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5.1 Children with Disabilities

RELATED GUIDANCE

Statutory visits to children with special educational needs and disabilities or health conditions in long-term residential settings - Statutory guidance for local authorities, health bodies and health or educational establishments (DfE/DoH, November 2017)

RELATED CHAPTERS

Safeguarding Disabled Children: Practice Guidance

Short Breaks Guidance

Children and Young People Aged 0 - 25 with Special Educational Needs and Disabilities

AMENDMENT

This chapter was updated in March 2018 to add Statutory visits to children with special educational needs and disabilities or health conditions in long-term residential settings - Statutory guidance for local authorities, health bodies and health or educational establishments, (DfE/DoH, November 2017). (See Related Guidance).


Contents

  1. Introduction
  2. The Children with Disabilities Duty System
  3. Referrals to the Children with Disabilities Service
  4. Single Assessments
  5. Available Services
  6. Procedures For Implementing, Monitoring and Reviewing Approved Packages of Support in the Community
  7. Service User Input - Opinion, Appeals and Complaints
  8. Guidance on Accessing Packages of Support in the Community

    Appendix I - Practice Guidance on Assessments

    Appendix II - Letter to Families


1. Introduction

The Children with Disabilities Team provides services to disabled children in Southwark between the ages of 0-14 years.

Young people will be referred to the Transition Team at the age of 14 yrs where they will be supported to develop independence skills, further their education, employment and where possible achieve independent living. The Transition Team will work with young people up to the age of 25 years.

Both teams will accept referrals where the child appears to come within the definition of a Disabled Child, namely that he or she has a severe or profound disability that is permanent.

The Children with Disabilities Team provides various levels of service, and each level has its own eligibility criteria. The services are as follows:

  1. Advice;
  2. Assessment for inclusion on the Council's Disability Register;
  3. Services accessed by Single Assessments (see Protocol for Single Assessments (agreed with Southwark Safeguarding Children Board):
    1. Referral to a specialist agency or resource;
    2. Casework;
    3. Package of support in the Community;
    4. Looked After Services.


2. The Children with Disabilities Duty System

The Team operates a duty system with a rota of duty workers.

Any changes to the Rota must be agreed by a manager, notified to the duty Practice Coordinator in good time and noted neatly in the Duty Diary.

The duty manager will monitor progress of all active cases being dealt with on duty. The duty manager will follow up on delays and ensure that the reason for any delay is logged and signed off on file.

The procedures for referrals and assessments carried out under the duty system are as set out in the relevant sections below.


3. Referrals to the Children with Disabilities Service

3.1

Southwark has recently introduced a ‘One Front Door’ service operating as part of the MASH service. This consists of a skill mix of front line managers working together to make good decisions about referrals as quickly as possible in order for children and families to gain services in a timely manner (See Thresholds for Children’s Social Care Safeguarding Services Procedure (agreed by Southwark Safeguarding Children Board)).

The Children with Disabilities Service operating within the ‘One Front Door’ service will accept referrals in relation to children who appear to come within the definition of a disabled child, namely that he or she has a severe or profound disability that is permanent.
3.2 Referrers may make initial contact by telephone using the One Front Door service through MASH, or a Common Assessment Framework (CAF).
3.3 All referrals for an assessment or Disability Registration from other professionals, must be made in writing using the CAF. Child Protection referrals will be taken over the phone, but must be followed up with a written CAF. The duty manager dealing with the referral will confirm receipt of the referral and ascertain whether the referral will be accepted. In the case of referrals from other Social Care Services, the duty manager will inform the service whether case responsibility will remain with the other service based on available information concerning eligibility. If this is unclear case responsibility may remain with the other service until more information becomes available.
3.4 When a referral is made on a CAF, the duty social worker is responsible for acknowledging receipt of the CAF and outlining any planned action once agreed.
3.5

Upon referral to the Service, the duty manager will make a decision about any required action and may take the opportunity to consult with managers from other services before passing to the duty social worker to take any planned action.

