments. The six parts are: The well being indicators to record and share information that may indicate a need or concern and then take appropriate action The use of My World Triangle (and where appropriate specialist assessments) to explore this information and to gather further information about the needs of a child or young person. The use of the resilience matrix to help organise and analyse information Summarising needs against the well being indicators Constructing the child plan and taking appropriate action Reviewing the child's plan. Further details of this can be found on www.scotland.gov.uk/gettingitright website. 6 Figure 1 - GIRFEC Practice Model Figure 2 7 The Integrated Assessment Framework To support the GIRFEC expectations and ethos of joint ownership and delivery of services, the integrated assessment framework provides all agencies with guidance to their role in assessment, analysis and care planning. The integrated assessment framework aims to facilitate the process of undertaking different forms/depths of assessment that are proportionate depending on the needs of the child and purpose of assessment. The assessment framework consists of four parts: Part 1 - Multi agency initial concern, assessment and referral tool Part 2 Adult services and parental support Part 3 Core and comprehensive assessment and Child’s Plan. The details of these are all located in the Integrated Children's Services website. Part 1- Multi agency initial concern, assessment and referral tool. This is a document that can be used to alert another agency of concerns, can be used as a stand alone initial assessment and can also be used as a referral document when required to send to any other agency for additional support. This can be carried out by almost any practitioner in any agency and the child's plan should be attached, wherever possible. An initial assessment can be based on one home or two home visits or selfreferral or referral from another agency. Refer to Part 1 of the integrated assessment framework for further detail. Part 2- Adult services and parental support. It is recognised that staff working in adult services undertake their own assessments, for example single shared assessment, care pathways. The importance of staff working with adults who have responsibility for caring for children cannot be underestimated. For the purposes of this integrated assessment framework, the relevance is for adults who have children or who may have the care of children, or who may have contact with a child on a regular basis. Part 3 - Core and Comprehensive Assessment and Child’s Plan The Core and Comprehensive Assessment currently is undertaken predominately by social work and will be the lead agency responsible for integrating core and comprehensive assessments. These assessments should be proportionate to the needs of the child. There are separate forms for the Core Assessment depending on whether the case is Child Care or Child Protection. But all Comprehensive assessments are completed on the same form. Each of the forms has a child’s plan designed to help all staff working with children and families think about the needs of children in a child focussed way. 8 The plan is for any child or young person where there is a concern or where assessments show that the child may need additional support so that they can be safe, healthy, achieving, nurtured, active, respected, responsible and included. Principles Underpinning the Assessment Framework This framework stresses the need for evidence based practice, multi disciplinary assessments and direct work with children, young people and their families. The following principles should guide all assessment work with children, young people and their families. These principles apply to any agency that undertakes an assessment and those agencies that contribute to an assessment. The GIRFEC values and principles as stated earlier should be taken account of as well as the following: recognise that children are children first, whatever may distinguish some children from others; recognise that each child is an individual and unique; be child-centred and address the developmental needs of each child; take an approach which locates the child within the family and the wider community; recognise and respect the responsibility and rights of parents; ensure that the child has a right to express his/her views and have these views taken seriously; ensure equality of opportunity; involve partnership working with children and families; build on strengths as well as identifying difficulties or concern; be inter-agency in approach and in the provision of services; be a continuous process and not a single event; be grounded in evidence based knowledge and be non-discriminatory. Information Gathering One of the fundamental components of assessment is information gathering. All agencies undertaking an assessment need to consider which other agency may be involved with the child and family. As well as sharing information with another agency, individual agencies should also ensure that they have shared information or undertake checks with other departments within their own agency. For example, social workers should undertake direct checks with other departments in the social work department (community care and criminal justice services) as well as other parts of children's services. Information Sharing The sharing of appropriate information is crucial to ensuring that services can jointly assess to ensure that appropriate services are developed and delivered to and with children and their families. There are multi agency protocols in place that detail the importance of information sharing. Copies can be found on the ICS Website. 