component 5: the purpose of the integrated assessment and...

The purpose of the Integrated Assessment and Child’s Plan

The purpose of the Integrated Assessment and Child’s Plan is to:

• establish a common language that is

accessible to children, young people,

families and all practitioners

• support consistency in the practice of

involving children, young people and

families in decisions that affect their lives

• identify and manage risk

• help children and young people, families

and agencies understand the strengths

and pressures in their lives and what

might help

• establish a co-ordinated, structured,

streamlined and simplified process

of information gathering, analysis

and decision making which increases

efficiency and reduces duplication

across agencies

• ensure that all relevant information

relating to a child’s unique situation is

considered and supports robust decision

making and planning

• establish a common framework to agree

the desired outcomes and the actions

necessary to achieve them

• empower all participants to contribute

fully to the process of assessment,

planning and review

• break down unnecessary professional

barriers that are not in the interests of

children and young people

• facilitate the practice of sharing

information where it is in the best

interest of children, young people and

families

• improve the confidence of professionals

to fully engage with a process with which

they are familiar and use regularly.

Component 5:

The Integrated Assessment and Child’s Plan

Section 7. Core Component 5. The Integrated Assessment and Child’s Plan 183

Within the integrated pathway for children and young people, the Integrated Assessment and Child’s Plan features in the two responses of:

Integrated working

Compulsory intervention

Practice Guide

184 Section 7. Core Component 5. The Integrated Assessment and Child’s Plan

Integrated working When the development of the child’s well-being depends on practitioners regularly sharing skills, information and expertise, the Integrated Assessment and Child’s Plan format will always be used. The objective is to gather all relevant information into one format allowing all participants, including children, young people and parents to fully understand what is going on and to contribute to decisions, plans and regular reviews of progress. There is an expectation that those working with the child will come together as the child’s Network of Support. The Network of Support will agree the desired outcomes and what actions are necessary to achieve them. The child/family should be part of the process from the beginning, understanding who will be involved and why. Informed Consent and Requests for Assistance will be used to ask other agencies to participate and all Single Agency Assessment materials, including Single Agency Chronologies, will be shared as appropriate. Agencies being asked to participate will use any Single Agency Assessment materials as the basis to complete the Integrated Assessment paperwork and add more detail as necessary. The child’s Network of Support will consider and discuss all perspectives and available information, including the child and family and the final content for the Integrated Assessment and Child’s Plan will be agreed. The Integrated Assessment and Child’s Plan will be reviewed at agreed intervals and an Integrated Chronology will also help to track positive and negative significant events.

Compulsory interventionWhere compulsory intervention is necessary, for example where children are looked after at home or away from home, where a child may be in need of protection or where compulsory measures may be necessary, the Integrated Assessment and Child’s Plan will be used to record the assessment and planning for the child. The Lead Professional, in these cases always from children and families social work, will Request Assistance from any agency working with the child and bring any assessment information together into the Integrated Assessment and Child’s Plan. Where no information exists, the Lead Professional may ask those working with the child to begin to gather and analyse information using the Integrated Assessment and Child’s Plan. There may be legal and or procedural time constraints to complete the initial exercise of information gathering and analysing. It may not always be possible to bring the child’s Network of Support together physically to analyse all available information before some decisions have to be taken. Where time permits, it is good practice for all contributors to have the opportunity to comment on the content before the finalised Integrated Assessment and Child’s Plan. As soon as possible, the Lead Professional will bring the child’s Network of Support together to discuss and plan the way forward, continuing to use the Integrated Assessment and Child’s Plan format. In child protection cases the core group will become the Network of Support to the child following the initial child protection conference. Where compulsory measures are being recommended to the Children’s Panel, the documentation used will be an Integrated Assessment and Child’s Plan.

When should an Integrated Assessment and Child’s Plan be used?

There are two points in the child’s pathway where the Integrated Assessment and Child’s Plan can be used:

A practitioner who is concerned that any child may be at risk of abuse should immediately make contact with children and families social work and/or the police, by telephone. Following the telephone call, the Notification of Concern form (7.b) should be completed and sent as soon as possible to children and families social work and/or the police, as a written record of concern.

CHILD PROTECTION


The Integrated Assessment is firmly based on the national practice model which considers the well-being of a child, assesses and analyses information using the My World Assessment Triangle, then plans to improve outcomes for the child, against the well-being indicators. The Integrated Assessment builds from Single Agency Assessments and has been designed to mirror the information fields used by the universal services. This will enable information to be collated by the Lead Professional, then added to (until all core components can be completed fully electronically). The model focuses on both strengths and difficulties within a child’s life. The Resilience Matrix may be used to support analysis.

Like all Getting it right for every child paperwork, the Integrated Assessment and Child’s Plan should be used appropriately and proportionately to the child’s situation. Each practitioner will contribute the information they are aware of and together the Network of Support will build a detailed profile of the child’s situation to better understand what might help.

When using the My World Assessment Triangle it may be necessary to repeat some issues to fully understand the impact of a child’s circumstances on their well-being.

A child who is living with substance misuse may be affected in several ways by their parents’ behaviour.

How I grow and develop – being healthy • it may be recorded that the child’s physical health is

being affected by the fact that the family income is prioritised to purchase alcohol rather than food

• alternatively, it may be that the child is fed by a grandparent every night and their physical health is not affected by lack of nutrition

What I need from the people who look after me – everyday care and help • it may be recorded that the child is struggling to

attend school because their everyday care and help is being neglected whilst the parents are intoxicated or hungover

• alternatively, it may be that the child is thirteen years old and more able to take care of themselves and get themselves to school independently

My wider world – enjoying family and friends• it may be recorded that the child is frightened and

alarmed by groups of unknown adults regularly consuming alcohol in their home

• alternatively, it may be recorded that the child sleeps over with the grandparent whilst the parents are drinking with their friends

The same adversity is repeated several times across the three dimensions of the triangle assessment so that the impact on the child can be fully understood. This repetition is necessary to highlight the priority issues that need to be addressed.

Using the Integrated Assessment and Child’s Plan

Who is responsible for completing

an Integrated Assessment and

Child’s Plan?

The Integrated Assessment and Child’s Plan will be completed by the child’s Network of Support co-ordinated by the Lead Professional or the Named Person acting in the role of Lead Professional until discussed and agreed by the Network of Support (please see guidance for Core Components 1 and 2). It is a way of different professional disciplines bringing together their particular or specialist knowledge to contribute to a clearer, holistic picture of the child, their family and their community. The process of completing the Integrated Assessment and Child’s Plan will consist of the same steps required in any assessment process:

• gathering information• structuring information• analysing information• taking decisions and recommending actions.

Analysing strengths/risks and

needs

Practitioners should consider what the evidence they have gathered means for the individual child. Analysis should:• clarify the balance between the strengths and

pressures in the child’s situation• evaluate the impact of the child’s situation on their

well-being • articulate immediate or emerging risks to the child

and the protective factors may ameliorate/reduce risks

• highlight any differences in understanding of the child’s needs

• explain levels of interest and/or motivation to change

The child, their family and practitioners contributing to the Integrated Assessment will be partners in the process and each should be supported to participate and kept fully informed throughout.

Practice Guide


The Resilience Matrix

In Lanarkshire, the Resilience Matrix is provided as an optional tool to support the process of analysis, particularly in complex cases with significant volumes of information. Where potential risks may be present, for example where children and families social work have been asked to assess a child’s safety under child protection procedures, the Resilience Matrix may be used. Where risk is not a predominant factor in an

Integrated Assessment and Child’s Plan, the child’s Network of Support may still decide to use the tool to make sense of the information gathered. However, where it is felt that using the Resilience Matrix is disproportionate to the child’s situation, practitioners may choose not to use the tool. Jane Aldgate’s guidance on the Resilience Matrix is included as section 6 of the Practice Guide.

Outcome planning

The Child’s Plan in section 9 of the Integrated Assessment and Child’s Plan is an essential element of the documentation. Guidance on the Child’s Plan was issued by the Scottish Executive in 2007 and the sections in this document are included to ensure compliance.

The Child’s Plan is based on outcome planning and has been designed to help all staff working with children and families to think about the needs of a child or young person using the same framework of understanding.

When planning and thinking about a child or young person’s needs, every practitioner should think about the whole child or young person.

Articulating outcomes

The definition adopted by the Social Policy Research Unit at York University in their work on outcomes and practice (2003) is used for the purpose of this guidance: “an outcome means … the impact, effect or consequence of help received”

Outcomes must be:

• specific to each of the well-being indicators – it is not necessary to identify one or more outcomes under each of the well-being indicators. It is a question of identifying what needs to change using the well-being indicators as the structure. For example, if the child is struggling with their learning, under the achieving indicator an outcome might be - for the child to achieve the majority of their personal learning goals over the next six months.

• specific to the difficulties identified by the child’s Network of Support – if a difficulty is identified as lack of physical and emotional safety within the home, then there should be a related outcome such as: improved physical and emotional safety within the home. The outcomes should match, not introduce new issues.

• specific to the individual child – a child’s outcome is specific to them rather than the adults who care for them. It may be that improving a child’s well-being will depend on changes to the parents’ circumstances, condition or behaviour but it is essential to record the change desired for the child. For example, the desired outcome may be under nurture – improved attachment to the baby’s primary carer whilst the action may be to improve the mother’s mental health.

• specify whether they are short, medium or long term outcomes (where approppriate and helpful to families) – it may be that improved outcomes must be developed in stages, for example making sure the child is free from the immediate risk of sexual abuse in the short term, whilst the long term goal may be to increase the capacity of the parents to protect their child from abuse and the longer term outcome may be for the child to be safe from sexual abuse in their home environment.


Who should be involved in

outcome planning?

The child’s Network of Support should be involved in the process of outcome planning as part of the assessment process and may include:

• children should be involved in planning according to their age, stage and understanding. Some children may need help to explain their thoughts and views. Sometimes this may be done by a person whose job it is to make sure the child or young person’s views are taken into account.

• parents, where a parent has any contact with their child, they should be involved in the plan. However, this is always subject to safety considerations (for example, where the child may be exposed to

domestic abuse). In some cases, involving absent parents in the child or young person’s life and plan may be key to his or her current or future well-being.

• carers who have day-to-day care of the child or young person (for example, kinship carers, foster carers or residential carers).

• practitioners who can contribute to the child or young person’s well-being or risk management. They may work directly with the child or young person (for example, teachers) or with the adults who care for them (for example, GPs, addictions workers etc.).

• other important people, such as extended family and friends, depending on the nature of the plan and the child or young person’s circumstances.

Review

• The Child’s Plan should be reviewed at a time agreed at the start and within any time limits set down in law or procedure.

• No child or young person should have to experience unnecessary reviews.

• Reviews should be held as required, taking account of all information, including risk and risk management, in each case. When things are unstable for a child or young person, or when a number of agencies are being very active in supporting his or her needs, the plan is likely to be reviewed or renewed frequently.

Reviews should detail:

• how well the child or young person is doing: a review of progress measured against agreed outcomes and milestones.

• new information or change of circumstances: to include changes in living circumstances, schools, new incidents or concerns.

• a summary of contacts with the child and family (where relevant and helpful): this should include contacts or appointments, both kept and missed, with the child or young person and their parents.

• has everyone done what they set out to do? accounting for any changes to the agreed actions.

• have these actions had the desired effect? recording the actions that have had an impact on progress or outcomes (positive and negative) and those that appear to have had no impact.

• is there a need for further action? identifying the current level of needs and risks and what else, if anything, needs to be done and who should do it.

• the child or young person’s views (and those of their parents or carers) about any part or all of the plan and review.

When the Child’s Plan is reviewed, new and different outcomes may need to be set. It may be that concerns have been resolved and no further action is needed. On the other hand, it may be necessary to revise the assessment of the circumstances of the child or young person and their family, setting new timescales and a date for the next review. Where concerns have been resolved but action is needed to sustain progress, action should continue. Where there is a supervision requirement agreed at a Children’s Hearing, the plan should include any actions required in relation to the terms of the supervision requirement.

Safe

· The child is free from physical/emotional/sexual abuse · The child is physically and emotionally safe in their home environment · Improved capacity to make safe choices in relation to alcohol and drugs · Increased capacity to protect her personal space from unwanted sexual attention · Increased protective factors to ensure the child’s safety

Healt

hy · The child is receiving appropriate treatment for their medical condition

· The child reaches appropriate growth and development milestones · Evidence of improved emotional well-being · Evidence of increased self-confidence

Achie

ving

· The child is positively engaged with their learning · The impact of the child’s learning difficulty is minimised and learning is progressing in line with their potential · The child has achieved their personal learning goals

Nurt

ure

d · Evidence of positive attachment · The child receives regular positive attention and encouragement · Evidence of increased resilience · The child is soothed and comforted appropriately by their parents · The child is able to express their emotions appropriately

Act

ive · The child pursues a hobby once a week

· The child is engaged in physical exercise on a daily basis · The young person is engaged in positive alternatives to previous antisocial behaviour

Resp

ect

ed

· The child is able to express their need for support before they reach crisis · The child is expressing their opinion regularly within a group of peers · The child’s view is welcomed, and responded to within their home environment

Resp

onsi

ble

· The child has regular daily routines that provide structure in their life · The child is clear about what behaviour is expected of them and able to respond appropriately · Improved understanding of the relationship between actions and consequences

Incl

uded · Evidence of new friendships with young people her own age

· Regular contact with his paternal grandparents · The child is invited to join in with peers on a regular basis · The family is engaged in activities within the community

Practice Guide


Example of outcome against the well-being indicators

The following list provides examples of outcomes using well-being as the structure, it is not an exhaustive list

PP PP


The role of the practitioners in implementing

the Integrated Assessment and Child’s Plan

• ensure that children, young people and families are supported to understand and participate in an Integrated Assessment and Child’s Plan process

• seek permission to share personal information as part of any Integrated Assessment process (other than child protection)

• check anything being asked of them if unsure, i.e. dates for submissions and meetings

• provide any information known about the child using the sections provided in the Integrated Assessment and in line with the guidance

• prioritise the child’s Network of Support meetings or make alternative arrangements if necessary

• engage fully in the process of analysis and decision making, ensuring that disagreements are expressed and recorded where necessary

• commit to achieving the desired outcomes and agreed actions

• ensure that children and families understand any limitations about what can be achieved

• ensure that any resource implications are explored and resolved

• where risks exist, to make sure there are contingencies in place and realistic timescales for review

• ensure that everyone understands what will happen if the desired outcomes are not achieved

• report to the Lead Professional as agreed and support one another in implementing the plan

• seek support through professional line management structures if necessary

• ensure that any statutory or procedural obligations are adhered to

• participate fully in evaluating the effectiveness of the Child’s Plan

• participate in discussions reflecting on experience of using the Integrated Assessment and Child’s Plan.