In order to determine whether the child meets the eligibility criteria for a service from the Children with Disabilities Service the duty social worker will contact the parent,to obtain as much information as possible about the child. The duty social worker will also request verbal consent to contact other professionals for information. This information will be passed to the duty manager to make a decision whether there is sufficient evidence that the child in question may come within the above definition to justify an acceptance of the referral.
3.6

The duty manager will sign off the Referral, deciding tasks for further action (e.g. Single Assessment, Disability Registration, referral under Child Protection Procedures, no further action). This decision will be made within 24 hours of receipt of the referral.

If the duty manager accepts the referral they will decide on and log the date for the home visit to complete the Single Assessment in the Duty Diary so that the home visit takes place within 6 working days of the start date of the Single Assessment.

The duty manager will ask the duty Practice Co-ordinator to send an appointment to the parent and include a consent form to request information in relation to the child's medical diagnosis and information from other involved professionals. A stamped addressed envelope will be sent with the request and the consent form.
3.7 The Practice Coordinator will confirm this action with the duty manager and log the information on Mosaic.


4. Single Assessments

Note: Please see Protocol for Single Assessments (agreed with Southwark Safeguarding Children Board).

Single Assessments

Where the duty manager has decided a Single Assessment is necessary, the Mosaic log date is the start date for the Single Assessment.

The Single Assessment Disability Registration process must be completed within 10 working days.

At the end of the Single Assessment, the social worker will complete and write up the Assessment and pass it to the duty manager.

The duty manager will read and sign off the Single Assessment within 10 working days of the Mosaic log date, making recommendations in writing. The duty manager will at this stage decide whether the case should be allocated for further assessment and work, whether any immediate tasks should be completed prior to closure, or whether the case can be closed.

If registration is agreed and no further action is required, the duty Practice Coordinator will write to the parents confirming that their child’s name has been added to the Disability Register and enclose a copy of the Single Assessment, and information on services in Southwark including details of the Local Offer website.

If immediate tasks need to be completed the duty manager will reassign the case to the assessing duty social worker to complete any immediate outstanding tasks. These may, for example, include a referral to another service for a specific action or support.

The duty social worker will complete those tasks, and, where appropriate, inform the referrer of the outcome of the referral. Once completed the duty social worker will reassign the case to the duty manager.

The duty manager will either close the case or record this on the Single Assessment that further assessment is required and the case will be allocated for completion of the Single Assessment. Details of this decision will be passed to the duty Practice Coordinator to add to the allocations list.

The duty Practice Coordinator will ensure the case details are presented to the weekly allocation meeting where the duty manager will present the case and allocate to a social worker to compete the Single Assessment within the required timescale.

N.B. Urgent interim support: Once the Single Assessment has been completed, the duty social worker can recommend, and the duty manager can, subject to her/his approval limit, approve, essential Section 17 support services as an interim measure prior to the case going to the Care Package Review Panel.

Process of Initial and Core Assessments

The service will undertake Single Assessments, in accordance with the Procedures contained in Part 1.2, Assessment and Planning, of this Handbook. Relevant chapters can be accessed via the Contents Button.

In summary, the process of the assessment will be as follows:

4.1 Home Visit(s) and enquiries

At the first home visit, written parental consent to contact other professionals must be asked for, if this has not already been provided by the parent.

The worker will make one or more Home Visits, observing and analysing the child and family's strengths, needs and requests, covering the domains in the Assessment Framework. In doing so, s/he will take careful note of the underlying evidence for any opinion or conclusion s/he makes. S/he will supplement those observations as necessary with enquiries to other agencies, having first obtained the child's/carer's permission to do so.

4.2 Analysing the observations

Using the Practice Guidance and in discussion if desired with a manager, the worker will relate the observations to the levels of concern in each Domain.

4.3 Quantifying the level of concern

The worker will complete the assessment highlighting any key factors that give rise to concern. In doing so, the worker will be careful to evidence the observations that give rise to the conclusions.

4.4 Management discussion

The worker will then take the conclusions arrived at to her/his manager for discussion.

As a result, the recommendation will be confirmed or amended. If the result of the assessment so far is that the level of need warrants a care package. The appropriate care package forms will be completed and forwarded to the Designated Manager (Children with Disabilities) and/or CRAM Review Panel for decision. If the need is assessed as urgent, the worker's manager may authorise the worker to make urgent interim arrangements. The interim arrangements will last until a formal decision is made at the next CRAM Panel. In either event, the worker will fill in a Care Package Plan and Funding Request Form, specifying the details of the package proposed.