9 Recording of information Each agency will have their own recording systems but as an example, all professional meetings (e.g. core group, Initial Referral Discussions (IRD's) will be minuted and include an action plan with timescales and person responsible for progressing the action, this should be contained in a child's plan. For those involved in these meetings, the agency will receive a copy of the minute Promoting Inclusive Practice Practitioners have to take account diversity in children, understand its origins and pay careful attention to its impact on a child’s development and the interaction with parental responses and wider family and environmental factors. When assessing a child’s needs and circumstances, care has to be taken to ensure that issues, which fundamentally shape children’s identity and wellbeing, their progress and outcomes, are fully understood and incorporated into an assessment. “Issues of race and culture cannot be added to a list for separate consideration during an assessment; they are integral to the assessment process. From referral through to core assessment, intervention and planning, race and culture have to be taken account of using an holistic framework for assessment.” Dutt and Phillips (Department of Health, 2000a). Use of the framework requires that children and families’ differences must be approached with knowledge and sensitivity in a non-judgemental way. Ignorance can result in stereotyping and an inappropriate or even damaging assumptions being made, resulting in a lack of accuracy and balance in analysing children’s needs and parenting capacity. To achieve sensitive and inclusive practice, staff should avoid: using one set of cultural assumptions and stereotypes to understand the child and family’s circumstances; insensitivity to racial and cultural variations within groups and between individuals; making unreasoned assumptions without evidence; failing to take account of experiences of any discrimination in an individual’s response to public services; failing to take account of the barriers which prevent the social integration of families with disabled members; and Attaching meaning to information without confirming the interpretation with the child and family members. Protecting and Promoting Welfare For all assessments: 10 there must be clarity of purpose about the questions to be answered by the assessment process; evidence, and not unsubstantiated opinion, of what is seen, heard and read must be carefully collected and recorded; attaching meaning to the information collected must distinguish the child’s and family’s understanding from that of professionals; there must be clarity about the sources of knowledge which inform professional judgement; severity, immediacy and complexity of the child’s situation will have important influences on the pace, scope and procedural formality of assessment; co-ordinated and holistic assessments must be followed by judgement leading to clear decisions and co-ordinated and holistic planning and intervention/action; and there has to be clarity about what has to change, how it will be achieved, in what timescale and how it will be measured and reviewed Some of the important questions that will determine the process of assessment are, for example: What are the strengths to be built on? What are the difficulties that need addressing? What are the best options for this child? How will this child cope with services/intervention? How well is this child doing (following intervention/services/placement)? What is the impact on the child and family? Does the plan need amending? Dimensions of a Child's Development Needs - (Appendices 4 & 5a &b) When practitioners are undertaking an assessment of a child’s developmental needs they should: identify the developmental areas to be covered and recorded; plan how developmental progress is to be measured; ensure proper account is taken of a child’s age and stage of development; and Analyse information as the basis for planning future action. It would be beneficial when undertaking assessments that a statement is made about what is the developmental stage of a child, e.g. a child of age 1-3 years should be standing, walking, picking up small objects, whereas child A has poor physical development and co-ordination. This is an example only and reference should be made to the developmental charts (Appendix 5a and 5 b). 