The role of the practitioners in implementing the Integrated Assessment and Child’s Plan is to:

Practice Guide



Index

INTEGRATED ASSESSMENT AND CHILD’S PLAN

Partner agencies involved or consulted in the Integrated Assessment

Int. 1 Information about the child/young person and reason for an Integrated Assessment and Child’s Plan

Int. 2 What I need from the people who look after me

Int. 3 How I grow and develop

Int. 4 My wider world

Int. 5 Summary analysis of child’s world

Int. 6 Areas of disagreement

Int. 7 Specialist assessment tools used

Int. 8 Decisions and agreements that have taken place in relation to the Lead Professional

Int. 9 Child’s Plan

Int. 10 The child or young person’s Network of Support

Int. 11 Signatories to the Integrated Assessment and Child’s Plan

Int. 12 Review dates of Child’s Plan

Int. 13 Contingency plans

Exemplar: Rory

Exemplar: Lily

192

193

194

198

201

204

205

205

205

206

207

208

208

208

210

222

Int. GUIDAnCE IntEGrAtED AssEssmEnt AnD ChIlD’s PlAn GUIDAnCE

Unique reference numbers: SWIS/MySWIS:

Number available if known by social work

CHI:Health unique identifier

SEEMIS:

Education unique identifier

Forename:

Name registered with your service

Surname (of mother if unborn child):

Name registered with your service

Other surnames previously used:

This helps to trace the identity of children and for the electronic matching process if sharing across agencies

Known as (if different):

May have taken the name of a partner in the household unofficially

Male: (X) Female: (X) Unknown

Home address including postcode: Telephone contacts

Landline 1: All available phone numbers should be recorded

Current address including postcode (if different from above):

Where the child is currently residing

Mobile 1:

Mobile 2:

Date of birth/expected date of delivery:Should align with the CHI

Stage of education: (e.g. P1 or S2)i.e. none/nursery/primary/secondary/college/work experience

School/nursery (if appropriate):Name and locality of the establishment the child is registered on the roll

Current legislation:Any legislation relating to the child or significant others which is current

Family composition in household: Additional household members

Forename and surname: D.O.B./Age: Relationship to child: Occupation:

Full details of all residents within the household are essential to support the child’s well-being

Communication needs: (eg first language/ prefered language/ interpreter required)


Agency Name Contact details

Education

Ch. & Families Social Work

Adults Social Work Services

Maternity Health Care

Primary Health Care

Other Health Care

Housing

The Reporter

Children’s Hearing Panel

The Police

Voluntary Organisation

Other

The name of the professionals from any agency which contributed information to the Integrated Assessment and Child’s Plan, including voluntary sector providers, should be included here. Readers must be able to tell at a glance where the information has come from

Readers may need to check an aspect of the information included in the Integrated Assessment and Child’s Plan therefore full contact details should be included to promote effective communication and co-ordination

Practice Guide


Assessment requested/suggested by:The name of the professional, member of the family or Network of Support, who has requested or suggested that an Integrated Assessment and Child’s Plan may benefit the child

Date requested/suggested: Record exact date requested

Date completed:Assessment is ongoing, especially for children who may need this level of detailed consideration. This date should record the completion of this phase of the assessment process

Consent to complete and share information from Integrated Assessment

Consent from Yes (X)

No (X)

With (agencies should be listed here)

Child/YP

Parent

Professional co-ordinating assessment/current Lead Professional

This section should record the professional who is responsible for gathering information from a number of agencies and for bringing agencies together to analyse the findings and agree the Child’s Plan

Purpose of the Integrated Assessment and Child’s Plan (What is the assessment trying to find out?)

This section should clarify the precise reasons for undertaking an Integrated Assessment and Child’s Plan recording the original concern which led to the decision to use this format. Examples are provided below.

· To establish whether the parents’ capacity to provide well-being is sufficient to ensure the child’s continuing development

· To identify the impact of the child’s significant learning difficulty on his/her life and the most appropriate support to ensure continued development of well-being

· To establish the impact of long term exposure to domestic violence and the most appropriate course of action to promote the child’s physical and emotional recovery

· To establish whether there are any grounds for compulsory measures

· To establish whether the child is appropriately protected from physical harm

· To establish what actions need to be taken to ensure a successful transition to adult services

· Example: This assessment will consider whether additional support is required to ensure this young person receives appropriate guidance and care from those responsible for her, namely her parents and family. Similarly, it will assess whether this young person is safe in her current living arrangement or whether further support is required to ensure that she has a safe and caring home environment.

Basis of assessment (what information is the assessment based on and how was it gained, i.e. face-to-face, number of home visits, written contributions from other professionals, etc?)

This section should provide a summary of the approach to the assessment. Practitioners should record the length of time it has been agreed with the family that the assessment will take and their understanding as to why an assessment is necessary. It is important to understand the depth of information known about the child so that the right decisions can be taken. The extent of face-to-face contact there has been with the child, meetings with parents/carers, contributions from professionals, perspectives of other supportive adults such as voluntary organisations, significant others with relationships with the child or family. It is essential to understand the level of input the child has had themselves to their Integrated Assessment and Plan and how the information was gained.

Unique profile of the child (a brief description of the individual child)

When completing the child’s unique profile there should be a focus on:

· Knowing the child: personality, favourite things, dislikes, hobbies/interests, best friend, pets, what makes him/her frightened, happy, enthusiastic, excited, etc. What expectations, aspirations and ambitions does the child have for the future?

· A day in the life of the child: describe a typical day, e.g. who gets him/her up in the morning, provides breakfast, organises clothes, gets them to school. What does he/she normally do after school, weekends or during holidays?

· Include additional considerations for some children such as the detail of restrictions in their life due to disability, caring responsibilities etc.

Child’s family background and history

This section should include the historical living and care arrangements for the child, historical relationships with family members, sense of family culture and identity relevant to this particular assessment. Professional intervention in care arrangements should also be covered in detail.

Situation for the child at the moment

The current issues of pressure, priority or risk for the child at the point of assessment and the impact on their well-being. How is the child’s well-being at the moment – are they safe, healthy, achieving, nurtured, active, respected, responsible and included? The child/parent/carer expectations of what is going to happen next should also be covered.


Int.1 GUIDAnCE Information about the child and reason for an Integrated Assessment and Child’s Plan

Practice Guide


Strengths/protective factors Pressures/adversities

This section should record the information gathered under the seven fields of What I Need from the people who look after me, focusing on parental capacity to provide well-being and should include any evidence of positive or negative indicators. Where Single Agency Assessments either Part I or Part II are in place the information can be used as the basis for the Integrated Assessment and Child’s Plan using the colour coding provided. Practitioners should be rigorous in considering each of the fields above. Guidance on the My World Triangle is also provided. It is important to remember that children/parents/carers will view the information gathered therefore careful attention should be paid to the language used.

Analysis of strengths/needs/risks

In completing this section, practitioners should think about the questions below:

· what does all of the information above mean for this child?

· what pressures and difficulties are there for the people who look after the child or created by them? Are the people who look after them able to meet some of the child’s needs or is every aspect of what they need affected?

· are there immediate risks to the child from the people who look after them or will risks begin to emerge if the child continues in their current situation?

· from the evidence recorded above, what is the balance between the strengths, and the pressures and adversities? Does the child have enough personal resilience and external support to meet some of their needs or does the child need intervention to make sure they have what they need?

· are there very different views about what is causing difficulties in the child’s life and what would make it better or does everyone have the same understanding?

· does the child have any control or are they entirely dependent on others?

· what is the level of understanding of what the child needs from the people who look after them and what is the interest in or motivation to change?

· how strong is your view of what the difficulties are and what might help?

Int. 2 GUIDAnCE What I need from the people who look after me

Provide information only where evidence is available. Consider each of the headings under this dimension of the triangle providing any evidence – positive or negative – that might contribute to the strengths or pressures for this child. These are:

•everydaycareandhelp

•keepingmesafe

•guidancesupportingmetomaketherightchoices

•knowingwhatisgoingtohappenandwhen

•understandingmyfamily’shistory,backgroundandbeliefs

•beingthereforme

•play,encouragementandfun


Safe

Keeping me safe: keeping the child safe within the home and exercising appropriate protection outside. Practical care through home safety such as fireguards, car seat safety, cooking safety, protection from adults who present risks, etc. Protecting from physical and emotional dangers such as noise, pollution etc. Is the caregiver able to protect the child consistently and effectively? Seeking help with and solutions to domestic problems such as mental health needs, substance misuse, violence, offending behaviour. Are there any identifiable risk factors? What is the understanding of parents’ responsibilities to prevent risks to the child?

Evidence of: · carers understanding the child’s need for

protection from risk and harm and taking appropriate action

· consistent and appropriate structures and boundaries and supervision to keep the child safe

· the child having a relationship with a reliable adult to communicate needs

· appropriate contingency plans in place by the carers to provide protection such as extended family or neighbour support

· physical safety measures such as safe sleeping, bathing, car safety, stair gates, socket and cable protectors, garden fences and gates, storage of toxic substance etc.

· protection from emotional harm such as appropriate communication, encouragement, support etc.

Evidence of: · the child being exposed to danger or harm

including violence · impaired capacity to protect due to physical or

mental health issues, substance misuse, domestic abuse or cognitive difficulties

· evidence of risk taking by the carers such as crime · evidence of inappropriate relationships or contacts

which present risks · evidence of intolerance to the child’s need for

attention · inappropriate control and discipline · other children accommodated · any sign of physical or emotional abuse or

physical neglect · exposure to aggression or violent behaviour

Everyday care and help: this is about the ability to provide day-to-day physical and emotional care, food, clothing and housing, access to school etc. Being able to recognise, respond to and meet the child’s changing needs over time. Support in meeting parenting tasks and help with carers own needs.

Evidence of: · basic care needs are met – food, drink, clothing,

warmth, shelter and hygiene · attention to health and development support

needs · attention to stimulation and learning which are

understood and addressed · growth and development appropriate to age and

stage

Evidence of: · health issues, including mental health issues,

which affect the child or could affect the unborn infant

· evidence of any other factors which affect carers’ capacity to provide everyday care and help such as disability, including learning disability, substance misuse, domestic abuse, cognitive difficulties

· children taking on inappropriate caring responsibilities for the child

· regular changes in carers · other children accommodated · inappropriate exposure to parental or sibling

emotional distress or family difficulties

Int.2 GUIDANCE on thE my WorlD AssEssmEnt trIAnGlEWhat I need from the people who look after me

1/3

Strengths/protective factors Well-being Developmental needs/adversities

Nurt

ure

d

Being there for me: love, emotional warmth, attentiveness and engagement. Who can be relied on to recognise and respond to the child’s needs? What is the level of stability and quality of relationships in the household including siblings? Are there issues of attachment? Who is of particular significance? Is there sufficient emotional security and responsiveness in the child’s current caring environment? Do issues between parents impact on their ability to parent? Are there issues within a family history that impinge on the family’s ability to be emotionally present?

Evidence of: · positive attachment and interaction between carers

and child

· physical, psychological support, encouragement and emotional warmth including affection

· positive family relationships including extended family

· the child’s expectation that their needs will be met

· evidence of emotional stability, security and confidence

Evidence of: · attachment disorder

· frequent change and instability

· the child’s needs being secondary to needs of carers

· anxiety and hyper-vigilance in the child concerning reactions to or interactions with carers

· Dismissing or ignoring the child/young person’s need for positive attention

Act

ive

Play, encouragement & fun: engaging positively in preparation for parenthood. Receptiveness to parenthood education and learning. Early attachment and bonding through voice and touch. Interaction with the child?

Evidence of: · access to a stimulating and educationally rich

environment including appropriate toys/games/equipment

· carers providing stimulation or engaging in play activities with the child

· carers’ encouragement for the child to explore his or her environment

· proactive efforts to support the child’s learning through play, music, leisure and fun

Evidence of: · lack of resources to provide stimulation and play

opportunities for the child

· carers’ needs being met to the exclusion of the child’s need for stimulation and play

· health/disability issues which prevent access to play activities

· carers’ inability to understand the need to provide stimulation, play, encouragement and fun

Resp

onsi

ble

Guidance, supporting me to make the right choices: values, guidance and boundaries. Are household roles and rules of behaviours appropriate to the age and understanding of the child? Are responses to behaviour appropriate? Is the child treated with consideration and respect, given personal space to sleep, eat, wash, dress at appropriate times within a safe and protective environment? Are there any specific aspects which may need intervention?

Evidence of: · consistency in routines and boundaries

· appropriate socialisation for a child

· positive modelling behaviour

· encouragement to understand choice and to exercise choice incrementally in line with age and stage of development

Evidence of: · inappropriate choices for age and stage of

development

· inappropriate sanctions or reactions to child

· violence, aggression, abusive language

· chaotic activity which disrupts development of regular routines and boundaries


2/3


Practice Guide


Resp

onsi

ble

Knowing what is going to happen & when: is the child’s life stable and predictable? Are routines and expectations appropriate and helpful to age and stage of development? Are the child’s needs given priority within an environment that expects mutual consideration? Who are the family members and others important to the child? Is there stability and consistency within the household? Can the people who look after the child be relied on? Is change controlled and appropriate for the child to cope with?

Evidence of: · stability and predictability in care giving · the child connecting with the setting they are in · positive connections with the community · the child’s ability to adapt to change and

difference · regular contact with absent parents/carers/

relatives if this is in the child’s best interests · dialogue with the child to sooth, calm and

reassure

Evidence of : · frequent changes of carers, living accommodation · behaviours which indicate insecurity or lack of

stability · inappropriate adults or activities within the home

environment · antisocial behaviour · current department monitoring or investigation

activities · chaos or unplanned change

Incl

uded

Understanding my family’s history, background and beliefs: family and cultural history, issues of spirituality and faith. Do the child’s significant carers foster an understanding of their own and their child’s background – their family and extended family relationships and their origins? Is their racial, ethnic and cultural heritage given due prominence? Do those around the child respect and value diversity?