4.5 Presentation to Senior Management

The worker will then present the recommendation to the Designated Manager (Children with Disabilities), together with the Assessments.

The Designated Manager may approve, amend, or refuse the recommendation, or may send it back for more information to be gathered, either in a specific area, or through a Single Assessment.

In doing any of the above, the Designated Manager will set a date for its review of the Package.

The services accessible through this process are set out in Section 5, Available Services below.


5. Available Services

5.1 Advice

The team is happy at any point in its contact with a child or family to give advice on universal or specialist services.

5.2 Assessment for Inclusion on the Register of Children with Disabilities

All Local Authorities must keep a Register of Children with Disabilities. Assessment for inclusion on the Register is open to all children.

Criteria for Registration

The Team will undertake an assessment of a child for inclusion on the Register against eligibility criteria based on the following definition:

"A child with a disability is a child between the age of 0 and 18 who has a severe or profound disability that is permanent".

The assessment is carried out within the framework of the Community Health 'Special Needs Module' which guides the assessments by Community Health professionals of

"children with a defined condition or problem leading to functional impairments who need special services and regular follow-up over a long period of time".

The areas of functioning separately assessed in this module are:

Motor Manipulation/Hand function
Vision Hearing
Communication Developmental delay/learning
Persistent disability in health or growth Personal Care
Behavioural/emotional/personal  

Each area of functioning is assessed on a scale, as follows:

0 No problem
1 Mild
2 Moderate
3 Severe
4 Profound

Where any area of functioning is assessed at level 3 or 4, this meets the Council's criteria for registration and the child's name will be placed on the Register.

Process of Registration

Eligibility for inclusion on the Register is an important, although not necessarily sufficient condition, for other services provided by the Team. 

An Single Assessment is essential prior to completing any Registration but it need not happen at the same time if essential reports from other professionals are not available at the time of referral or shortly afterwards.

The duty social worker should request professional reports on the child as soon as possible after parental consent has been given. 

The duty Practice Coordinator will pass all reports to the duty manager, together with the appropriate case file name and Mosaic number.

On receipt of the professional reports, the duty manager decides whether or not to proceed with an assessment for Registration. 

Where Registration is not appropriate on the information contained in the reports, the duty manager will inform the referrer in writing to that effect, also making an offer to reassess if there is a significant change in circumstances in the future.

Where Registration is appropriate on the information contained in the reports, the duty social worker will complete the Disability Registration Form from the information contained in the Single Assessment and the professional reports, if necessary also telephoning the parents.

The duty manager will then sign off the Disability Registration Form with recommendations for any further casework action required, and pass to the Practice Coordinator who will add the child’s details to the Disability Register and send the letter of registration to the parent(s).

Where the duty manager has recommended further casework action the Practice Coordinator will add the file to the weekly allocations list.


5.3 Other Services Accessed By Single Assessments

a.

Referral to a specialist agency or resource

These services include:

  • Charlie Chaplin Adventure Play scheme;
  • London PE - Easter and Summer Play schemes;
  • Home Care services;
  • Camden Society;
  • Resources for Autism;
  • Whippersnapper;
  • After School provision;
  • Other defined Summer Play schemes;
  • Early Years service.

The eligibility criteria for these services are:


b.


Casework

Social workers, caseworkers and the Communications specialist in the Team will work with both carers and children:

  • To explore the nature of the disability;
  • To explore its impact upon on their own lives and the lives of people close to them;
  • To work towards a relationship with the disability, which works for them.

The service can be provided at any point following assessment, together with any other of the services offered by the Team, or on its own.

The eligibility criteria for these services are:


c.


Package of support in the community

This service is delivered to support carers in caring for the child within their families. It can either take the form of help in caring for the child within the home itself ('home care'), or of caring for her/him for a short period away from home ('Respite care') to give all parties a rest. The services may be provided jointly with the Health or Education services. See Section 5, Available Services below for the detailed procedure.

