Welcome to Integrated Processes Training. Welcome and housekeeping Fire Toilets Refreshments Telephone Messages Smoking

Welcome to Integrated

Processes Training

Welcome and housekeeping

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What is integrated working?

Integrated working is when everyone supporting

children, young people and families works together effectively to put them at

the centre, meet their needs and improve their

lives.

Integrated working aims to help identify needs early

and provide support so that any problems do not

become more serious.

Working together to improve outcomes for children and young people

Make a positive contribution Achieve economic wellbeing

Be healthy Enjoy and achieve Stay safe

The policy context for integrated working• Every Child Matters and the 5 outcomes.

• Children’s Trusts.

• The National Service Framework for Children, Young People and Maternity Services (2004).

• Youth Matters (2005) and Targeted Youth Support (2007).

• The Children's Plan (2007).

• 21st Century Schools: A World-Class Education for Every Child (2008).

• Think Family (2008).

• 2020 Children and Young People’s Workforce Strategy (2008).

• Recent policy updates.

Improved outcomes:

• Be healthy.

• Stay safe.

• Enjoy and achieve.

• Make a positive contribution.

• Achieve economic well-being.

Integrated working processes and tools

Tools and processes that support integrated working

Lead professional and TAC

CAF and National eCAFInformation sharing

Common coreContact PointMulti-agency working

A continuum of needs and services

The benefits of integrated working

Earlier, holistic identification of needs

Earlier, more effective intervention

Improved information sharing across agencies

Better service experience for children, young people and families

More effective practice for practitioners and organisations

It is what is best for the children that counts and we feel this new way forward is absolutely the best for our children and young people

You can’t be an expert in everything. We now have a tool to consult others – this saves huge amounts of time trying to become an expert in every subject

Everything is so exciting, but what is most exciting is that all our new pieces of work are now linked

Guiding principles for the workforceEveryone in the children and young people’s workforce should:

• Work in partnership with children, young people and families.• Work in partnership with other practitioners.• Work in a child and young person centred way.• Share information appropriately and effectively.• Use a holistic approach.• Focus on strength as well as need.• Consider all potential sources of support. • Be proactive and accountable.• Promote the well-being of children and young

people and safeguard them from harm.

Common assessment

Framework

The CAF as part of integrated working

Improved outcomes:

• Be healthy.

• Stay safe.





Lead professional and TAF


Common coreMulti-agency working

What is CAF?Using the CAF will help us develop a common understanding of strengths, as well as needs and how to work together to meet them.

The CAF will help us assess children and young people’s additional needs for services, earlier and more effectively.

The CAF is a shared assessment and planning framework to help us in our work with children, young people and families.

The CAF principles

Holistic

Child and young person

centred

Voluntary and only undertaken

with consent

Focused on strength

as well as needs

Coordinated (only ever one active CAF

episode per individual)

A standardised process

supported by a form

Able to improve links to specialist

assessments

Not something services can require before access to provision – but is able to

inform better referrals

Who will use CAF and when?

Do not use the CAF when:• Progress is good.• Needs are identified and

already being met.• Needs are clear and all

can be met by one service.• There is no consent.

If, at any time, there are concerns that a child may be at risk of harm, then follow LSCB procedures without delay

Use the CAF when:• There are concerns about

progress or wellbeing.• Needs are unclear and not

being met.• Needs are broader than

your service can address.

Any practitioner can use the CAF with an individual child or young person

Identify initial concerns regarding family outcomes – consider need for pre-assessment or signpost to other services

Holistic Family Assessments - REFERRAL

Undertake a holistic family assessment to identify family needs and services required to support better family outcomes

Team around the family (TAF) meeting to agree action plans and agree roles, responsibilities and timescales, agree Lead Professional

Produce a multi-agency action plan to ensure a shared approach to information sharing and improving outcomes

Review the action plan to measure outcomes for the family until they are back to universal services

ACTIVITY

‘TO CAF OR NOT TO CAF!’

Scenario 1 – Chantelle

Chantelle moved to the area a month ago, with her brother and her mum, Karen. They moved closer to Karen's mum, who now looks after the children when Karen is at work. They do not have much money and are currently living in a small one bedroom, 8th floor flat that Karen says is a little damp. Chantelle has not yet started at a new education provider since the move. Chantelle seems small for her age and has a rash on her arm that she scratches a lot. Karen says it has been there a few weeks and she will take her to the doctors once they register with one. Chantelle is quiet and does not talk much.

Scenario 2 – Carlos

Carlos has a serious stutter that sometimes makes it hard for others to understand him, but he is working with a language therapist. Other than that, he is healthy, intelligent and popular – but a little shy. He lives with his mum and dad and 2 siblings in a 4 bedroom detached house.