Evidence of: · strong sense of individual and family identity · understanding of relationships within the family,

extended family and community

Evidence of: · discrimination against any member of the family · negative perceptions or expressed views about

any member of the family · difficulties in understanding family relationships

and background


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Practice Guide


Strengths/protective factors Developmental needs/adversities

This section should record the information gathered under the seven fields of How I grow and develop and should include any evidence of positive and negative indicators focusing on the child’s own development which is individual to them. Where Single Agency Assessments either Part I or Part II are in place the information can be used as the basis for the Integrated Assessment and Child’s Plan using the colour coding provided. Practitioners should be rigorous in considering each of the fields above. Guidance on the My World Triangle is also provided. It is important to remember that children/parents/carers will view the information gathered therefore careful attention should be paid to the language used.


This is the most important section to guide the child’s Network of Support in their decisions about the most appropriate and proportionate help for the child. In completing this section, practitioners should think about the questions below:

· what does all of the information above mean for this child?

· how are the pressures and difficulties impacting on the child’s well-being? Are they negatively impacting on every aspect of the child’s growth and development or is there evidence of some positive growth and development?

· are there immediate risks to growth and development, or will risks begin to emerge if the child continues in their current situation?

· from the evidence recorded above, what is the balance between the strengths, and the pressures and adversities? Does the child have enough personal resilience and external support to withstand the pressures of their current situation and continue to grow and develop or will their growth and development not progress without intervention?

· what is the level of understanding of this child’s growth and development across their Network of Support? Are there very different views about what is causing difficulties in the child’s life and what would make it better, or does everyone have the same understanding?

· does the child have any control over their own growth and development or are they entirely dependent on others?

· how strong is your view of what the difficulties are and what might help?

Int.3 GUIDAnCE How I grow and develop


•beinghealthy

•learningandachieving

•beingabletocommunicate

•confidenceinwhoIam

•learningtoberesponsible

•becomingindependent,lookingaftermyself

•enjoyingfamilyandfriends


Healt

hy

Being healthy: this includes full information about all aspects of a child’s health and development relevant to their age and stage. Developmental milestones, ill health, hospital admissions, any impairments, disabilities or conditions affecting development and health. It includes physical, emotional and social health and development.

Evidence of: · the child’s growth and development in line with

their age and stage · the family is knowledgeable and confident about

medical issues · the family readily and appropriately seeks advice

and help with health issues · carers accepting, understanding of and coping

with any impairments or disabilities affecting the child

Evidence of: · developmental concerns about the child (birth

asphyxia, congenital abnormalities) · the child’s medical needs reducing the parents

ability to care for them · regular visits to A&E or use of NHS 24 · regular admissions to hospital · diagnosed non-accidental injuries · sensory impairments or other disabilities which

negatively impact on the child’s life

Being able to communicate: this includes development of language and communication. Being in touch and communicating constructively with others. Parent recognising and responding to attempts to communicate from the child. Parents’ understanding of the child’s modes of communication, e.g. crying, gesturing, specialist communication etc.

Evidence of: · positive responses to child’s cues for attention

regardless of age and stage

· understanding of and use of verbal and non-verbal communication appropriate to age and stage such as soothing, affection, change of tone, eye contact, firmness, etc.

· awareness of language and communication appropriate in different situations

Evidence of: · difficulties in responding appropriately to verbal

and non-verbal communication from the carer

· lack of communication

· inappropriate communication such as shouting, shaking etc.

· physical difficulties which may impact on ability to communicate

· unusual communication such as child never crying or seeking attention

Ach

ievi

ng

Learning and achieving: this includes parental interest in the development of the child’s physical, social, emotional and cognitive development. Showing an interest in the child through stimulation, talking, supporting to learn and challenge themselves. Impact on child’s learning or any learning difficulty of carers.

Evidence of: · parental interest in the development of the child

· appropriate stimulation and recognition of need to progress and learn

· understanding and support to overcome any difficulties with learning

· encouragement to engage in all forms of learning

Evidence of: · carers’ lack of engagement or co-operation with

learning

· parental impaired learning due to social or emotional difficulties which may reduce the capacity of carers to progress learning such as a learning difficulty or mental health problem

· barriers to accessing appropriate supports to overcome difficulties such as birth asphyxia or congenital abnormalities, learning difficulties, etc

Int.3 GUIDANCE on thE my WorlD AssEssmEnt trIAnGlEHow I grow and develop

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Resp

ect

ed

Confidence in who I am: child’s temperament and characteristics. Nature and quality of early and current attachments. Emotional and behavioural development. Resilience, self-esteem.

Evidence of: · parental bonding · recognition of and respect for individual

characteristics in child and emerging personality and strengths

· healthy attachment · strong sense of self in child

Evidence of: · over generalising about child and failure to

recognise individuality · leaving the child unattended or lacking in attention

for unacceptable periods of time · use of inappropriate language · undermining, overly critical, dismissive parenting

style

Resp

onsi

ble

Learning to be responsible: learning appropriate social skills and behaviour. Consider parental responsibility that will enable the child to develop, learn routines and what is expected of them. Values, sense of right and wrong. Consideration for others.

Evidence of: · parental understanding of rights and

responsibilities and appropriate pursuit of same · understanding of introducing routines, boundaries

and structures at the appropriate time for the child · role model of carers demonstrating socially

acceptable lifestyle · parental understanding and introduction to morals,

ethics, rules and expectations

Evidence of: · inappropriate social behaviour such as domestic

violence, substance misuse or antisocial behaviour etc.

· not recognising or inappropriate responses to the needs of the child

· lack of routines, boundaries and expectations to guide and support child

Becoming independent, looking after myself: the gradual acquisition of skills and confidence needed to move from dependence to independence. Do the parents rely on others to meet the child’s needs? Are the parents overprotective?

Evidence of: · parental understanding of managing independently · ability to adequately care for the child independent

of other family support · self-reliance of carers and need to prove

independence · good role modelling in self-care and independence · carers’ understanding of stages of development

and realistic expectations of children · carers’ engagement with health, social services as

required · active encouregement to develop independence

Evidence of: · poor parenting skills, role modelling · chaotic lifestyle · non-engagement with services · overprotective parenting · parents rely too much on family or professionals to

support parenting activity · behaviour which inhibits the development of

independence

Incl

uded

Enjoying family and friends: opportunities for parents to make and maintain relationships. Do extended family and social networks exist and are they encouraged? Are there physical inhibitors to connecting with the community such as rurality, lack of transport, telephone connections etc. This links and overlaps with what a child needs from the people who look after him or her in the wider world

Evidence of: · positive and constructive relationships with family

and friends · engagement with network of family friends and

social contacts · support from adults at a similar stage in parenting · external interest in the child’s progress · parents’ understanding of good relationships and

stability · participation in social activities which develop new

relationships

Evidence of: · social isolation · family conflict · discrimination or exclusion from family or

community · lack of wider family and friends · carers’ poor or inappropriate relationships with

family, friends or acquaintances

Int.3 GUIDANCE on thE my WorlD AssEssmEnt trIAnGlEHow I grow and develop

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Practice Guide



This section should record the information gathered under the seven fields of the child’s Wider world, focusing on the home and external environment the child is experiencing and should include any evidence of positive indicators. Where Single Agency Assessments either Part I or Part II are in place the information can be used as the basis for the Integrated Assessment and Child’s Plan using the colour coding provided. Practitioners should be rigorous in considering each of the fields above. Some guidance on the My World Triangle is also provided. It is important to remember that children/parents/carers will view the information gathered therefore careful attention should be paid to the language used


This is the most important section to guide the child’s Network of Support in their decisions about the most appropriate and proportionate help for the child. In completing this section, practitioners should think about the questions below:

• what does all of the information above mean for this child?• what pressures and difficulties are there in the child’s wider world? Are there some areas which are positively helpful or is

every aspect of the child’s wider world creating pressure? • what is the level of understanding of what the child needs from their wider world from within their immediate family and what

is the interest in or motivation to improve the current situation? • are there immediate risks to the child in relation to their wider world or will risks begin to emerge if the child continues in their

current situation?• from the evidence recorded above, what is the balance between the strengths, and the pressures and adversities, does the

child have enough personal resilience and external support to meet some of their needs or does the child need intervention to improve their wider world?

• are there very different views about what is causing difficulties in the child’s life and what would make it better or does everyone have the same understanding?

• does the child have any control over their wider world or are they entirely dependent on others?• how strong is your view of what the difficulties are and what might help?


Int.4 GUIDAnCE My wider world


•supportfromfamily,friendsandotherpeople

•school

•localresources

•enoughmoney

•comfortableandsafehousing

•workopportunitiesformyfamily

•belonging

Safe

Comfortable and safe housing: is the accommodation suitable for the needs of the child and family – including adaptations needed to meet additional needs, appropriate space etc? Is it in a safe, well-maintained and resourced child-friendly neighbourhood? Have there been frequent moves?

Evidence of: · accommodation providing adequate space,

safety and amenities · maintaining a tenancy or mortgage · well-maintained accommodation · accommodation which offers access to support

network and community resources

Evidence of: · homelessness · temporary accommodation · inadequate accommodation including

overcrowding · rurally isolated or separation from support

network · poorly maintained

Ach

ievi

ng

School: from pre-school and nursery onwards, the learning environment plays a key role. What are the experiences of educational and peer networks and relationships? What aspects of the learning environment and opportunities for learning are important to the child? Availability of appropriate learning opportunities, study support, out of school learning and special interests. Can the school provide what is needed to meet the particular educational and social needs of the child?

Evidence of : · positive engagement with learning setting · constructive relationships with learning providers · regular uptake of compulsory and voluntary

learning opportunities · appropriate support for any identified learning

difficulties

Evidence of : · conflict with learning setting · lack of engagement and failure to attend · frequent changes of learning settings · difficulties with learning that haven’t been

addressed · issues with access to learning environment

Resp

onsi

ble

Work opportunities for my family: are there local opportunities for training and rewarding work? Cultural and family expectations of work and employment. Support to remain at home with the child if desired.

· Evidence of: · carers in employment · adequate employment opportunities · access to childcare to allow parents to work if

required · family culture of work and expectations of working · support and encouragement to work from

extended family, friends or community · work experience, skills and abilities which would

allow employment

Evidence of: · unemployment · family history and culture of unemployment · long term plans to rely on benefits · lack of work experience, skills, abilities

appropriate to employers’ needs

Enough money: has the family adequate income to meet day-to-day needs and any special needs? Have problems of poverty and disadvantage affected opportunities? Is household income managed for the benefit of all? Are there problems of debt? Do benefit entitlements need to be explored? Is income adequate to ensure the child will have what he/she needs?

Evidence of: · adequate income to meet the needs of the family · planning and purchasing essential items to meet

the needs of the child · application for appropriate benefits and grants in

place · financial support from extended family if

necessary

Evidence of: · poor money management · spending beyond means/inappropriate spending · not enough resource to meet the essential items

required for the child · non-attendance at professional appointments due

to transport costs · evidence of malnourishment or missing out on

opportunities other children experience

Int.4 GUIDANCE on thE my WorlD AssEssmEnt trIAnGlEMy wider world

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Practice Guide


Incl

uded

Support from family and friends: networks of family and social supports. Relationships with grandparents, aunts and uncles, extended family and friends. What supports can they provide? Are there tensions involved in or negative aspects of the family’s social networks? Are there problems of lost contact or isolation? Are there reliable, long term networks of support which the child or family can reliably draw on? Who are the significant people in the child’s wider environment?

Evidence of: · a support network including extended family,

friends and social contacts · community resources which facilitate meeting and

maintaining relationships · external interest by family and friends in the

growth and development of the child

Evidence of: · social isolation including rurality which inhibits the

development of a social network · family conflict or breakdown which restricts

support · inappropriate relationships or social contacts

which negatively impact on well-being

Local resources: resources which the child and family can access for leisure, faith, sport, active lifestyle.Projectsofferingsupportandguidanceattimesofstressortransition.Accesstoandlocalinformation about health, child care, care in the community, specialist services.

Evidence of: · local amenities, facilities and resources which

support the child’s well-being such as mother and child groups, community centre facilities, youth clubs, etc.

Evidence of: · poor facilities, amenities and resources · lack of access to facilities due to prohibitive cost

or only private access · lack of infrastructure to access basic health and

social care facilities

Belonging: : being accepted in the community, feeling included and valued. What are the opportunities for taking part in activities which support social contact and inclusion, e.g. family and child, environmental improvements, parents’ and residents’ groups, faith groups, school events, etc? Are therelocalprejudicesandtensionsthatwillaffectthechild’sopportunitiestofitin?

Evidence of: · community involvement and a community network

which actively involves parents and child

Evidence of: · missing previous community · prejudice, discrimination or exclusion from

community · language difficulties or communication

Int.4 GUIDANCE on thE my WorlD AssEssmEnt trIAnGlEMy wider world

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Practice Guide


What are the views of those who have participated in the Integrated Assessment?

The child’s view of where he or she is and what needs to be sorted out: attach What I Think tool if completed

The only exception to asking the child for their view is when it would cause further trauma to do so and is not the right time. There are various tools available to support practitioners to encourage the child’s views, such as the What I Think tool, viewpoint and specialist tools such as communication boards for children with disabilities. There are also practitioners with specialist skills that could help such as children and family social workers, disability workers, speech and language therapists, translators or professional advocates. Practitioners can ask for help within their own agencies or request assistance if necessary.

It is important to capture the child’s views in their own words rather than paraphrasing for them. Their understanding of what is happening should be recorded, their personal priorities for what they want to get better and their view of their own strengths and capabilities should be recorded as well as anything they are finding difficulty in coping with.

Parents’/carers’ and significant others’ views of where the child is and what needs to be sorted out

This section should detail/specify whether the parents’ views in relation to the assessment have been gathered and what their views are. Every effort should be made to engage with the parents to establish their view of what is happening except where this might present a risk to the child. Lanarkshire’s parenting strategy emphasises the need to engage both parents wherever possible, using every opportunity in contact with parents to highlight the crucial role male parents have in their children’s lives. Some parents will need support to understand what is happening before articulating their view. This section should highlight any ongoing concerns that parents/carers may have and what they would view as the desired outcomes for themselves and their child. Parents’ views of their child’s strengths should also be included. This section should also capture any differing views between parents/carers. It is important to capture parents’ views in their own words rather than paraphrasing for them.