Services included as part of packages of support are:

  • Home care;
  • Personal Care;
  • Escorting;
  • Residential Respite Care (incl. Orient Street);
  • Foster Respite Care (incl. Family Link scheme).

The eligibility criteria for these services are:

Where substantial Council resources may be involved, any package proposed as a result of an assessment must have the approval of the Designated Manager (Children with Disabilities) and/or the Care Package Review Panel before it is finalised.

The services to be provided will be set out in a Child in Need Plan and subject to regular review (see Child in Need Plans and Reviews Procedure.)

5.4 Looked After Services

It is the Team's experience that once a Disabled Child is Looked After, other than in the context of short breaks, he or she seldom returns home.

As this is such a serious consequence for both child and family, the decision to look after a child should always be very much as a last resort.

The eligibility criteria for these services are:

A decision to look after a child, unless in an emergency, requires the approval of the Designated Manager (Children with Disabilities). The Team may enter into a joint arrangement with either the Education or Health Service in providing this service.

If a decision is made that the child should be Looked After, the procedures set out in Part 3, Looked After Services, of this Handbook should be followed. Relevant chapters can be accessed via the Contents Button.


6. Procedures for Implementing, Monitoring and Reviewing Approved Packages of Support in the Community

6.1 Commissioning the package

The worker will then arrange for one or more providers to undertake the work approved by the Designated Manager (Children with Disabilities) or Child Resource Allocations Meeting Panel (CRAM).

6.2 Detailing and notifying the Package

  1. The worker will revise the Care Package Plan and Funding Request Form as necessary following the Designated Manager/Panel's decision. In doing that, s/he will make sure the form contains the hours, days of the week, and provider of the service, and the hourly rate. Where there is more than one provider, or more than one hourly rate, the worker must specify which hours these difference apply to;
  2. The worker will get the signature of her/his line manager;
  3. The worker will then hand this form to their practice group coordinator, who will enter the details in the database. Where the form does not provide the details, the Practice Coordinator will obtain the information from the worker, and the worker will amend the form accordingly. The practice coordinator will enter the date of the review, and will trigger the case's return to Panel;
  4. The Practice Coordinator will then hand the form on to Finance section, which will enter the details in their database, returning the form to the Practice Coordinator, who will place the original on file.

6.3 Feedback to Service User

The worker will then inform the service user, through the standard letter, of the Package that the Department has agreed. The standard letter details the appeals procedure.

6.4 Monitoring the package

The worker will visit the family within the first four weeks of the package commencing at a time when the carer is present to ensure that the carer is clear about their role. Thereafter as agreed with manager, to ensure that the package is working well. The worker will take up any complaints about the quality of the service direct with providers, and inform his or her manager if in her/his opinion the components of the package need revision.

6.5 Reviewing the package

  1. Four weeks before the due review date, the Practice Coordinator will remind the Advanced Practitioner of the relevant practice group that a review is due. The Advanced Practitioner will allocate the task to a social worker within the practice group. The Practice Coordinator will request information from the provider about the carers views and any recommendations concerning any changes to the package;
  2. The social worker will visit the family, and with them, examine each component of the package, and its relationship to their needs taking the carers report into consideration;
  3. The worker will write a report to the Designated Manager (Children with Disabilities) or CRAM Panel with recommendations, together with a new Care Package Plan and Funding Request Form, and will discuss it with her/his line manager, who will confirm or amend it as necessary, and countersign it;
  4. The worker will hand it to the Practice Coordinator no later than 1 week before the Panel date, and the Practice Coordinator will make sure all Panel members have a copy;
  5. Panel will meet every fortnight to make a decision;
  6. The Practice Coordinator will action the Care Package Plan and Funding Request Form as before, and will re-notify the family through the standard letter.

See also Child in Need Plans and Reviews Procedure.

In the case of services that include respite care, the first Review should be held within 28 days of the first overnight stay, the second review should be within 3 months, and subsequent Reviews should be held annually. An Advanced Practitioner from the Children with Disabilities Team will chair the reviews and will complete a formal Review Record as for Looked After Reviews. Prior to the Review, the child and parent will be asked to complete LAC Consultation papers.