11 Dimensions of Parenting Capacity - (Appendix 6) The assessment of parenting capacity is integral to all assessments of children and young people. Parenting capacity refers to parents' ability to nurture their children, protect them from risk and enhance their developmental experiences. Parenting capacity is the ability to parent in a good enough manner long term. It is different from parenting ability where an individual may be able to parent for a short period of time in specific circumstances but not have the capacity to parent effectively long term. Family and Environmental Factors - (Appendix 7) The care and upbringing of children does not take place in a vacuum. All family members are influenced both positively and negatively by the wider family, the neighbourhood and social networks in which they live. The history of the child's family and of individual family members may have a significant impact on the child and parents. An adult’s capacity to parent may be crucially related to his or her childhood experiences of family life and past adult experiences prior to the current difficulties. Special attention should be given to the needs of disabled children who experience multiple caregivers as part of their regular routine, and to their need for reasonable continuity of caregivers. Assessment of Children in Special Circumstances (Appendix 8) Some of the children referred for help because of the nature of their problems or circumstances, will require particular care and attention during assessment. These are children who may become 'lost' to the statutory agencies, whose wellbeing or need for immediate services may be overlooked and for whom subsequent planning and intervention may be less than satisfactory. Analysis of need and assessment At the conclusion of any assessment, there should be clear summaries which identify from the information gathered, the child’s developmental needs, parenting capacity and family and environmental factors. The My World Triangle encompasses these by brining together the assessment that covers What I Need from People Who Look After Me (Appendix 9) How I Grow and Develop (Appendix 10) My Wider World (Appendix 11) In weighing up the impact that various factors have on a child, it has to be borne in mind that not all factors will have equal significance and the cumulative effect of some relatively minor factors may be considerable. The analysis of a child’s needs requires drawing on multi agency information sharing, professional judgement and an understanding of the child’s needs within his or her family. 12 Making Judgements (Appendix 12) It is very important to ensure that judgements are made and considered before decisions are taken. The intervention should be considered first on the basis of the assessment, identified need and what is known to best address this need. The second stage is to make decisions regarding intervention. Making Decisions (Appendix 13) In drawing up a child's plan careful distinction should be made between judgements about the child’s developmental needs and parenting capacity and decisions about how best to address these at different points in time. All assessments, judgements and decision making must be undertaken in a non discriminatory way and adhere to the UN Conventions on the Rights of the Child. Chronologies (Refer to separate guidance) A Chronology must be appended to any assessment and the Child’s plan. This should outline significant events in the child’s life, derived from 1) the agencies involved (past and present) records, and 2) contributions from the child/family. The chronology plays a key role in any assessment of a child’s circumstances and of parental capacity and motivation to work with agencies to make any changes required. NB Significant events should be events that inform the assessment and demonstrate the impact on the child The following table provides guidance for workers undertaking assessments of children and young people. It is a guide only and professional judgement should be made regarding the depth of assessment required that is proportionate to the needs of the child. Assessment Part 1 Initial/child's plan Purpose Part 3 Core/Child Care or Child Protection/unborn baby assessment/ child's plan From one agency to another when concerns are identified and additional supports are being considered. (all agencies) Initial Assessment Report for the Reporter to the Children's Panel Section 22 Assessment Report to Initial Looked After review (if core or comprehensive report has not yet been completed) SBR for the Reporter and or children's hearing this may include an ASSET report Report for Initial Child Protection Case Conference with Risk assessment. S.23 - Report on Child with, or Affected by Disability S.24 - Report on the Carers of Child with, or affected by disability S25 - Assessment to consider whether or not a child should be accommodated. Report to 6 week Looked After Review 13 Part 3 Comprehensive/unborn baby assessment/child's plan Children and Young people looked after at home 6 monthly Review Child Protection case conferences, this will include an update risk assessment. Assessment of an accommodated child for the 3 month Looked After Review as a basis for producing a childcare plan. This can include a rehabilitation assessment. Assessment to inform application for a Permanence Order Assessment to inform a Form E. (child in need of permanency including adoption) Glossary of terms Social Work (Scotland) Act 1995 Section 22 The duty of a local authority to safeguard and promote the welfare of children or in need by providing a range and level of services appropriate to their needs Section 23 Assessment of children with or affected by disabilities Section 24 Assessment of Carers of Child with, or affected by disability Section 25 The duty of a local authority to provide accommodation for any child within their area if they consider hat to do so would safeguard and promote the welfare of the child Children's Hearings IER Initial enquiry report IAR Initial assessment report SBR Social Background report Other Form E Report to an adoption or permanence panel where a child is being considered for permanent substitute care 14