Views of agencies: please include views of the different agencies involved with the child

This section should capture the perspectives of the agencies involved with the child highlighting any significant differences of opinion. Quotes from practitioners are helpful. It is also helpful to record the different settings in which these views were formed, for example one practitioner may observe the child in the class/school setting whilst a voluntary organisation may observe the child on a one-to-one basis and a health professional may observe the child in health clinics or in their own home.

Conclusions and recommendations:

This section requires agencies to consider all information gathered and analysed and asks for the final conclusions and recommendations from all sections of the assessment.

Int.5 GUIDAnCE Summary analysis of child’s world

Consider all the information you know about the child’s whole world summarising the most important factors (using the Resilience Matrix to help if necessary). Use the following section to conclude where the child is now and what they need to develop well-being.

Resilience Matrix:

The matrix is appended as a tool which can either be used in a single or multi-agency environment. It supports practitioners to analyse the more complex information in terms of the child’s strengths and pressures, particularly where risks may be present, and plot them on a blank matrix to better understand the level of resilience or vulnerability the child is experiencing together with the adverse and protective factors that may influence the outcome. Further information on using the Resilience Matrix is contained in the Getting it right for every child in Lanarkshire practice guide


Disagreement by Reason for disagreement Action taken to resolve

Any disagreement between professionals must be recorded

Is the disagreement about the desired outcome, the action necessary to achieve the outcome, or is the disagreement about the analysis of what the strengths and pressures are for the individual child

For example, have agencies agreed to pursue one course of action for a given period and review.

Int.6 GUIDAnCE Areas of disagreement

Areas where partners hold different views about the child or parent/carer not reflected in the summary analysis and conclusions.

Any specialist assessments tools used within health, education, social work or adult services which have informed the analysis, conclusions and recommendations

Int.7 GUIDAnCE Specialist assessment tools used

Note any specialist assessment tools or guidance including ASSET, substance misuse, resilience assessment tools etc.

Int.8 GUIDAnCE Decisions and agreements that have taken place in relation to the Lead Professional

Where there is a compulsory role for children and families social work they will automatically assume the role of the Lead Professional for a period of time, otherwise a discussion about who will lead on the Child’s Plan will be necessary. This should generally be the professional with the most expertise to offer the Child’s Plan and who can lead and review. It is also helpful if this individual is able to work closely with the child and family but the Named Person can also help with this task.

Name Designation Contact Details

Wha

t is

the

des

ired

out

com

e fo

r th

is c

hild

?

(the

pos

itive

cha

nges

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bei

ng s

houl

d g

o he

re)

Wha

t w

e ar

e g

oin

g t

o d

o?

(thes

e ar

e th

e ac

tions

tha

t ar

e ne

eded

to

achi

eve

the

des

ired

ou

tcom

es)

Ho

w w

ill w

e kn

ow

?

(the

evid

ence

tha

t w

ill in

dic

ate

imp

rove

men

ts o

r d

eter

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tion

in

wel

l-b

eing

)

By

whe

n?

(the

late

st a

ccep

tab

le d

ate

to

achi

eve

pos

itive

cha

nge)

Who

is h

elp

ing

me?

(whi

ch p

rofe

ssio

nal w

ill b

e re

spon

sib

le)

Saf

e:

Out

com

es s

houl

d:

• sp

ecify

cle

arly

the

des

ired

ch

ange

to

the

child

’s w

ell-

bei

ng•

be

spec

ific

to e

ach

of t

he w

ell-

bei

ng in

dic

ator

s•

be

spec

ific

to t

he in

div

idua

l ch

ild

• sp

ecify

whe

ther

the

y ar

e sh

ort,

m

ediu

m o

r lo

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erm

• b

e sp

ecifi

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the

diffi

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iden

tified

thr

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the

ana

lysi

s

This

sec

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shou

ld in

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ome

in t

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revi

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Wha

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rate

w

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e ac

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are

ha

ving

a p

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gativ

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pac

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the

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ld’s

wel

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The

dat

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outc

ome

shou

ld b

e ac

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ed b

y A

ny m

emb

er o

f the

chi

ld’s

N

etw

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of S

upp

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who

is

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resp

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ty fo

r ac

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this

imp

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d

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ome

Hea

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:Th

e in

dic

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s of

wel

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sh

ould

be

used

as

the

stru

ctur

e to

rec

ord

out

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es b

ut it

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rec

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ome

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ome

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may

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w

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Ach

ievi

ng:

Nur

ture

d:

Act

ive:

Res

pec

ted

:

Res

po

nsib

le:

Incl

uded

:

Practice Guide


Int.9 GUIDAnCE Child’s plan

Name and address:Anyone who is contributing to improving outcomes for the child including family, extended family or professional

I live with this child

YES NO

My relationship to child:Family, friend or professional

Home Tel: any that exist should be included

Work Tel:

Mobile Tel:

Email:

The best way and time to communicate with me isThis information is essential to improve communication

The notice I need to be able to participate isSome professionals need more notice than others

Legal status



YES NO



Work Tel:

Mobile Tel:

Email:



Legal status



YES NO



Work Tel:

Mobile Tel:

Email:



Legal status



YES NO



Work Tel:

Mobile Tel:

Email:



Legal status


Int.10 GUIDAnCE The child’s Network of Support

What Network of Support does the child have within their home, their school and their community? This should include immediate family, extended family, neighbours, friends and professionals.

Name Signature Date

Review date How? Who will organise?

When progress and any changes to the plan will be considered

Whether progress will be reviewed through a meeting, telephone calls or by submitting progress reports to the Lead Professional

The Lead Professional will normally organise but may receive help from administration or ask another member of the group to help if this is not possible

Record any agreements on what will happen if the outcomes of the Child’s Plan are not achieved Agencies must record what they intend to do if the Child’s Plan is unsuccessful in achieving the desired improvements to well-being

Practice Guide


Int.11 GUIDAnCE Signatories to the Integrated Assessment and Child’s Plan

The signatures of the adults who have contributed to and agreed this Integrated Assessment and Child’s Plan as the fairest picture of the child’s strengths and pressures.

Int.12 GUIDAnCE Review dates of Child’s Plan

Int.13 GUIDAnCE Contingency plans

Resilience

Normal development under difficult conditions, e.g. secure attachment, outgoing temperament, sociability, problem solving skills

Adversity

Life events or circumstances posing a threat to healthy development, e.g. loss, abuse, neglect

Protective factors

Factors in the child’s environment acting as a buffer to the negative effects of adverse experience

Summary analysis using Resilience Matrix

Taking each axis of the Resilience Matrix into consideration, what is the summary analysis for this child

Vulnerability

Those characteristics of the child, their family circle and wider community which might threaten or challenge healthy development, e.g. disability, racism, lack of or poor attainment


This tool can be used within single agencies or with multi-agency groups of professionals to assist with the process of analysis. Practitioners can access guidance within the Getting it right for every child in Lanarkshire Practice GuideSection 6

Int.1 EXEMPLAR Integrated Assessment and Child’s Plan Exemplar: Rory

Unique reference numbers: SWIS/MySWIS: CHI: SEEMIS:

Forename:

RorySurname (of mother if unborn child):

Watson

Other surnames previously used: Known as (if different):


Home address including postcode:

21 Main StreetHamilton

Telephone contacts

Landline 1:

Current address including postcode (if different from above):

Mobile 1:

Mobile 2:

Date of birth/expected date of delivery:

12-11-1995

Stage of education: (e.g. P1 or S2)

S5

School/nursery (if appropriate):

Brownlee High

Current legislation: Family composition in household:

Mother, father, sister Marie 19, brother Brian 11


Brian WatsonMarie WatsonMargaret WatsonGordon Watson

11194244

BrotherSisterMotherFather

Attends schoolUniversityGraphics designerArt teacher

Communication needs



Education Senior Manager Pupil SupportCh. & Families Social Work Disability Social WorkerAdults Social Work Services


Primary Health Care Paediatric ConsultantOther Health Care PhysiotherapistHousing

The Reporter


The Police


Other South Lanarkshire Leisure disability sports SDS Careers Officer

Practice Guide


Assessment requested/suggested by:

Date requested/suggested:

Date completed:


Consent from

Yes (X)

No (X)


Child/YP

Parent

Professional co-ordinating assessment/ current Lead Professional


· This assessment is trying to summarise Rory’s own strengths and capabilities to manage the transition from secondary school where everything has been adapted to a university environment away from home

· The assessment has been agreed as a very thorough examination of what needs to be put in place for Rory to manage a successful transition to university

· The opinions of the medical professional are crucially important to make sure that the risks to Rory’s health are managed


This assessment is based on the following: · three guidance meetings with Rory · one meeting, with Rory’s knowledge, of his peer group in school · one meeting with Rory’s parents alone · four meetings of Rory’s Network of Support, two of which his parents and Rory attended · one careers interview with Rory through Skills Development Scotland


Rory was a happy, healthy, well adjusted young man until a skiing accident aged 14 changed his life. Rory suffered severe spinal injuries which resulted in paralysis and significant medical needs, primarily respiratory. He spent a year in the spinal accident unit under the care of a paediatric consultant. With support from education and health, Rory completed his standard grade courses in hospital achieving eight Grade 1 passes. His ambition was to return to school in fifth year and his occupational therapist took on the role of Lead Professional, arranging for the necessary adaptations to provide classroom and toilet facilities as well as training and support for Rory’s teachers, support assistants and network of friends. Rory requires daily support, including home care and support assistants in school, to provide for his medical needs. Rory’s Plan has ensured that he has been challenged to regain as much of his physical and emotional independence as possible, supported by his peer group. Since he has been settled and stable in school, Rory’s guidance teacher has assumed the role of Lead Professional, continuing to work closely with health and social work to make sure that Rory’s well-being is developing as it should. Rory is sitting four Highers and applying for university admission and is expected to achieve the grades he needs for entry.


· Rory has lived in South Lanarkshire for all of his childhood. He has two parents who work in the arts and an older sister and younger brother. The family are close and stable with a large extended family and friends network

· Rory’s academic record shows that he has always been a high achiever, integrating into the social environment as well as succeeding academically

· Rory was involved in a skiing accident in the winter of his fourth year at school which resulted in severe spinal injuries and paralysis from the neck down

· Rory has a very close group of friends who have stuck by him throughout his difficulties. They have remained close and are extremely important to him; he is rarely seen outside their company

· The family has been extremely challenged by the shock, trauma and complete change for Rory but they have managed the difficulties with strength, dignity and positive resolve to navigate the various obstacles they have been faced with and not restrict Rory’s aspirations due to their own anxieties

· Rory himself has shown remarkable strength of character and resilience facing each new challenge with determination and a positive attitude. From very early on in his recovery in the Southern General, he spoke of continuing his education and sitting his standard grades if remotely possible


Int.1 EXEMPLAR (Rory) Information about the child and reason for an Integrated Assessment and Child’s Plan


Being Healthy – Rory’s physical resilience is apparent, based on his recovery from major trauma. The risk to Rory’s health continues to be the respiratory restrictions which have to be carefully monitored and his position changed regularly but Rory himself is aware of, and able to take some responsibility for, his condition. Rory’s physical strength requires development to increase his physical independence and a regular programme which he commits to should be part of any plans. With the right medical support and supervision his physical needs can be catered for. There is also clear evidence of emotional resilience and strength of character, based on Rory’s adaption to radically changed circumstances. This is in large part due to his strong sense of identity and efficacy before the accident but also supported by a close network of family before and after the accident. Learning and Achieving – Rory had demonstrated his ability to learn and achieve, even under the most extreme circumstances, and his intelligence and cognitive abilities will continue to be a significantly positive factor in his life. Being able to communicate – Rory is an able communicator in expressing and asserting views appropriately and without aggression. He is able to demonstrate interest in and empathy towards others. Although able to express his opinions, his capacity to listen and accept advice requires development and there is a tendency to present as stubborn and rigid in his thinking.Confidence in who I am – Rory’s sense of self has been developed primarily as an able bodied individual and his self-confidence remains high, reinforced each time he successfully navigates obstacles such as sitting his standard grades in hospital. He had an expectation of making a successful transition from home and school to independent living and university. Learning to be responsible – Rory has taken responsibility for his studies but up to this point his parents and carers had assumed most of the responsibility for managing his care. A planned transition would be required for Rory to move from receiving care to managing those who provide his care. Encouragement is also required to express his limitations and actively request help appropriately. Becoming independent and looking after myself – Rory demonstrates potential to take the steps towards independent living and more responsibility in looking after himself. However, making the transition to living alone may present challenges and Rory will have to be prepared for this and consider strategies to overcome the obstacles he encounters.Enjoying family and friends – has been a major feature of Rory’s life before and after the accident and he is dependent on this for his sense of identity and belonging. His ability to make and maintain relationships is apparent, but careful effort will have to be made to ensure that Rory connects with his new community and develops new relationships to fill the gap left by a very close peer group.

· Rory returned to the secondary school for his fifth year and completed a course that included four Highers. His prelim results suggest he will have no problem achieving the grades he needs to enter the university course he has chosen

· Rory has been supported significantly by the medical profession who have ensured that every element of his care has been in place · The school environment has been adapted on advice from Rory’s specialists and every member of staff from management to his

daily support assistants have done everything in their power to make sure his experience has been positive


As the Lead Professional and Rory’s pupil support teacher I am aware that Rory’s conditional offer will be confirmed on receipt of his results and that he will need significant support to make a successful transition to university. Rory is determined to study away from home rather than attend a university near his home and travel daily. I have Requested Assistance from all professionals working with Rory which includes staff from the spinal unit, the occupational therapist, physiotherapist, the public health nurse, district nurse, social work disability services and a number of school support staff to update Rory’s Integrated Assessment and Plan. Rory’s strengths and pressures must be recorded within his Integrated Assessment to bring the most up to date information together in order to look at the best way forward to ensure a successful transition to university. Rory, his parents, his university of choice and adult disability services must be part of discussions and decisions about his future plans and agree on what needs to happen. The information recorded against the My World Triangle is summarised below.