Scenario 3 – Tammy and her baby

Tammy is 15 and lives with her Grandmother. She has recently given birth to a baby girl. She says she wants to go back to school as soon as possible so she can get an education and a good job to support her baby. Her Grandmother is supportive, but Tammy says she is considering applying to move into a flat once she is 16 so she and the baby can begin life as a proper family.

Scenario 4 - Pravin

• Pravin is having a few difficulties in education. He is not keeping up with his peers and says he is being bullied. The home situation seems loving and supportive. Both Pravin and his parents say they do not want a common assessment to take place

Scenario 5 – Paulette and Mickey

Paulette (14) and Mickey (3) live with their mum and her boyfriend. Both Mum and her boyfriend are regular heroin users and deal from the flat to support their habit. Mickey has signs of bruising on his back and Paulette has what appears to be a cigarette burn on her arm. Both seem undernourished and are dirty.

• Basic/background information.• Consent, at various stages.• Assessment in three domains

(see below).• Initial action plan.• Delivery plan and review.

What does the CAF consist of?Through the process standard information will be gathered and recorded:

Development of the child or young person

Parents and carers Family and the environmentAssessment domains

A good CAF discussion should…

Lead to a better understanding

of strengths and needs, and what

can be done to help

Build on effective engagement and communication

Not be too formal or a big event

Build on existing information

to avoid repetition

Fully involve the child or young person and their family

Cover relevant areas but look

beyond the surface

An assessment that is:• Focused on strengths as well as

needs.• Valid and accurate.• Clear and uses appropriate

language.• Inclusive.• Unbiased.• Authentic.• Professional.• Solution focused.• Practical.• Evidence based with opinion

recorded as such.

What makes a good CAF assessment?Using an approach that is:

• Empowering.

• Accessible.

• Developmental.

• Transparent.

Leading to…


Holistic Family Assessments - ASSESS





Activity

Completing A CAF

Family risk factors for assessment

Economic well

being

Communities & staying safe Health and family

structures

Most Excluded Families

•Poverty and debt•Worklessness•Education and skills

• Crime and ASB • Alcohol and drugs• Poor housing and homelessness

Domestic violence Relationship conflict Mental and physical health

•KEY INDICATORS

What makes a good CAF plan?Good action planning is:

• Comprehensive.

• Efficient.

• Inclusive.

• Informative.

• Focused.

• Logical.

• SMART.

• Transparent.

CAF initial plan and delivery plan should:

• Build on strengths and help meet needs identified through the assessment.

• Not promise support on behalf of others.

• Agree who will do what by when and when review will happen.

• State anticipated outcomes and how progress will be measured.

• Record consent to record and share.

Gather information

Undertake assessment

Analyse Plan

The CAF reviewThe CAF review should gather and record:

• Who is present.

• Progress against each of the actions in the CAF delivery plan.

• Next steps.

• Review notes.

• Child/young person and parent comments and where necessary, additional consent .

Outcomes of the review could be one of

the following:

New assessment neededNew actions agreed and review date set CAF closed

Activity

The CAF Plan

Closing a CAF

A CAF can be closed for many reasons, including:

• Additional needs met.

• Child or young person has moved to another area.

• Child or young person has made the transition into adult services.

• CAF assessment superseded by specialist assessment.

• Consent withdrawn.

• Others?

The team around the

family (TAF) and the

lead professional

Identify initial concerns regarding family outcomes – consider need for

pre-assessment or signpost to other services

Holistic Family Assessments - TAF





Lead professional and team around the child as part of integrated working

Improved outcomes:

• Be healthy.

• Stay safe.








The Team around the family (TAF)

The TAF is a multi disciplinary team of

practitioners established on a

case by case basis to support a child or young person and

their family.

Practitioners in the TAF can come from across the

workforce and will focus on strength as well as need.

The model does not imply a team that is located together or who work together

all the time.

Forming the TAF• Where a multi-agency response to the CAF assessment is required,

a TAF should be arranged by the person who initiated the CAF assessment.

• The child or young person and/or their parent/carer must be a full and active part of the TAF at all stages and be invited and encouraged to attend meetings.

• Invite relevant practitioners, as identified through the CAF assessment.

• TAF practitioners might include those from statutory as well as voluntary/third sector organisations and include:

• Universal services.• Targeted services.• Specialist statutory services, if appropriate.

TAF meetingsInitial meeting

Share information to gain a fuller picture

Initial meeting

Agree a lead professional

Agree achievable goals

Agree and record actions to meet goals

Set date for review meeting (within three months is

recommended)

Review meetings

Discuss progress

Share any new information

Update plan

Agree achievable goals

Agree new actions, OR close, stating reasons

Activity

Convening an initial TAF Meeting


Holistic Family Assessments - PLAN





TAF practitioner responsibilities• The lead professional coordinates delivery of the plan.• Each practitioner in the TAF is responsible/accountable to

their home agency for the services they deliver.

