5.1 Children with Disabilities |
Contents
- Introduction
- The Team's Duty System
- Referrals to Children with Disabilities Team
- Initial and Core Assessments
- Available Services
- Procedures For Implementing, Monitoring and Reviewing Approved Packages of Support in the Community
- Service User Input - Opinion, Appeals and Complaints
- Guidance on Accessing Packages of Support in the Community
Appendix I - Overview of the Process
Appendix II - Practice Guidance on Assessments
Appendix III - Summary of Need
Appendix IV - Guide to Level of Need
Appendix V - Analysis Form
Appendix VI - Letter to Families
1. Introduction
The Children with Disabilities Team provides services to disabled children in Southwark. This includes children affected or infected with HIV/AIDS.
The Team 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 Team provides various levels of service, and each level has its own eligibility criteria. The services are as follows:
- Advice;
- Assessment for inclusion on the Council's Disability Register;
- Services accessed by Initial/Core Assessments:
- Referral to a specialist agency or resource;
- Casework;
- Package of support in the Community;
- Looked After Services.
Children with Disabilities Team Contact Details.
2. The Team's Duty System
The Team operates a duty system with a rota of duty workers.
Any changes to the Rota must be agreed by duty manager of the day, notified to the duty administrative officer in good time and noted neatly at the top of the day's entry in the Duty Diary.
The duty manager and the duty administrative officer will together keep the DUTY TRACKING RECORD updated on a daily basis in order to 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 Children with Disabilities Team
| 3.1 | The Children with Disabilities Team 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, inter agency referral form or by letter. If another professional telephones in a referral, the duty social worker must request a written referral. The duty social worker will ascertain and record details of the referral and the other professionals involved, including the ethnicity and religion of the family. |
| 3.3 | Referrals for an Initial Assessment and Disability Registration from the District Teams, as with other referrals, must be made in writing. The duty social worker dealing with the referral will inform the duty manager, who will send a fax to the district office to confirm receipt of the referral and ascertain that case responsibility will remain with the district until the assessment is complete and a positive decision about Disability Registration has been made. |
| 3.4 | When a referral is made on an inter agency referral form, the duty social worker is responsible for ensuring that the return slip is sent to the referrer. |
| 3.5 | Upon referral to the Team, the duty worker will request information in relation to the child's medical diagnosis for consideration by the duty manager, in order for the manager to decide 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 social worker will record details of the referral; and inform the duty administrative officer of the basic referral details. |
| 3.7 | The duty administrative officer will search CareFirst and the filing system, inform the duty social worker of the referral's CareFirst status, and pass to her/him any files or papers in the system. |
| 3.8 | The duty social worker will complete a Green Initial Referral form as fully as possible, make recommendations for action, sign, date and then pass the completed form and any relevant file/papers to the duty manager to make a decision as to future action. This will all be carried out within 24 hours of receipt of the referral. |
| 3.9 | The duty manager will sign off the Referral Form, deciding tasks for further action (e.g. Initial Assessment, Disability Registration, referral under Child Protection Procedures, no further action) and pass the Referral Form to the duty administrative officer |
| 3.10 | The duty administrative officer will log the referral on to CareFirst, and make up miscellaneous papers/file. |
4. Initial and Core Assessments
Initial Assessments
Where the duty manager has decided an Initial Assessment is necessary, the CareFirst log date is the start date for the Initial Assessment.
The Initial Assessment must then be completed within 7 working days.
The duty social worker will request Consent from the parents verbally to contact other professionals. This will be followed up directly by a written request for written parental consent. A stamped addressed envelope will be sent with the request and the consent form.
The duty manager will decide on and log the date for the home visit to complete the Initial Assessment in the Duty Diary so that the home visit takes place within 6 working days of the start date of the Initial Assessment.
At the end of the Initial Assessment, the duty social worker will complete and write up the Initial Assessment and pass it to the duty manager.
The duty manager will read and sign off the Initial Assessment within 7 working days of the CareFirst log date, making recommendations in writing and pass these to the team administrative officer.