Practice Guide


Int.2 EXEMPLAR (Rory) How I grow and develop


•beinghealthy

•learningandachieving

•beingabletocommunicate

•confidenceinwhoIam

•learningtoberesponsible

•becomingindependent,lookingaftermyself

•enjoyingfamilyandfriends


Everyday care and help – Rory’s medical condition and disability will continue to require significant support on a daily basis. The organisation and structure of care is well in place at home and careful planning will be required to ensure continuity of care to enable Rory to live at an accessible distance from university but will require live-in assistance. Keeping me safe – The risks to his physical safety due to his medical condition have already been covered. Rory is physically and emotionally safe at present living within his home, school and community. He has not experienced prejudice and discrimination up till now and is not aware how that may present. Some preparation for this might be required to live in the wider community. Safe transportation from home to university will also be required.Being there for me – Rory has a very supportive network of family, friends and professionals who offer him practical help and emotional encouragement as and when it is required. Careful planning will be necessary to ensure that Rory can access his existing network whilst developing a new Network of Support around himself. Play, encouragement and fun – Rory’s ability to be physically active is restricted by his medical condition but he has interests and hobbies which are not dependent on his physical capabilities which could be continued if support were available through the university.Guidance, supporting me to make the right choices – Rory has had very positive influences from his family and professional network to equip him to make the right choices. There may be challenges in not overextending his independence initially. He has shown insight in university course choices, considering the practicalities of the types of working environments that may be more suitable to his needs and capabilities. These skills are transferable to other situations and there is evidence of his ability to adapt.Knowing what is going to happen and when – At present predictability is a large feature of Rory’s life. It is essential to know when carers are arriving, what time transport can be expected and where he has to be on the school campus. He has developed a level of organisational skills around the detail of his care and these routines offer stability to his life. New routines and schedules will have to be developed to provide a similar structure to his life as well as developing his ability to be flexible as new arrangements embed. Understanding my family’s background and beliefs – Rory’s family have a strong connection with culture and the arts and this is part of his own identity. He has no issues in this area and the family as a unit has grown stronger as a result of the extreme pressures rather than the opposite.


Rory continues to need twenty-four-hour care to meet his basic needs and ensure his continued well-being. Securing the right mix of skills and experience to provide support around him is critical to his successful transition. Rory must be involved in the process of finding the right carers as he will be responsible for managing his own care. Updating his passport (tool detailing care needs) with Rory would be a helpful step. Accessible and reliable transport will also be essential. Rory is aware of the risks to his safety and takes responsibility for this; he is intelligent and well able to seek support if he feels his safety is being threatened. Disability awareness work might help to prepare him to cope with prejudice which he hasn’t experienced up till now. His care must be highly organised and structured but also discrete enough to allow Rory to take part in university life and form new relationships.


There are risks to Rory’s health, primarily the continuing respiratory difficulties which must be planned for. However he has shown significant physical and mental resilience thus far and demonstrates awareness of his own health needs. He has proved his intelligence, cognitive skills and ability to respond to radical changes in circumstances, all of which will help to make the transition from receiving care to managing those who provide his care. He is well able to express his opinions although requires support to listen and accept advice from those with greater experience. Early discussions with Rory about course choices would help to address accessibility issues. Detailing his timetable and mapping out daily journeys would also be helpful prior to starting. His support network has been crucial to his strength and success, particularly his peer group, therefore a key element of the transition would have to be proactively building a new Network of Support for Rory within his new community. With the right care package secured, there is every possibility that Rory could maintain independent living and study away from home.


Int.3 EXEMPLAR (Rory) What the child needs from the people who look after him/her



•keepingmesafe




•beingthereforme



Support from family, friends and other people – already covered. Rory’s world will have to extend to meet the demands of university life and living with less support may be a challenge initially.School – has been a major protective factor and opportunity for academic and social development for Rory. This could be an advantage or disadvantage as it may have provided too much protection from the wider world for Rory. University could provide the same function but only with some preparation to explore the supports available.Local Resources – the local resources of his new community will have to be thoroughly explored. Rory has not previously taken advantage of disability support groups such as the coalition for disabled people or the disabled student council but may benefit from this type of support during his transition. The university community may have other resources that could support his interests and these should be explored.Enough Money – Rory and his family are currently in receipt of benefits which may change during this transition. Efforts will have to be made to ensure that adequate financial supports are available. Failing this there may be grants and special awards for students in his position.Comfortable and safe housing – presently Rory is lucky in that his home environment has every adaptation he requires. The main issue with the transition to university will be securing the right accommodation to meet his needs. The university and housing department will have to be involved to explore the options. Work opportunities for my family – at this point this is less relevant to Rory’s transition. His parents work and are in the medium wage bracket and Rory has an expectation to earn his living in the future.Belonging – Rory has a strong sense of belonging currently within the school and community. Every effort will have to be made to ensure that he is integrated into the community he intends to live and learn in. This will facilitate a smooth transition to further education.


The crucial issue for Rory is securing the right accommodation that will facilitate a successful transition away from home and every effort must be made to achieve this. Student accommodation adapted for disability may be the best option as long as it can also accommodate his carer/s. Rory’s statutory entitlement to financial support must be confirmed and any additional funding support available from independent sources should be explored to ensure his income will provide what he needs. Connecting Rory to community supports such as the student disability council, groups of interest and the student advisory services is very important. It would be helpful to begin this work now to ensure supports are in place from the outset. Arranging a mentor or buddy for Rory might also help to connect him to his new community and encourage a sense of belonging.

Practice Guide


Int.4 EXEMPLAR (Rory) My wider world



•school

•localresources

•enoughmoney



•belonging



My views about what needs to be sorted out are:I am disabled because of a freak skiing accident that damaged my spine and means I have to use a wheelchair to get about and have to be careful to keep my respiratory canals clear so that the flow of oxygen is not interrupted. I know I also need carers in the morning, help with transport and nurses come in to do some specialist treatments. But this still doesn’t mean I shouldn’t do things other people do it just means it’s much more difficult for me.I have already shown that I am intelligent enough to go to university. The course I want to do isn’t available in Scotland and I can’t change that. I want to be able to study the course of my choice not the one that is available nearest to my home. I’ve also shown that I can follow what professionals say and will not take risks that are not advised but I’m determined to leave home and go to a university outside of Scotland as this was always my plan. I know this means we have to do a lot of planning to make this possible and I’m happy to do my bit of that, even the programme of physical fitness that I haven’t stuck to very well up till now. I know that all my carers are in my home town and I will have to make a lot of arrangements to make sure that I have things in place for my mobility and medical needs. If everyone gets together to help me I know that it will be possible for me to be independent at university. I am willing to do anything to make this happen.I know everybody is worried about what I want to do and how I will cope, but people have to understand that I have coped with the most extreme thing ever apart from a death and in a lot of ways losing my legs and some of my health has been like a death to me and I’ve coped with that. I know I can cope with this next step even if it’s really hard.

Parents’/carers’ and significant others’ views of where the child is and what needs to be sorted out: attach parents’/carers’ well-being indicators assessment if available

We are keen to support Rory although we know we will worry about him leaving home to go to university. However, we also know that this is what he would have done before the accident, and if it is possible to put supports in place and allow him to attend we don’t want to stand in his way. In fact we will do everything possible to support his dream of attending university, even if it means leaving home. We don’t have all the answers and hope that the medical profession and the school will help us to make sure everything is in place for Rory. We have had some moments of crisis since the accident and we know some of the things that have to be in place for him. Rory also has to understand that he has to listen to the professionals to help make sure he is not being overambitious because everything will be so very different once he is away from school which is familiar and where everyone has looked after him so well. We want to make sure that all the risks are known to everyone and they know what to do if we’re not there.


Rory is an extremely capable young man and is very determined to become independent and attend a university in England. He has shown remarkable strength of character up till now, far beyond what most people expected and he is determined in his desire to study at university. However, we know from our experience of taking responsibility for Rory’s well-being these last two years that his needs are complex and very careful planning will be needed to make sure he is safe and well and makes a successful transition to university. He has many strengths to tackle such a high ambition but his complex needs also mean he is extremely vulnerable and will be facing a lot of changes at the same time. I think we all owe it to Rory to be completely up front about the obstacles he will have to overcome to make this change and support his understanding and development.


Int.5 EXEMPLAR (Rory) Summary analysis of child’s world


Resilience Matrix:

The matrix is appended as a tool which can either be used in a single or multi-agency environment. It supports practitioners to analyse the more complex information in terms of the child’s strengths and pressures, particularly where risks may be present, and plot them on a blank matrix to better understand the level of resilience or vulnerability the child is experiencing together with the adverse and protective factors that may influence the outcome. Further information on using the Resilience Matrix is contained in the Getting it right in for every child Lanarkshire Practice Guide


NA NA NA

Rory is regularly assessed using various occupational health and physiotherapy specialist assessment tools which help to set new physical development targets. The most significant outcome of his current assessment is the recognition of the need to develop his upper body strength to allow him more physical independence. He is at a crucial stage of physical development and if muscle development is not encouraged now it may be more difficult as he gets older. This assessment is based on the use of the well-being indicators and assessment triangle in combination in line with the Getting it right for every child national practice model and core components. It also reflects the core values of GIRFEC with the child at the centre and families as partners.


Audrey McVey Pupil support (head) Brownlee High


No one is in any doubt that there is an element of risk involved in Rory’s choice to study in England away from all current professional and personal networks of support. Rory has the right to exercise his choice and for professionals to help make this possible. It is essential that Rory fully understands the impact of opting for so many changes at once and is prepared for the change from his currently stable and secure situation. Current medical professionals, carers and his education staff are familiar with his needs and know how to respond appropriately. It is essential that those taking over must be brought up to speed well in advance of Rory moving so that complete continuity of care can be provided. Rory himself has demonstrated incredible capacity to cope with extreme change and as he says himself, this proposed change cannot be greater than becoming severely disabled overnight. He adapted so quickly to this change, proving that he is unusually able and determined, if not remarkable in his strength of character. If Rory has the capacity to manage this transition successfully, he will have ample opportunity to demonstrate this potential over the coming months of planning. The most important factors in a successful transition for Rory will be securing appropriate living accommodation and transferring the knowledge, skills, and expertise developed through the experience of meeting Rory’s individual needs to those who will support him in his new environment. Rory’s own role is crucial to the successful transition and fully engaging with the preparations will be essential. The achievement of the actions outlined in section 12 will have to be carefully monitored between now and the proposed move in September to ensure that all facilities, amenities and support mechanisms are in place. Rory’s family and friends network will be the constant and are willing to stick by him to provide some of the continuity of care and information to help him move on. They will also be at the other end of the phone to support him to adjust and he has developed lasting positive relationships with some of his professional network that are willing to do the same.

Practice Guide


Int.6 EXEMPLAR (Rory) Areas of disagreement


Int.7 EXEMPLAR (Rory) Specialist assessment tools used


Int.8 EXEMPLAR (Rory) Decisions and agreements that have taken place in relation to the Lead Professional


Wh

at

is t

he

de

sire

d o

utc

om

e f

or

this

c

hild

?

(the

po

sitiv

e ch

ang

es in

wel

l-b

eing

sh

oul

d g

o h

ere)

Wh

at

we

are

go

ing

to

do

?

(the

se a

re t

he a

ctio

ns t

hat

are

need

ed t

o

achi

eve

the

des

ired

out

com

es)

Ho

w w

ill w

e k

no

w?

(the

evi

den

ce t

hat

will

in

dic

ate

imp

rove

men

ts

or

det

erio

ratio

n in

wel

l-b

eing

)

By

wh

en

?

(the

late

st a

ccep

tab

le

dat

e to

ach

ieve

p

osi

tive

chan

ge)

Wh

o is

he

lpin

g m

e?

(whi

ch p

rofe

ssio

nal w

ill

be

resp

ons

ible

)

Sa

fe

·Al

l ris

ks to

phy

sica

l saf

ety

succ

essf

ully

m

anag

ed th

roug

h pe

riod

of tr

ansi

tion

·Ph

ysic

ally

and

em

otio

nally

saf

e w

ithin

his

ne

w a

ccom

mod

atio

n ·

Rory

is a

ble

to tr

avel

saf

ely

to a

nd fr

om

the

univ

ersi

ty

·Ro

ry is

saf

e w

ithin

the

univ

ersi

ty

envi

ronm

ent

·Pu

t the

righ

t per

sonn

el in

pla

ce in

clud

ing

daily

ca

rers

and

pro

fess

iona

l sup

port

sta

ff ·

Secu

re a

ppro

pria

te a

ccom

mod

atio

n ·

A pr

ogra

mm

e of

risk

aw

aren

ess

and

man

agem

ent

for R

ory

and

his

care

rs ·

Dev

elop

a ri

sk m

anag

emen

t pla

n un

ders

tood

and

ag

reed

by

all r

elev

ant p

artie

s ·

Upd

ate

pass

port

det

ailin

g ex

act m

edic

al a

nd

phys

ical

requ

irem

ents

·Ro

ry re

port

s th

at h

is

phys

ical

and

em

otio

nal

need

s ar

e m

et ·

He

has

acce

ss to

a

wid

e ra

nge

of a

ctiv

ities

w

ithin

the

univ

ersi

ty

Dec

embe

r 201

1D

isab

ility

Soc

ial W

orke

r

He

alt

hy

·Th

ere

is e

vide

nce

of R

ory’

s in

crea

sing

ph

ysic

al s

tren

gth

·Ev

iden

ce o

f em

otio

nal w

ell-b

eing

, and

gr

owin

g co

nfide

nce

in h

is in

depe

nden

ce ·

Evid

ence

of a

bilit

y to

see

k su

ppor

t with

m

edic

al c

are

whe

n re

quire

d

·Pr

ovid

e a

full

and

deta

iled

med

ical

repo

rt o

f Ror

y’s

med

ical

car

e ne

eds

·D

evel

op a

nd m

onito

r a p

rogr

amm

e w

ith R

ory

to im

prov

e hi

s ph

ysic

al s

tren

gth

to in

crea

se

inde

pend

ence

·Li

aise

with

dis

tric

t nur

sing

, pub

lic h

ealth

, NH

S em

erge

ncy

serv

ices

, hos

pita

l spi

nal u

nit t

o en

sure

th

ey a

re fu

lly a

war

e of

Ror

y’s

heal

th c

are

need

s an

d pu

t an

appr

opria

te p

acka

ge o

f med

ical

car

e in

pla

ce

·Re

gula

r mon

itorin

g th

roug

h ph

ysio

ther

apis

t will

sh

ow im

prov

emen

t ·

Det

aile

d pa

ckag

e of

ca

re in

pla

ce

Sept

embe

r 201

1

Ac

hie

vin

g

·A

succ

essf

ul tr

ansi

tion

to u

nive

rsity

·Ac

cess

to a

ll cl

asse

s, tu

toria

ls a

nd

acad

emic

sup

port

sta

ff ·

Evid

ence

of a

cade

mic

dev

elop

men

t co

ntin

uing

in li

ne w

ith R

ory’