Jointly responsible for developing/delivering the CAF delivery and review plan

Responsible for delivering the planned activities

Responsible for monitoring and keeping TAF informed about their progress

Attend TAF meetings and contribute to taking minutes, chairing and other tasks

Support the lead professional, including providing information and offering guidance and advice

Contribute actively and positively to problem solving and resolving difficulties in a child centred way

Remember the ‘T’ in TAF stands for team


Holistic Family Assessments - REVIEW


Team around the family (TAF) meeting to agree action plans and agree roles, responsibilities and timescales



The role of the lead professional

The lead professional is a set of functions to be carried out as part of the delivery of effective integrated support, when a range of services is involved with a child or young person following a common assessment.

The lead professional will:

Coordinate the delivery of the

actions agreed by the practitioners

involved.

Act as a single point of contact for the

child, young person or family.

Reduce overlap and

inconsistency in the services

received.

“Myth Busting” – the lead professional

Does not have to be an ‘expert’ in

everything

Is not automatically the person who

initiated the CAF

Does not need any particular

qualifications

Will not be expected to work outside their usual

remit

Is not responsible or accountable for actions by other practitioners or

services in the TAF

Will have support mechanisms in place to resolve

any issues

Does not become responsible for the needs of the entire

family

May use more time in one area, but

save time elsewhere

Who can be a lead professional?

Core tasks of the lead professional

Be a single point of contact for the child, young

person and family

Be a single point of contact for all

practitioners working with the child

Build a trusting relationship to

secure engagement

Continue support if appropriate,

if specialist assessments are needed

Convene the TAF meetings to enable

integrated multi-agency support

Identify where others may need to be

involved and broker involvement

Support the child/young person

through key transition points

Ensure a safe and planned ‘handover’ if a different LP is agreed and more

appropriate

Coordinate delivery of solution focussed actions and ensure

regular reviews

Knowledge and skills of a lead professional

Knowledge – understand:• CAF and integrated working.• How to access services. • The child/young person’s strengths

and needs.• Information sharing, consent and

confidentiality.• Safeguarding.• Boundaries of own knowledge.

Skills – ability to:• Establish relationships.• Support, empower and

challenge children and young people.

• Convene inter-agency meetings.• Work with practitioners from a

range of services.

Knowledge and skills underpinned by:• Effective communication.• Planning, organisation and coordination.• Critical and innovative thinking.

Activity

Exploring the Lead Professional task, knowledge and skills

Criteria for selecting a lead professionalCriteria for selection could consider:• The wishes of the child or young person, and their family.• Any statutory responsibility to lead on the work.• The level of trust built up.• Any previous or potential ongoing relationship.• Who has primary responsibility for addressing the needs.• The main needs (as assessed through the CAF).• The skills, ability and capacity to provide leadership and

coordination in relation to other practitioners involved.• The ability to draw in and influence universal and

specialist services.• An understanding of the surrounding support systems.

Activity

Selecting a Lead Professional

Management for lead professionals and the TAF

Lead professionals should expect managers to ensure:• Lead professional responsibilities are taken into

account when setting caseloads.• Performance in delivering the lead professional

functions is recognised and recorded.• Clear communication between agencies to

support lead professional practice. • Appropriate and up to date training and supervision

is provided along with coaching and mentoring where appropriate.

TAF practitioners should also expect support to fulfil their responsibilities

Supervision for lead professionalsLine management supervision for lead professionals:

Managerial Focused on effective delivery of services and the lead professional functions

Support Focused on reflection and evaluation of lead professional practice (could be from line manager and/or local support functions)

Training and development

Focused on continuously assessing strengths and identifying training and development needs for practitioners acting as the lead professional

Resolving disagreements and disputes

Could arise over:

• Selection of the lead professional.

• Roles and responsibilities of TAF members.

• The need for action and by whom.

• Communication.

• Others?

Resolve problems quicklythrough clear local systems:

• Between the parties.

• Line manager support and/or other local support systems.

• Negotiation between agencies at senior management level.

• Children’s Trust coordinated arrangements at strategic level.

• Director of Children’s Services.

Transfer and endings for the lead professional

• Being a lead professional is not a permanent thing:– Children and young people’s needs change

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

• Transfer and endings of the lead professional functions, where appropriate, need to be carefully planned and managed.

Information sharing

Information sharing as part of integrated working

Note: This training is about information sharing and not data sharing

Improved outcomes:

• Be healthy.

• Stay safe.








Sharing information as part of early intervention and preventative services

• Effective partnership working between universal and targeted specialist services.

• Active processes for identifying those at risk of poor outcomes.

• Sharing between adult and children’s services.

• Sharing to support transitions.