The team administrative officer will log the Initial Assessment as completed within 10 working days from the start date, and return the file to the duty manager to allocate for further work or close the case.
The duty manager will then return the file to the assessing duty social worker to complete the necessary tasks. These may, for example, be to write a letter or to refer-on.
The duty social worker will complete those tasks, and send a copy of the Initial Assessment to the parent(s) and, where appropriate, inform the referrer of the outcome. The duty social worker will then pass the case file to the duty manager.
The duty manager will either close the case or decide it needs allocation within the Team, and pass the papers to the duty administrative officer.
The duty administrative officer logs the duty manager's decisions on to CareFirst. If the decision is to close the case, the duty administrative officer will file the case papers. If the decision is for allocation, the duty administrative officer will ensure the case papers are at the allocation meeting for the duty manager to present the case.
N.B. Urgent interim support: Once the Initial 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 Team will undertake Initial and, where appropriate, Core 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 happened.
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 set out in the Appendices below, 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 then fill in the 'Summary of Need' in Appendix III - Summary of Need, highlighting the 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. (See above for presentation of Initial Assessment to duty manager).
As a result, the recommendation will be confirmed or amended. If the result of the assessment so far is that the level of need is 'high' or 'medium', the proposed package may go forward to the Designated Manager (Children with Disabilities) and/or Care Package Review Panel for decision. If the need is assessed as 'high' and 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. 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 Analysis (Appendix V - Analysis Form).
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 Core 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
(also see Flowchart for Disability Registration Assessment Process)
Eligibility for inclusion on the Register is an important, although not necessarily sufficient condition, for other services provided by the Team.
An Initial 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 administrative officer will pass all reports to the duty manager, together with the appropriate case papers.
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.
The duty manager will then pass the case papers to the duty administrative officer. The duty administrative officer will log the duty manager's decision on to CareFirst and file the case papers.
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 Initial 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 the papers/file to the team administrative officer. The team administrative officer will log the result on to CareFirst and send out the letter of registration to the parent(s).
Where the duty manager has recommended further casework action, the team administrative officer will pass the case papers back to the duty manager for the
allocation of that work. Otherwise, the team administrative officer will log the case as closed and file the papers accordingly.
The duty manager will pass the further work concerned to the duty social worker or allocate the work within the Team.
Where further assessment is required, the duty manager will allocate the case for assessment for registration to a worker in the team at the weekly Team Allocation meeting. The allocated worker and her/his line manager will make the decision about Registration and any further casework action required.
Flowchart for Disability Registration Assessment Process
Click here to view Flowchart for Disability Registration Assessment Process
5.3 Other Services Accessed By Initial/Core Assessments
| a. | Referral to a specialist agency or resource |
These services include:
The eligibility criteria for these services are:
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b. |
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Social workers, caseworkers and the Psychologist in the Team will work with both carers and children:
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:
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c. |
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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:
- The child meets the criteria for Disability Registration (see Paragraph 5.2, Assessment for Inclusion on the Register of Children with Disabilities above);
- Assessed as necessary to address potential significant developmental impairment;
- The child has suffered a family breakdown or is likely to do so if the service is not provided; and
- Attempts at support within the family network have proved unsuccessful.
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 Care Package Review Panel.
6.2 Detailing and notifying the Package
- 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;
- The worker will get the signature of her/his line manager;
- The worker will then hand this form to the team's administrative staff, who will enter the details in the database. Where the form does not provide the details, the administrative staff will obtain the information from the worker, and the worker will amend the form accordingly. The administrative staff will enter the date of the review, and will trigger the case's return to Panel;
- The administrative staff will then hand the form on to Finance section, which will enter the details in their database, returning the form to the administrative staff, which will take a copy for their own records, placing the original on file.
6.3 Feedback to Service User
The worker will then inform the service user, through the standard letter (Appendix V - Analysis Form), 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 and 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
- Three weeks before the due review date, the administrative staff will remind the worker that a review is due;
- The worker will visit the family, and with them, examine each component of the package, and its relationship to their needs;
- The worker will write a report to the Designated Manager (Children with Disabilities) or Care Package Review 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;
- The worker will hand it to the administrative staff no later than 1 week before the Panel date, and the administrative staff will make sure all Panel members have a copy;
- Panel will meet and make a decision;
- The worker 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. A Practice Supervisor 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 access to the Department's Complaints Procedure if it does not agree with the decision.