s po

tent

ial

·Ev

iden

ce o

f dev

elop

ing

inte

rest

s in

ad

ditio

n to

uni

vers

ity c

urric

ulum

·W

ork

with

Ror

y an

d un

iver

sity

to p

lan

Rory

’s

cour

se c

hoic

es, d

aily

tim

etab

le a

nd s

uppo

rt

assi

stan

t ·

Supp

ort w

ith p

re-c

ours

e pr

epar

atio

n su

ch a

s bo

ok

lists

and

read

ing

·W

ork

with

stu

dent

sup

port

ser

vice

to s

ecur

e an

y ad

ditio

nal f

undi

ng a

nd s

uppo

rts

for l

earn

ing

such

as

lapt

op, i

nter

net a

cces

s et

c. ·

Supp

ort t

o at

tend

ope

n da

y, Fr

eshe

r’s a

ctiv

ities

etc

. ·

Keep

a d

iary

of t

he tr

ansi

tion

to h

elp

othe

r you

ng

peop

le in

sim

ilar s

ituat

ions

·Ev

iden

ce o

f Ror

y su

stai

ning

his

ne

w s

ituat

ion

and

rem

aini

ng a

t uni

vers

ity,

copi

ng w

ith th

e co

urse

w

ork,

dev

elop

ing

new

in

tere

sts

Dec

embe

r 201

1


Int.9 EXEMPLAR (Rory) Child’s Plan

Nu

rtu

red

·Ro

ry is

con

fiden

t and

hap

py in

his

ne

w e

nviro

nmen

t and

incr

easi

ng

inde

pend

ence

·

Rory

has

a te

am o

f car

ers

that

mee

t his

ne

ed fo

r dai

ly c

are

and

emot

iona

l sup

port

sa

tisfa

ctor

ily ·

Evid

ence

that

Ror

y ca

n ac

cess

sup

port

w

hen

requ

ired

·Ro

ry h

as s

uffici

ent i

ncom

e to

cov

er a

ll hi

s ca

re n

eeds

·W

ork

with

Ror

y, fa

mily

and

frie

nds

to p

lan

and

man

age

the

chan

ges

and

over

com

e ob

stac

les

· W

ork

with

uni

vers

ity a

nd s

tude

nt s

uppo

rt s

ervi

ce

to d

evel

op a

new

Net

wor

k of

Sup

port

·

Wor

k w

ith s

tude

nt s

uppo

rt s

ervi

ce to

acc

ess

any

addi

tiona

l sup

port

ava

ilabl

e an

d en

sure

that

Ror

y re

ceiv

es h

is fu

ll fin

anci

al e

ntitl

emen

t ·

Rory

to m

anag

e as

muc

h of

the

tran

sitio

n as

po

ssib

le to

rein

forc

e hi

s st

reng

ths

and

deve

lop

new

abi

litie

s as

king

for s

uppo

rt w

hen

he n

eeds

it,

incl

udin

g re

crui

tmen

t of n

ew te

am o

f car

ers

Repo

rts

from

Ror

y of

feel

ing

a se

nse

of

belo

ngin

g w

ithin

his

new

co

mm

unity

Evid

ence

of u

sing

sup

port

st

ruct

ures

Ac

tive

·Ev

iden

ce o

f im

prov

ing

phys

ical

fitn

ess

·Ev

iden

ce o

f acc

essi

ng a

num

ber o

f le

isur

e ac

tiviti

es o

utw

ith th

e un

iver

sity

cu

rric

ulum

·Ro

ry to

wor

k w

ith e

xist

ing

phys

ioth

erap

ist t

o ac

cess

con

tinue

d pr

ogra

mm

e in

new

env

ironm

ent

·En

cour

age

and

supp

ort R

ory

to e

xplo

re th

e op

port

uniti

es a

vaila

ble

in h

is n

ew e

nviro

nmen

t an

d be

pro

activ

e in

pla

nnin

g hi

s le

isur

e

Phys

ical

test

s sh

ow

impr

ovem

ent i

n up

per

body

str

engt

h an

d fit

ness

Evid

ence

Re

spe

cte

d

·Ro

ry a

chie

ves

a ne

w le

vel o

f in

depe

nden

ce

· Ev

iden

ce th

at R

ory

part

icip

ates

fully

in

any

activ

ity th

at re

quire

s ex

pres

sion

of

his

view

s an

d op

inio

ns

·Ro

ry to

par

ticip

ate

in a

ll de

cisi

ons

and

plan

ning

ar

rang

emen

t sw

hich

will

affe

ct h

im in

clud

ing

recr

uitm

ent o

f all

prof

essi

onal

car

e an

d su

ppor

t ·

Pre-

mee

tings

with

stu

dent

sup

port

ser

vice

s an

d fir

st y

ear t

utor

s ·

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Practice Guide


Name and address:


YES NO

My relationship to child:

Home Tel: any that exist should be includedWork Tel:

Mobile Tel:

Email:

The best way and time to communicate with me is

The notice I need to be able to participate is

Legal status

Name and address:


YES NO



Mobile Tel:

Email:



Legal status

Name and address:


YES NO



Mobile Tel:

Email:



Legal status

Name and address:


YES NO



Mobile Tel:

Email:



Legal status


Int.10 EXEMPLAR (Rory) The child’s Network of Support


Name Signature Date


Practice Guide


Int.11 EXEMPLAR (Rory) Signatories to the Integrated Assessment and Child’s Plan

The signatures of the adults who have contributed to and agreed this Integrated Assessment as the fairest picture of the child’s strengths and pressures.

If a meeting is convened to develop the Child’s Plan this sheet should always be signed before people leave.

Int.12 EXEMPLAR Review dates of Child’s Plan

Int.13 EXEMPLAR Contingency plans

Resilience

· Cognitive abilities and intellectual capacity · Evidence of adaptation to radical changes in

circumstances · Strong personality including determination

to succeed · Family culture of success and achievement

Adversity

· Dependence on professionals to meet daily care needs who lack experience of Rory’s exact needs

· Physical restrictions of wheelchair access · Requirement for specialist accommodation

including room for carers · Unknown community including resources to

support disability · Lack of established Network of Support

Protective factors

· The considerable experience and expertise of the university in supporting the needs of young people with complex difficulties

· SW and health resources within the new community

· Continuity of his Network of Support particularly from family but also friends

· The accumulated knowledge and expertise of how to meet Rory’s needs


Rory’s decision to move away from a familiar home and community presents undeniable risks but there are also several protective factors and evidence of physical and emotional resilience in Rory. The main issue is replicating the quality of care and protection Rory currently has and creating the same standards and stability in his new community without any increased risks during the transition period. Rory will have the support of his existing Network of Support to create a smooth transition and pass on the knowledge, understanding and experience of successfully managing his well-being. In addition, Rory himself will contribute to making a success of his choice.

Vulnerability

· Rory’s significant disability and medical care needs

· The medical risks related to Rory’s physical condition

· Diminished links with family and friends · Many significant changes happening

simultaneously · Dependence on unknown professionals to meet

all daily care needs · Distance from family


This tool can be used within single agencies or with multi-agency groups of professionals to assist with the process of analysis. Practitioners can access guidance within the Getting it right for every child in Lanarkshire Practice GuideSection 6 (pages 45 and 46)

Int.1 EXEMPLAR (Lily) Integrated Assessment and Child’s Plan guidance

Unique reference numbers: SWIS/MySWIS: CHI: SEEMIS:

Forename:

Lily

Surname (of mother if unborn child):

Grainger

Other surnames previously used: Known as (if different):


Home address including postcode:

27 Main Street, Motherwell, ML3 1TV

Telephone contacts

Landline 1:

Current address including postcode (if different from above): Mobile 1:

Mobile 2:

Date of birth/expected date of delivery:

18-04-1998

Stage of education: (e.g. P1 or S2)

S2

School/nursery (if appropriate):

Lanarkshire Academy

Current legislation: Family composition in household:

Mother, mother’s partner, two brothers, sister and maternal uncle and aunt (pregnant)


Communication needs:



Education Joan Wilson, learning support teacherMay Easton, guidance teacher

Lanarkshire AcademyLanarkshire Academy

Ch. & Families Social Work Louise Allan Lanarkshire social work officeAdults Social Work Services


Primary Health Care Nikki Stewart, public health nurse Lanarkshire medical centreOther Health Care

Housing

The Reporter


The Police


Other

Practice Guide


Assessment requested/suggested by: Learning support teacher/public health jointly

Date requested/suggested:

Date completed:


Consent from

Yes (X)

No (X)


Child/YP

Parent

Professional co-ordinating assessment/ current Lead Professional Louise Allan, children and families social worker


· This assessment will consider whether Lily’s needs are being met at home, within the community and in terms of her health. · The assessment will consider the risks and protective factors present in Lily’s life in all aspects of her wider world and will assess

whether she is at risk of significant harm as a result of deficiencies in any of those areas. · This assessment will consider whether additional support is required to ensure that Lily receives appropriate guidance and care

from those responsible for her, namely her parents and family. Similarly, it will assess whether Lily is safe in her current living arrangement or whether further support is required to ensure that she has a safe and caring home environment.

· The assessment will consider whether Lily requires support to develop positive and appropriate peer relationships and what impact these relationships may have on her emotional well-being and development. Similarly, this assessment will consider how agencies can support Lily in her educational requirements, particularly in light of her recent non-attendance.

· Finally, given Lily’s health issues, this assessment will consider how agencies can work together to support the family to manage these issues and to understand Lily’s needs in relation to this.

· It should be noted that as this assessment is primarily an assessment of risk following a child protection referral this assessment will be used to determine whether Lily’s name requires to be placed on the child protection Register.


· The assessment is based on written Single Agency Assessment (Part II) received from education and public health · Meetings/telephone calls with education and public health to confirm their findings · Four meetings with Lily on her own · Three meetings with Lily’s parents, one with mother alone, two with Lily’s mother and partner together · One meeting with the family as a unit including mother, partner, Lily and two brothers · Interviews with Lily’s two brothers


· Lily is a 13-year-old girl with normal physical growth and development for her age and stage with the exception of the medical diagnosis below. She is a pupil at Lanarkshire Academy where she receives additional support for learning to help with academic and social development. Lily’s academic development is assessed as Level B, her emotional development as immature and her attendance can be irregular. Lily suffers from pseudo seizures, diagnosed three years ago by Yorkhill Hospital. Lily has no friends her own age. She lives with her two brothers aged 12 and 18, her mother and her mother’s partner. She has no contact with her birth father. Lily’s maternal grandmother and uncle also feature prominently in her life.

· On xxxxxxxx Lily disclosed alleged sexual activity between herself and her two brothers to her learning support teacher and has not returned to the school since. She is now experiencing family tensions as a result of the disclosure.


· Lily’s mother advised the writer that she has lived in the local area for xx years. She advised that prior to this she lived in xxxx where she had a child. Parent 1 advised she left her previous partner after difficulties with him and advised that he got involved with drugs and she felt things were getting difficult for them. She advised that she did not feel safe in her tenancy and after her father died she did not feel she had any reason to stay in xxx and therefore moved up to xxxx to stay with her mother. Parent 2 advised that he was not concerned about taking on a parenting role for Child 1 and confirmed that when she moved up to stay in xxx he spent a lot of time with Lily and took her everywhere with him. Child 1 advised that xxxx did not have any contact with his father who eventually moved to xxx and died of a drug overdose a few years ago.


Int.1 EXEMPLAR (Lily) Information about the child and reason for an Integrated Assessment and Child’s Plan

· Child 1 was an open case to the children and families team between xxxx and xxx due to behavioural difficulties. Child 1 was offered support regarding his transfer from xx to school and Parent 1 and 2 were offered support in relation to DLA claims etc. During this time Parent 1 also had a stillbirth and the family were offered support and advice regarding coping with this.

· Social work services have received two prior referrals in relation to Lily; initially Lily was referred due to concerns that the seizures she was suffering were linked to social factors around the family. The child and family clinic advised that this family had experienced a lot of difficulty with Lily’s father having a nervous breakdown and the family moving house and felt that the parents’ capacity to cope may be diminished as a result of this. Concerns were also raised that the couple may be physically chastising the children. Parent 1 was extremely reluctant to believe that Lily’s seizures were not of a medical nature and was keen to pursue a second opinion. Other than this it was considered that the parents responded appropriately to the children’s needs and there were no concerns regarding the care of the children.

· In January a referral was made in relation to Lily allegedly having sexual relations with an adult male within the community. Police interviewed both Lily and the adult in question. No further action was taken as it was concluded that the referral was made by other youths spreading malicious rumours. There was also a referral made by Parent 2 in relation to Child 1 advising that he had threatened him with a knife and thrown him on a table which had broken.

· In 2009, Lily advised school staff that she was sharing a bed with her uncle. Social work staff visited the family and discussed the sleeping arrangements with the family. Parent 1 advised that Lily and her uncle were sharing bunk beds but not the same bed. It was agreed that this was not appropriate and that Lily would move to another room. No further concerns were raised and public health agreed to monitor this during home visits.

· Since the current child protection investigation Lily’s behaviour has continued to be difficult. She has advised the writer that she is angry with her parents for not believing her about what had happened. Similarly, there have been a number of incidents in recent weeks where family members have physically restrained Lily because her behaviour has been deemed out of control. Lily admitted that she had punched and kicked at her gran. Lily also advised that her father held a knife out to her and told her to use it after she had threatened her mother with a knife. Lily also advised that her uncle had put his arm round her neck to stop her from running out the house. The writer has discussed all of these incidents with the family and advised that physical restraint has not been appropriate. Parents 1 and 2 appear to have taken on some of the concerns of social work, however there continues to be negative feelings towards Lily regarding her disclosure and the family are struggling to accept that there may be truth in the allegation.


· Lily currently lives with her mother xxxxxxxx xxxxxxx and her father xxxxxx. Also living in the family home are her two brothers xxxxxxxxx, xxxxxxxxx as well as her sister xxxx and her maternal uncle xxxx xxxxxxxxx and aunt who is currently pregnant and is due to give birth in xxxxxxx.