Success depends upon…

Increased emphasis on

integrated working across services to better identify and

meet needs

Sharing information if concerned about significant or serious harm

Always consider referring concerns to children’s social care or police, following LSCB procedures

Seek advice if unsure what to do

Practitioners must: Issues to consider:

Confidential information can be shared without consent if justified in the public interest

Timely sharing is important in emergency situations

Significant harm to children and young people or serious harm to adults can arise from a number of circumstances

It is good practice to seek consent and/or discuss concerns, unless this would increase the risk of harm

Information sharing decisionsDecisions about information sharing should be based on an assessment of benefits and risks to the child, young person or family.

You must assess:

• What are the benefits of not sharing information?

• What are the risks if information is shared?

You must assess:

• How would sharing information benefit the child, young person or family?

• What are the risks if information is not shared?

Decision to shareDecision not to

share

Activity

The Benefits and challenges to information sharing

Seven golden rules for information sharing

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

• Be open and honest with the person from the outset.

• Seek advice where in doubt.

• Share with consent where appropriate and where possible, respect the wishes of those who do not consent to share (unless there is sufficient need to override the lack of consent).

• Always consider the safety and well-being of the person and others.

• Ensure information is accurate and up to date, necessary, shared with the appropriate people, in a timely fashion and shared securely.

• Record the reasons for the decision – whether it is to share or not.

Key questions to inform decision makingIs there a clear & legitimate purpose to share the information?

Does the information enable a living person to be identified?

Is the information confidential?

Do you have consent to share?

Is there sufficient public interest to share?

Are you sharing information appropriately and securely?

Have you properly recorded your decision?

The law

The common law duty of confidentiality

Legislation containing express powersor which imply powers to share:

• The Children Act 1989 and 2004.• Local Government Act 2000.• Education Act 1996 and 2002.• Learning and Skills Act 2000.• Education (SEN) Regulations 2001.• Children (Leaving Care) Act 2000.• Mental Capacity Act 2005.• Protection of Children Act 1999.• Immigration and Asylum Act 1999.• Crime and Disorder Act 1998.• National Health Service Act 1977 and 2006.• The Health and Social Care Act 2003.• Criminal Justice Act 2003.• Adoption and Children Act 2002.

The Human Rights Act 1998

The Data Protection Act 1998

What is confidential information?

Confidential information is…

Can be shared if….

• Personal and private or sensitive, and…

• Not already in the public domain, and…

• Shared in confidence.

• Consent is given by the person who provided the information or the person to whom it relates.

OR

• It can be shared without consent if justified in the public interest.

• Reasonable cause to believe that a child is suffering or at risk of suffering significant harm

• In the prevention and detection of a crime

• Or information is subject to a court order

What constitutes consent?Consent is key to information sharing, it is good practice even where the law does not demand it.

Consent:• Must be informed.• Should be explicit but can be

implied in some circumstances.• Is preferably written, but can

be verbal.• Must be willing and not inferred

from a non response.• Must be sought again if things

change significantly.• Can be withdrawn and have limits.• Should be recorded and stored.

When gaining Consent:• Explain it at the start, using suitable

language.

• Explain the limits to confidentiality.

• Be aware of relevant legislation.

• Follow local policies and procedures.

Do not seek consent where it would increase risk

Whose consent should be sought?• People aged 16 and over –

generally presumed to have the capacity to understand and may give (or refuse) consent.

• Children aged 12 or over – may generally be expected to have sufficient understanding to give (or refuse) consent.

• Younger children may also have sufficient understanding.

Sufficient understanding is indicated if they can:

• Understand the question.

• Understanding what might be shared, why and implications of sharing/not sharing.

• Appreciate and consider alternative actions.

• Weigh up aspects of the situation.

• Express clear, personal, consistent view.

Record the decision and try to balance the wishes of the child or young person and the parent/carer

Activity

To share or not to share?

What to share and how to share it

Distinguish between fact and opinionShare in secure way

Share only what is necessary for

purpose

Understand the limits of consent

Check information is accurate and

up-to-date

Share only with those who need to

know

Inform person to whom it relates,

and/or who provided information if safe to

do so

Record reasons for sharing; what

shared; with who

Establish whether recipient will pass to others – ensure they understand limits of

consent given

Support for practitioners

Practitioners need:• A culture that supports sharing.• Secure processes for sharing.• Processes for explaining information sharing.• Effective training, supervision and support.• Mechanisms for monitoring, advice and conflict resolution.

Organisations should:• Fulfil duties under sections 10 and 11 of the Children Act 2004.• Establish an information sharing governance framework.

Main web links

The following national websites hold further information and overviews, as well as links through to guidance and training materials, for all of the processes and tools of integrated working:

• CWDC – www.cwdcouncil.org.uk/integrated-working or www.cwdcouncil.org.uk/sharestreet

•[email protected]

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Documents

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