7.2 Complaints
The Manager 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:
- Make clear links between a worker's observations and their conclusions;
- Make judgments as to the seriousness of the concerns through Practice Guidance;
- Follow the guidance of the Assessment Framework;
- Combine and quantify the level of the concerns;
- 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 - Overview of the Process
Click here to view Overview of the Process Flowchart
Appendix II - 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:
- The child's medical needs;
- The child's abilities compared to what might be expected of a child of the same age;
- The prognosis of the condition;
- The child's presenting behaviour;
- The carer's ability to care for the child;
- The carer's strengths;
- The child's wishes;
- The strengths of the extended family network;
- 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:
- Initial Assessment Record or Core Assessment record;
- Summary of need;
- Care package funding request form, where appropriate.
These forms need to be completed before any consideration will be given to the provision of a 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 III - Summary of Need
Summarise the judgments you have made in consulting the Practice Guidance in the Grids below, being careful to state the source of your judgments
| Child's Developmental Needs | ||||
| HIGH | MEDIUM | MODERATE | LOW | |
| Health | ||||
| Education | ||||
| Emotional & behavioural development | ||||
| Identity | ||||
| Family & social relationships | ||||
| Social presentation | ||||
| Self care skills | ||||
| Parenting Capacity - Ability to provide: | ||||
| HIGH | MEDIUM | MODERATE | LOW | |
| Basic care | ||||
| Ensuring safety | ||||
| Emotional warmth | ||||
| Stimulation | ||||
| Guidance & boundaries | ||||
| Stability | ||||
| Family & Environmental Factors - Comment on: | ||||
| HIGH | MEDIUM | MODERATE | LOW | |
| Community Resources | ||||
| Family's social integration | ||||
| Income | ||||
| Employment | ||||
| Housing | ||||
| Wider family | ||||
| Family history & functioning | ||||
| Defining the Priority Bands | |
HIGH There has been *significant developmental impairment and a definable incident of family breakdown impacting on the child's immediate welfare, whether from emotional, or physical Neglect, and the impact is continuing |
MEDIUM There is likelihood of *significant developmental impairment and family break down impacting on a child's welfare, whether from emotional, or physical neglect |
MODERATE There has been, or is likely to be, a moderate impact on a child's welfare, health or safety without intervention |
LOW There has not been and is unlikely to be impact on child's welfare, safety or health. |
*Most, if not all of the children with whom the Team works will have significant developmental impairment by reason of their long-term condition. The particular meaning of this phrase in the context of the Team's work is where there has been additional significant impairment as a result of action or inaction on the part of carers, or some aspect of the caring environment.
A rating of 'High' or Medium' in at least one of these domains will be necessary to give the overall assessment such a rating.
Appendix IV - Guide to Level of Need
Click here to view Appendix IV - Guide to Level of Need
Appendix V - Analysis Form
| Service User | D.O.B | ||
| What Tasks is the Service(s) temporarily providing Respite to and why these particular ones? State whether it is because carer cannot do tasks or not |
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| At what level of frequency is it recommended the Tasks are relieved, and why? |
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| What are you hoping will be achieved during this period of respite to enable the parent to resume either full or a greater level of care in the future? |
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| Service Duration (While Respite may be of longer duration, or episodic, it should normally be time-limited to avoid dependency) |
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| Necessary Tasks to be undertaken |
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| Number of hours minimally required to fulfil those tasks |
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| Worker Signature | Date | ||
| Manager Signature | Review Date | ||
Appendix VI - 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 make a complaint under the Department's Complaints system. I will give you a copy of a Form to help you do this, if you wish. Send it to the address below stating what your objection is and what you believe would be a proper award, given your child's circumstances.
Annette O'Callaghan
Team Manager
47b East Dulwich Road
London SE22 9BZ
Yours sincerely
Worker
End