· Since disclosing to her teacher that her brothers had had sex with her Lily has refused to return to school. She advises that she has never liked school although her parents state that they never had any extreme difficulty in getting her to school prior to the disclosure. Lily’s behaviour within the family home has also deteriorated significantly since her initial disclosure and the family have had to physically restrain her on a number of occasions. Discussions have taken place with the family regarding the unsuitability of this action; however, the writer also acknowledges that these occasions do generally appear to be in response to Lily being out of control as opposed to physically chastising her. Nonetheless, the family have agreed that they will not get into this position with her again.

· Since her disclosure, the writer feels that a negative view of Lily has developed within the family and she is viewed to be a troublemaker. The family has focused on ensuring the boys are not bothered by Lily and trying to reassure them after their experience of being interviewed by the police. Both Parent 1 and Parent 2 talk about how the boys want nothing to do with Lily and how they can understand why. The writer is of the view that extended family feels the same as well and Lily has stated to the writer that she is angry with her parents for not believing her. On a number of occasions the writer has been told by Parent 2 that he is unable to deal with Lily any longer and will kill himself if this continues. Both parents admit that Parent 2’s use of alcohol has increased since the disclosure.

· Lily has also refused to wash regularly since the disclosure. The family admits that this has always been an issue for Lily, however she is now going weeks without washing. Lily has advised the writer that this is in relation to not wanting to take her clothes off and that there is no one she trusts to make sure people don’t come in while she’s washing. The family are also concerned that it may be in relation to her being worried about having a seizure in the bathroom as the door cannot be locked for this reason.

· Lily is very socially isolated: she talks about friends of her brothers who are older, however Parent 1 has rightly stopped her seeing these boys after rumours that one of them may have interfered with a younger child. Other than this Lily appears to have no other friends. Both the writer and youth counsellor have had conversations with Lily about our roles as she has asked us both to be her best friend and talks incessantly about what we would do as best friends. Lily appears to have little understanding of social relationships and boundaries and has asked the writer why her uncle can not sleep in her room and why her gran can’t come in the bath with her.

· Lily has also talked quite negatively about her aunt’s recent pregnancy advising that she feels there are enough children in the family and there is no need for any more. The aunt advises that Lily has tried to kick her and hit her and shows no understanding of the risk this presents to the baby.

· Lily is clearly very distressed at present and is struggling to engage with any of the agencies in place to support her. She has completely disengaged from school; she refuses to do any focused work with the writer advising that she does not want to answer any questions. She has advised that she no longer wants to see her youth counsellor and is focused instead on developing unrealistic friendships with workers supporting her.

Practice Guide



· Until xxx Lily was attending school although it is recognised prior to this her attendance was slightly lower than desired. Lily receives learning support within the school to support her as it is recognised that she can struggle academically. Lily can present as immature and overly anxious and it is felt that her poor emotional development has impacted on her ability to learn. Lily struggles to focus for any period of time and becomes easily fixated with one aspect of a conversation. This means that she can find it difficult to follow lessons but similarly means that she struggles to develop friendships within the school. It is recognised by all agencies that Lily is socially isolated; she is unable to identify any appropriate friendships and is overly keen for workers to become her friend. Lily appears to struggle to understand social boundaries and roles and this makes her increasingly vulnerable to exploitation within the community.

· Lily also suffers from seizures which impact on her attendance at school as well as her confidence and she has advised the writer that she does not like practical classes such as home economics and science in case she has a seizure and hurts herself. There continues to be debate about whether these seizures are epileptic or pseudo seizures triggered by anxiety and stress. It is noted that abuse can often be a trigger for these types of seizures; however the family are reluctant to believe that the seizures could be linked to Lily’s psychological well-being.

· Throughout her school time it is clear that Lily has felt comfortable with staff and has used these relationships on a number of occasions to make disclosures or raise concerns regarding her home situation. It is a concern, however, that since this disclosure she has not attended school therefore increasing the risk of social isolation and reducing the likelihood of her disclosing any further issues. Similarly, Lily has advised the writer that she is not sure if she would tell anyone if anything else happened to her and has advised that she does not want to answer any more questions.

· Lily’s family are concerned about her lack of attendance at school and are keen to support any moves to get her back to education. The family are responsive to requests from the school to support Lily by taking her home after a seizure and appears genuinely concerned about her well-being. Parent 1 in particular is increasingly concerned about Lily’s refusal to wash and bathe and is keen for any type of support to encourage her to do this. There does therefore appear to be genuine concern for Lily at present. Despite this the family have developed an increasingly negative view of Lily since her disclosure and have identified her as attention seeking as opposed to in crisis. Lily has stated that she does not care what happens to her and her behaviour has become increasingly destructive, including threatening to break windows, kicking holes in doors and reportedly trying to throttle herself. Despite this Lily talks positively about spending time with her gran and uncle, and appears to have a close relationship to her sister xxx.

· Despite concerns that the family are unable to identify and support Lily’s emotional needs there is evidence to support the view that Lily’s physical health needs are being met. Public health advise that the family attend all medical appointments and that dental appointments are attended. All Lily’s immunisations are up to date and her physical growth is appropriate.


· Lily is clearly in crisis at the moment and showing increasingly distressed behaviour. While there have been previous positives such as attending school, feeling able to disclose to staff and being open about what has happened to her, the writer feels that she is now closing off these supports. Lily has clearly stated to the writer that she does not know if or who she would tell if something happened to her and the fear is that she feels unprotected and unsupported following this most recent disclosure. Lily’s anger appears to be mainly aimed at her mum who she is insistent knew about the incident although Parent 1 is determined that she was not aware of anything between the children.

· The writer feels that Lily is increasingly isolated now that she is not attending school and while the family do appear to be trying their best to put strategies in place there is concern that these will not be consistent. Her lack of understanding about social boundaries places her at increasing risk of abuse as she progresses into her teenage years. Her lack of appropriate friendships means that she is increasingly vulnerable to social isolation and her eagerness to please within social relationships leaves her vulnerable to exploitation.

· Lily’s anxious and immature responses to situations suggests a lack of emotional development and the education department already feel that this is impacting on her ability to learn. Lily clearly struggles to concentrate and follow conversations appropriately and again these issues are likely to impact on her future opportunities in terms of development.


Int.2 EXEMPLAR (Lily) How I grow and develop



•keepingmesafe




•beingthereforme


Practice Guide



· Lily has raised concerns in the past about lots of people being in and out of the house and about her father drinking. She has stated to education staff that this scares her and that she does not like it. Both Parent 1 and Parent 2 have acknowledged recently that Parent 2’s drinking has increased in response to the disclosure made by Lily. Parent 2 has also informed the writer that he feels suicidal and can not cope with Lily’s behaviour at present. It appears that Parent 1 is the main caregiver in the home with the children spending a lot of time between the family home and their grandmother’s home. Parent 1 also appears to rely heavily on support from her brothers in relation to the children. Parent 1 advises that the uncle stays with the family to help with the children and that she often calls gran round to help calm situations with Lily.

· There appears to be a number of adults therefore involved in providing guidance to the children however no clear indications as to who is the main caregiver for them. Lily states that Parent 1 only listens to her brother.

· The writer is aware that the aunt is currently pregnant and that Lily is negative about the prospect of another baby in the house. She often mentions her sister who died when she was younger but is unable to given any indication as to what happened. The writer believes this was a result of a stillbirth. Lily is positive about her sister however she does not appear to have a positive relationship with Lily and reports she wants nothing to do with her any more. It appears therefore that Lily spends a good deal of time entertaining herself within the home and can present as quite frantic for attention when adults are available.

· The writer has observed that the family, as discussed previously, are clearly concerned about Lily’s current behaviour. However, there appears to be a focus on the physical aspects of this such as not washing and how this will appear, and her behaviour and how this can be resolved. There is little focus on Lily’s emotional well-being and despite requests that the family talk to Lily and reassure her about her disclosure it appears that they have been unable to do this. The family have advised that they are ensuring that the children are not in each other’s rooms in order to protect them from each other; however this appears more focused on protecting the boys from any more accusations as opposed to considering the risks to Lily. Despite this they are trying to ensure that xxx and xxx do not stay in the house on the same nights and brother 1 is reported to have moved to his uncle’s.

· The family have a caravan which they go to each year for a fortnight. Parent 1 is keen to continue doing this as she feels it is beneficial for them to have a holiday. Despite this she is not sure how they are going to cope with Lily this year and has talked about going a separate week with Lily. The negative view of Lily as a troublemaker at present is likely to place her at further risk of isolation.


· The family appear loving and interested in their children, however are clearly struggling to cope with this difficult situation. There is concern that Parent 2 is not coping and his increased drinking is placing all the children at risk but particularly Lily who is being blamed for this. This kind of negativity impacts on her psychological well-being and makes her increasingly the scapegoat for the family problems. Similarly, the family appear to parent in a community style with extended family playing a large part in the family home. While this offers positives in terms of support there is concern that Lily has no parental role models and no clear indication as to who her main caregivers are. Lily has clearly indicated that she loves her gran very much while gran is stating that she needs to pull back from the family to focus on her own life. If this is not done with sensitivity Lily may once again feel rejected by her gran.

· The focus on protecting the boys from accusations leaves Lily vulnerable and feeling unsupported. There is little understanding of her emotional needs within this and once again reinforces the idea that she is not believed and that she is attention seeking. This further places her at risk as if future events place her at risk she may not feel able to seek support for fear of the same response.

Int.3 EXEMPLAR (Lily) What the child needs from the people who look after him/her



•keepingmesafe




•beingthereforme




· Lily previously received support within her school environment where she had good relationships with staff. Unfortunately Lily has not developed any lasting friendships within the school community and is currently refusing to return to school. The situation has left her isolated and lacking in social opportunity. When at school Lily was offered an opportunity to join lunch groups and social clubs however was reluctant to do this and has advised that she does not wish to join groups but would rather have one-to-one friendships. The writer wonders whether Lily is able to cope in group situations as the school report that she is not keen on joining in with activities.

· Lily has stated that she has friends outwith school, however these appear to be older boys who the family have now stopped her seeing. Recently the writer took Lily to MacDonald’s where she started talking to a member of staff there who is a friend of her grans. This man was clearly much older than Lily and appeared to have learning difficulties. Despite this Lily hugged and kissed the man and referred to him as a “lovely wee boy”. She appears to have little understanding of adult relationships and social boundaries.

· Lily does not attend any local resources and is not involved in any youth groups or social activities. The family are open to referrals to these types of things but do not appear to have pursued anything themselves and Lily is not keen to attend such activities. Lily’s gran helps out with a local club for adults with learning difficulties and Lily talks positively about her gran’s involvement in the community suggesting that she recognises that these types of things are valued.

· The family home is clean, warm and comfortable. Lily’s room is appropriately decorated and she shares this with her younger sister xxx. Lily clearly has a sense of belonging within the family as she does not appear to socialise outwith extended family, however the recent negativity towards her has clearly made her feel isolated within the family itself. Lily does not go out on her own and the family do not allow her to go out herself. This is understandable given the nature of her seizures, however the family are also currently concerned that she may tell individuals in the community about what has happened. The writer would be concerned about Lily being in the community on her own given her lack of social awareness, however is also conscious that as a 13-year-old she should now be developing some sense of independence within the community. It is difficult to say how this may be safely managed while her seizures are so unpredictable.

· Neither Parent 1 nor Parent 2 work therefore the family rely on state benefits, however they also try to offer the children opportunities such as holidays at the family caravan.


· Given that Lily is no longer attending school there is significant risk that she will not be offered any opportunity to develop her social skills nor will she have the opportunity to develop friendships and relationships outwith the family. Given that the family appear to go through periods of crisis and there are issues such as alcohol misuse and lack of parental guidance, there is potential that Lily will normalise this behaviour and accept it therefore placing her at further risk and making her vulnerable to abuse. Lily’s lack of understanding about relationships both within the community and within the family mean that she is unlikely to have opportunity to further develop positive social relationships which will in turn promote confidence, self-esteem and a positive future view.

· Without increased social opportunity Lily is not likely to develop her emotional understanding of social situations which will help her to cope in the future. Importantly without increased social opportunities Lily is likely to limit the relationships she has that could support her if she is further placed at harm or is looking to disclose anything further.

Int.4 EXEMPLAR (Lily) My wider world



•school

•localresources

•enoughmoney



•belonging



· Through discussions with Lily by the writer as well as feedback gathered from family members, discussions with health staff, parents and school staff it is clear that Lily is very unhappy at present. Lily has advised the public health nurse that she does not care if she hurts herself. She has advised that she does not ever want to return to school.

· These concerns appear to stem from having made the disclosure about alleged sexual activity with her brothers, however prior to this Lily had also informed both public health and education that she is worried about the number of people in the house

· Through discussions with the writer Lily has advised that she would like people in the house to stop shouting at her and hitting her. More recently, however, she advised that things appear to have improved in terms of her relationship with her gran.

· Lily has also made it clear that she would like to have more friends. She does not want to be involved in group activities but appears focused on having a best friend who she would like to spend time with. Lily has asked all professionals involved with her if they will be her best friend.

· Despite all of these concerns, Lily appears to think highly of her gran and her uncle and advised the writer that she enjoys spending time with them and that she likes staying with her gran.

Parents’/carers’ and significant others’ views of where the child is and what needs to be sorted out: attach parents’/carers’ well-being indicators assessment if available

· Both Parent 1 and Parent 2 are reluctant to accept that Lily’s disclosure may be true and have admitted that they find it difficult to accept this and feel that she may be attention seeking.

· Both parents are open about the difficulties they are having in dealing with Lily’s recent behaviour. Parent 1 and Parent 2 feel that they need support to deal with Lily’s challenging behaviour and feel that she requires help to behave better.

· Similarly, both parents acknowledge that Lily has stated on numerous occasions that she wishes to live elsewhere and that she struggles to make friends.


· Both health and education feel that the family require support to address Lily’s behaviour and to develop more positive family relationships. There is concern that lack of understanding about Lily’s emotional needs and lack of clarity about boundaries and family dynamics could lead to Lily being placed at risk of significant future harm.

· There are concerns that the family’s refusal to accept that Lily’s current seizures may be linked to psychological well-being, places Lily at further risk of abuse and harm.

· There are concerns regarding the family’s living arrangements in relation to numerous adults being in and out of the home and in relation to Parent 2’s level of alcohol use.