7. Service User Input - Opinion, Appeals and Complaints

7.1 Opinion

Workers will ensure that they pay close attention to the child and family's opinions of their own needs during their visits, whether in the assessment, monitoring or review stages, specifying them in the report, and noting the reasons in it if their opinion differs with that of the family.

Once Senior Management has made a decision, the worker will notify the family through the standard letter.

This letter states the family's right to appeal the CRAM Panel decision. It also provides details of how to access to the Department's Complaints Procedure (See Representations, Complaints and Claims Procedure).

7.2 Appeals and Complaints

All appeals will be discussed at the next available CRAM panel and the the chair will write to the parents with the outcome.

The Head of Service of the Children with Disabilities Team will deal with Complaints at Stage One of the Complaints Procedure. See Representations, Complaints and Claims Procedure.


8. Guidance on Accessing Packages of Support in the Community

Community Care packages and Respite Care are a high intensity, scarce resource, so it is especially important that the allocation of that resource is internally logical, transparent, and fair. To ensure the allocation of resource is appropriate, the Assessment should:

  1. Make clear links between a worker's observations and their conclusions;
  2. Make judgments as to the seriousness of the concerns through Practice Guidance;
  3. Follow the guidance of the Assessment Framework;
  4. Combine and quantify the level of the concerns;
  5. Link the combined level of concern to the provision of resources.

Packages can contain elements from one of the resources set out below:

  • Single agency community care package;
  • Joint funded community care package;
  • P&V Residential or agency fostering respite care;
  • Orient Street.

The procedures set out a means for management to oversee and guide the process of resource allocation based on such assessments, builds service user information and participation into the process; and provides for the regular and structured review of the resources allocated.

The purpose of packages of support is to help families with particular care tasks relating to the needs of the child with a disability. In the process, carers will also be enabled better to attend to the needs of any other children in the family. The prime function of the resources is to stabilise the family's capacity to support the child, and therefore, in all but the most exceptional circumstances, they should be seen as time limited.


Appendix I - Practice Guidance on Assessments

When completing an assessment to determine a recommendation for a level of service the following three grids need to be completed, in line with the Assessment Framework:

  • Child's Development Needs;
  • Parenting Capacity;
  • Family and Environmental Factors.

The assessment will take account of the following:

  1. The child's medical needs;
  2. The child's abilities compared to what might be expected of a child of the same age;
  3. The prognosis of the condition;
  4. The child's presenting behaviour;
  5. The carer's ability to care for the child;
  6. The carer's strengths;
  7. The child's wishes;
  8. The strengths of the extended family network;
  9. The strengths of the existing 'agency' network.

This evidence and analysis will determine whether the family meets the criteria for services, including, whether the needs are assessed as high or medium.

It is therefore important when you are completing the assessment:

  • That you complete one domain in each of the three dimensions (guidance is provided);
  • That your assessment is evidence based;
  • That you make an analysis of the information;
  • That you make clear recommendations to managers regarding the need to be met, the objective of any service provided, and the level of service required.

You need to complete the following documentation:

  • Single Assessment Record;
  • Summary of need;
  • Care package assessment, where appropriate.

These assessments need to be completed before any consideration will be given to the provision of a care package of services. Services are committed on behalf of the Department and require a manager's input and authorisation. It is thus unhelpful to the service user, yourselves and the service to share any view you may have on service provision prior to discussion with your manager and agreement. At that point, it is both appropriate and proper that the service user has a copy of the Department's assessment.


Appendix II - Letter to Families

Dear ........................,

Please find enclosed your child / young person's assessment (re-assessment) of need.

You will see that it has been decided to create a community care package for (child). This has been put together in the light of the level of need identified, in consultation with you and your family. The details of the package are as follows:

*

*

*

The package will begin on ................ at .................. Your contact with the Providers of the Package is ...................., tel. no. ............

It may be that this is not as much help as you feel you need. If this is the case, you can at any time appeal against the decision. The appeal will be considered at the next available panel, and you will be notified in writing within 10 working days of the panel. In emergency situations the appeal will be considered by the Head of Service outside of the panel and you will be notified within 2 working days.

If you are dissatisfied with any part of our procedures you can make a complaint under the Department's Complaints system. I have enclosed a copy of a Form to help you do this.

Yours sincerely,

Worker

End