· All agencies acknowledge that Lily presents as very immature and that her emotional development is impacting on her ability to learn, socialise and cope at present. As a result of this, agencies are seeking support to ensure that Lily is safe and is not at risk. The desired outcomes indentified by partner agencies involve support for Lily in relation to social inclusion as well as support for the family in relation to providing a safe, secure and caring environment in which she can feel safe and develop.

Practice Guide


Int.5 EXEMPLAR (Lily) Summary analysis of child’s world


Resilience Matrix:

The matrix is appended as a tool which can either be used in a single or multi-agency environment. It supports practitioners to analyse the more complex information in terms of the child’s strengths and pressures, particularly where risks may be present, and plot them on a blank matrix to better understand the level of resilience or vulnerability the child is experiencing together with the adverse and protective factors that may influence the outcome. Further information on using the Resilience Matrix is contained in the Getting it rightfor every child in Lanarkshire practice guide


NA NA NA

This assessment is based on the use of the well-being indicators and assessment triangle in combination in line with the Getting it right for every child national practice model and core components. It also reflects the core values of GIRFEC with the child at the centre and families as partners.

There is a compulsory role for children and families social work, therefore they will continue in the role of Lead Professional working very closely with education and health as the Network of Support.


Louise Allan Children and families social worker Lanarkshire social work office, 1 Main Street,


· It is clear from the assessment above that Lily is extremely vulnerable within her current situation. While there is clear evidence that the family are concerned for Lily and are keen to support any plan that will help Lily, it is also clear that there are some significant risks which she faces. Social isolation is a primary concern especially given her recent disclosure. Lily has no other relationships outwith those in her family. If she is subject to sexual abuse within the family there is limited evidence to suggest that she will be protected from this or any other type of abuse.

· School would have been a strong protective factor for Lily particularly as she is clearly comfortable about disclosing to staff, however now her established non-attendance at school means that this protective factor is no longer available to her and in fact becomes vulnerability. Similarly, while her ability to disclose shows resilience there is also the concern that she has now stated that she would be reluctant to do this in future.

· Since her disclosure Lily has increasingly been reluctant to wash, increasingly destructive in the family home and has stated that she does not care about what happens to her. While in the last week her relationship with her gran appears more positive, it is clear that this is a young person who is lacking in any sense of positivity about her own worth. The family’s difficulty in accepting her disclosure and lack of emotional response to her situation means that she feels rejected and isolated from the only people she has available to her. Lily is telling agencies that she feels frightened in the house because of her father’s drinking and because of all the people in and out the house, and we have acknowledged that she is particularly vulnerable because of her isolation, lack of social awareness and that she is unable to manage adult relationships.

· It would be the writer’s view therefore that Lily is at risk of significant future harm and the writer would recommend that her name be placed on the Child Protection Register under the category of sexual abuse.


Int.6 EXEMPLAR (Lily) Areas of disagreement


Int.7 EXEMPLAR (Lily) Specialist assessment tools used


Int.8 EXEMPLAR (Lily) Decisions and agreements that have taken place in relation to the Lead Professional


Wh

at

is t

he

de

sire

d o

utc

om

e f

or

this

c

hild

?

(the

po

sitiv

e ch

ang

es in

wel

l-b

eing

sh

oul

d g

o h

ere)

Wh

at

we

are

go

ing

to

do

?

(the

se a

re t

he a

ctio

ns t

hat

are

need

ed t

o a

chie

ve

the

des

ired

out

com

es)

Ho

w w

ill w

e k

no

w?

(the

evi

den

ce t

hat

will

in

dic

ate

imp

rove

men

ts

or

det

erio

ratio

n in

wel

l-b

eing

)

By

wh

en

?

(the

late

st a

ccep

tab

le

dat

e to

ach

ieve

p

osi

tive

chan

ge)

Wh

o is

he

lpin

g m

e?

(whi

ch p

rofe

ssio

nal w

ill b

e re

spo

nsib

le)

Sa

fe ·Li

ly’s

hom

e en

viro

nmen

t offe

rs h

er

phys

ical

, em

otio

nal a

nd p

sych

olog

ical

sa

fety

·Li

ly re

port

s fe

elin

g sa

fe a

nd s

ecur

e w

ithin

he

r sch

ool e

nviro

nmen

t ·

Lily

sho

ws

som

e ca

paci

ty to

mak

e sa

fe

choi

ces

in re

latio

n to

her

ow

n pe

rson

al

spac

e

·Pl

ace

on th

e re

gist

er a

nd w

ork

to a

chi

ld p

rote

ctio

n pl

an ·

Child

ren

and

fam

ilies

soc

ial w

ork

supp

ort t

o Li

ly’s

pa

rent

s to

impr

ove

pare

ntin

g ca

paci

ty, i

nclu

ding

th

eir n

eed

to p

rote

ct th

eir d

augh

ter f

rom

phy

sica

l an

d em

otio

nal h

arm

incl

udin

g lo

ck o

n ba

thro

om

door

and

bou

ndar

ies

for h

er b

roth

ers

·Su

ppor

t fro

m a

ddic

tions

ser

vice

s to

redu

ce th

e ne

gativ

e im

pact

of s

ubst

ance

mis

use

on L

ily a

nd h

er

brot

hers

·Su

ppor

t fro

m g

uida

nce

teac

her t

o co

nnec

t Lily

to

you

ng p

eopl

e w

ithin

the

scho

ol e

nviro

nmen

t. Co

ntin

ued

one-

to-o

ne ti

me

with

lear

ning

sup

port

te

ache

r ·

Incr

ease

att

enda

nce

to b

enefi

t fro

m s

choo

l as

prot

ectiv

e fa

ctor

·W

ork

with

pub

lic h

ealth

nur

se o

n pe

rson

al s

pace

is

sues

·Re

cord

ed im

prov

emen

ts

in L

ily’s

phy

sica

l and

em

otio

nal h

ealth

·Im

prov

ed a

tten

danc

e ·

Som

e ev

iden

ce o

f Lily

’s

own

awar

enes

s of

her

ne

ed fo

r saf

ety

·An

y ev

iden

ce o

f re

duct

ion

in s

ubst

ance

m

isus

e

Dec

embe

r 201

1D

isab

ility

Soc

ial W

orke

r

He

alt

hy

· T

here

is e

vide

nce

of im

prov

ed e

mot

iona

l w

ell-b

eing

and

redu

ctio

n in

anx

iety

ep

isod

es fo

r Lily

·O

ngoi

ng s

uppo

rt fr

om p

ublic

hea

lth n

urse

to

man

age

Lily

’s s

eizu

res

effec

tivel

y in

clud

ing

regu

lar

liais

on w

ith G

P fo

r inf

orm

atio

n fr

om Y

orkh

ill

·Re

ques

t for

Ass

ista

nce

from

CAM

HS

to c

ompl

ete

a fu

ll ps

ycho

logi

cal/c

ogni

tive

asse

ssm

ent

·Pr

oact

ive

wor

k w

ith p

aren

ts to

incr

ease

un

ders

tand

ing

of L

ily’s

nee

d fo

r em

otio

nal s

uppo

rt

·Pr

ogre

ss re

port

from

CA

MH

S w

ith a

ny n

oted

im

prov

emen

ts

·Im

prov

ed p

aren

ting

skill

s

Sept

embe

r 201

1

Ac

hie

vin

g

·Ev

iden

ce o

f pro

gres

s w

ith th

e pe

rson

al

lear

ning

goa

ls id

entifi

ed b

y Li

ly ·

Evid

ence

of i

mpr

oved

per

sona

l/sel

f-ca

re

skill

s

·O

ngoi

ng s

uppo

rt fr

om e

duca

tion

with

Lily

’s

Addi

tiona

l Sup

port

Pla

n ·

Any

evid

ence

of l

earn

ing

goal

s ac

hiev

ed

Dec

embe

r 201

1

Practice Guide


Int.9 EXEMPLAR (Lily) Child’s Plan

Nu

rtu

red

·Ev

iden

ce o

f inc

reas

ed c

onfid

ence

·Ev

iden

ce o

f im

prov

ed re

latio

nshi

ps

betw

een

Lily

and

her

mot

her,

mot

her’s

pa

rtne

r and

her

gra

ndm

othe

r

·Ch

ildre

n an

d fa

mili

es s

ocia

l wor

k to

faci

litat

e fa

mily

se

ssio

ns to

ena

ble

each

mem

ber t

o un

ders

tand

the

othe

r and

take

acc

ount

of L

ily’s

nee

d fo

r em

otio

nal

supp

ort a

nd e

ncou

rage

men

t ·

Faci

litat

ed ti

me

alon

e w

ith g

rand

mot

her t

o re

pair

the

rela

tions

hip

brea

kdow

n ·

Faci

litat

ed ti

me

with

mot

her’s

par

tner

to u

nder

stan

d th

e im

pact

of h

is a

ctio

ns o

n Li

ly e

mot

iona

lly

·An

y ob

serv

atio

ns o

r re

port

s of

impr

oved

fa

mily

rela

tions

hips

·Ac

hiev

emen

ts o

f any

go

als

agre

ed b

y fa

mily

Ac

tive

·Ev

iden

ce o

f pur

suin

g a

posi

tive

inte

rest

, th

at in

crea

ses

self-

confi

denc

e an

d in

crea

ses

conn

ectio

ns

·Su

ppor

t fro

m C

omm

unity

Lea

rnin

g an

d D

evel

opm

ent t

o en

gage

Lily

in a

ctiv

ities

that

cre

ate

an in

tere

st

·Su

ppor

t fro

m a

Bef

riend

ing

prov

ider

to g

ive

Lily

one

-to

-one

con

tact

with

a tr

uste

d ad

ult o

nce

wee

kly

·At

tend

ance

at i

nter

est

grou

ps o

r act

iviti

es ·

Evid

ence

of d

evel

opin

g fr

iend

ship

s

Re

spe

cte

d

·Ev

iden

ce o

f Lily

exp

erie

ncin

g pr

ivac

y an

d di

gnity

in h

er h

ome

·Ch

ildre

n an

d fa

mili

es s

uppo

rt to

Lily

’s p

aren

ts to

im

prov

e pa

rent

ing

capa

city

, inc

ludi

ng th

eir n

eed

to

affor

d th

eir d

augh

ter p

erso

nal s

pace

·O

bser

vatio

ns o

r rep

orts

of

few

er g

roup

s of

un

know

n pe

ople

in th

e ho

use

·An

y ev

iden

ce o

f a

priv

ate

spac

e fo

r Lily

w

hich

is re

spec

ted

by a

ll fa

mily

mem

bers

Re

spo

nsi

ble

·Ev

iden

ce o

f rou

tines

in te

rms

of a

dult

soci

alis

ing

in th

e ho

me,

bed

tim

es a

nd

scho

ol a

tten

danc

e ·

Evid

ence

of a

ge a

ppro

pria

te b

ound

arie

s an

d di

scip

line

·Ch

ildre

n an

d fa

mili

es s

uppo

rt to

Lily

’s p

aren

ts to

im

prov

e pa

rent

ing

capa

city

, inc

ludi

ng th

eir n

eed

to

affor

d th

eir d

augh

ter p

erso

nal s

pace

·Im

prov

ed a

tten

danc

e ·

Evid

ence

of L

ily’s

in

crea

sing

abi

lity

to

conc

entr

ate

and

focu

s

Inc

lud

ed

·Ev

iden

ce o

f con

nect

ions

with

chi

ldre

n an

d ad

ults

bey

ond

Lily

’s h

ome

·Su

ppor

t fro

m c

hild

ren

and

fam

ilies

soc

ial w

ork

and

PHN

to d

evel

op re

latio

nshi

ps w

ith c

hild

ren

and

adul

ts o

utsi

de o

f the

hom

e ·

Supp

ort f

rom

gui

danc

e te

ache

r to

conn

ect L

ily to

yo

ung

peop

le h

er o

wn

age

·Su

ppor

t fro

m C

omm

unity

Lea

rnin

g an

d D

evel

opm

ent t

o en

gage

Lily

in a

ctiv

ities

that

cre

ate

an in

tere

st

·Su

ppor

t fro

m a

Bef

riend

ing

prov

ider

to g

ive

Lily

one

-to

-one

con

tact

with

a tr

uste

d ad

ult o

nce

wee

kly

·Ev

iden

ce o

f dev

elop

ing

frie

ndsh

ips


Name and address:


YES NO



Mobile Tel:

Email:



Legal status

Name and address:


YES NO



Mobile Tel:

Email:



Legal status

Name and address:


YES NO



Mobile Tel:

Email:



Legal status

Name and address:


YES NO



Mobile Tel:

Email:



Legal status

Practice Guide


Int.10 EXEMPLAR (Lily) The child’s Network of Support


Name Signature Date



Int.11 EXEMPLAR (Lily) Signatories to the Integrated Assessment and Child’s Plan

The signatures of the adults who have contributed to and agreed this Integrated Assessment as the fairest picture of the child’s strengths and pressures.

If a meeting is convened to develop the Child’s Plan this sheet should always be signed before people leave.

Int.12 EXEMPLAR (Lily) Review dates of Child’s Plan

Int.13 EXEMPLAR (Lily) Contingency plans

Resilience

· Able to previously disclose to a trusted adult

Adversity

· Lack of parental capacity to provide well-being particularly understanding emotional needs and providing appropriate boundaries and structures

· Chaotic household with unknown adults

· Alcohol misuse · Parental mental health problems

Protective factors

· Close relationship with grandmother · Relationship with learning support

teacher and the school in general · Relationship with public health nurse


It becomes apparent when mapping Lily’s situation on the Resilience Matrix that there is virtually no evidence of resilience in Lily which would allow her to overcome her adversities and the factors which make her vulnerable. The protective factor identified as the school is only valid if Lily’s parents respect her right to an education and exercise parental control to encourage her to attend. Weighing up the adversities and vulnerabilities leads to the conclusion that Lily needs help to be protected from harm and registration is appropriate in this case

Vulnerability

· Learning difficulty · Emotionally immature and anxious · Socially isolated – no friendships

outwith family members · Not attending school · Preference to favour the boys within the

family · Negative family view of current

behaviour · Seizures · Lack of social awareness · Low self-esteem and confidence

Practice Guide


This tool can be used within single agencies or with multi-agency groups of professionals to assist with the process of analysis. Practitioners can access guidance within the Getting it right for every child in Lanarkshire Practice GuideSection 6 (pages 45 and 46)

Practice Guide


component 5: the purpose of the integrated assessment and...

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