Working together to support disabled parents
Template of a local, joint-working protocol - Processes, functions and responsibilities
This section of the protocol covers the different processes and functions which make up the relationship between agencies and families who need support. The processes and functions that should be covered are:
- initial contact and referrals
- sharing information between services
- assessment, planning intervention and review
- prevention of avoidable difficulties
- clarification of responsibilities
- coordinating assessments, planning intervention and review
- linking with a range of services
- enabling parents and children to participate fully in assessments, care intervention and review
- putting in place responses to assessed need
- responsibilities of agencies when children are considered to be at risk of harm and/or are accommodated by the local authority
- financial responsibilities of children’s and adults’ services
- care pathways and case studies.
Adults’ and children’s services should jointly agree referral procedures to prevent parents’ and children’s needs from failing to be met by either of the two services. It will be important that whichever service the family initially comes into contact with is aware of the protocol and of referral procedures.
The details of how to respond to initial contact with parents and to referrals will be determined by local procedures, including those which lay down target times for responses. However, common features of initial contact and referral procedures in good practice examples of joint protocols were:
- As a general rule, referrals for assessing the needs of disabled parents should be referred to adults’ services teams, unless specific child protection concerns dictate otherwise. In that case local procedures agreed by the Local Safeguarding Children Board should be followed.
- When referring disabled parents to adults’ services the referral should clearly state that the case involves a disabled adult with parenting responsibilities.
- When referring parents to a children and young people’s team the referral should highlighted that the parent has additional support needs relating to mental health, learning disability, physical and/or sensory impairment, a long-term health problem or a drug/alcohol-related problem.
- Accessible information should be provided to parents concerning referral, assessment and information-sharing procedures.
The protocol may also set out local procedures which generally relate to referrals involving adults or children, for example:
- the circumstances in which a referral can be made without an adult’s consent
- the roles of the Common assessment framework and Framework for the assessment of children in need and their families.
It is likely that there are already local procedures in place for sharing information between services when making referrals and assessments of disabled parents and their children. Procedures such as these are supported by Department for Education and Skills (DfES) practice guidance on information sharing. However, writing specific protocols which cover the referral and assessment of disabled parents provides an opportunity to assess whether these information-sharing procedures are effective and appropriate and to raise awareness of the procedures across children’s and adults’ services.
Common features of good information-sharing include:
- the identification of responsibility for information-sharing at all stages of the process, from referral, to assessment, to planning, to service provision and to review
- clarity about when information can and should be shared without consent of the adult concerned
- clarity about the range of potential sources of information, including universal services (for example, the school, GP or health visitor) and specialist services (for example, the community mental health team, Supporting People service or youth offending team)
- the appointment of people responsible for implementing information-sharing protocols within the organisations and who can act in an advisory capacity to help staff share information in a lawful way*.
*Note: In one good practice example the local authority used 'Caldicott Guardians’, who were introduced in the NHS following the 1997 Caldicott Report. Within the NHS this is a senior person, usually a health professional, responsible for safeguarding the confidentiality of patient information.
At the heart of a joint protocol will be the agreement, reached between children’s and adults’ services, of their respective responsibilities for assessment, planning interventions and review. In particular, these functions require agreement about eligibility criteria for service provision and the circumstances in which joint work will be carried out.
There are four key features of good practice in assessment and planning:
- preventing avoidable difficulties
- clarity of responsibilities
- mechanisms for coordination and planning
- making links with a range of services.
An important common feature of all the good practice examples was a clear statement that assessment arrangements and eligibility criteria for the provision of services by children’s and adults’ services should aim to prevent avoidable difficulties arising by:
- recognising low levels of need which, if unaddressed, are likely to lead to difficulties for parents and undermine children’s welfare
- recognising support needs at the early stages of the parenting experience
- anticipating support needs which may arise at different stages in a family’s life cycle.
The Fair access to care services and the Framework for assessment of children in need and their families, recognise the importance of adults’ services responding to lower levels of needs in cases where parents are living with the additional challenges of impairment, illness or drug and/or alcohol problems. Criteria for carrying out community care assessments and responding to needs should therefore take this into account. Norfolk County Council's protocol does this by stating:
… the combination of impairment and parenting responsibilities within the overall context of the individual family’s circumstances may generate a higher degree of need for support than a personal assessment of the disabled/ill adult alone.’
It is good practice to emphasise that, when determining eligibility for adults’ social care services, support should be given to parents where the risk to independence (as defined in Fair access to care services) currently falls within the 'moderate' band determined by local authority eligibility criteria for services provision but where there is reason to suppose that the risk will become 'critical’ or 'substantial’ if no support is provided. This practice follows the policy guidance set out in Fair access to care services (5) and preventative approach in the Framework for the assessment of children in need and their families.(6)
A key aspect of a preventative approach is the recognition that support for parents may prevent children from taking on inappropriate caring roles. It will be important to make links with the local multi-agency carers’ strategy and any local protocols concerning young carers.
Another common feature of the good practice examples included in the knowledge review was clarity about the respective responsibilities of adults’ and children’s services in assessments, planning intervention and review, and the circumstances when joint working would be required. Generally, the protocols agreed that:
- Adults’ services have responsibilities for assessment and care planning when there are no safeguarding concerns and where the parent needs assistance with the routine tasks of looking after children.
- Adults’ and children’s services should jointly coordinate assessment and care planning where parents need support for the medium- to long-term to enable them to meet their children’s developmental needs.
- Children’s social care lead assessment and planning (with specialist input from adults’ services) where intervention is required to prevent children suffering significant harm or where children’s needs are complex and/or there is a disabled child in the family.
This agreement on responsibilities is often visually illustrated by a chart setting out the pathways through the assessment and planning process. It may be helpful to look at the flow charts developed by the local authorities whose good practice examples of joint protocols are listed later in this guide.
This section of the protocol will need to be cross-referenced with local procedures for implementing the statutory guidance Working together to safeguard children.
A key part of this section of the protocol will be the arrangements for resolving disagreements between services. These arrangements will need to cover the whole process from referrals, assessments and planning, through to financial responsibilities, joint working and reviewing. Each locality will want to develop its own agreements but one example is a protocol which states:
In the event of a dispute about lead responsibility and/or the allocation of costs between staff at practitioner level, the two team managers should first seek to resolve this by reference to this policy. If they are unable to do so the case should be referred to area service manager level for dispute resolution.’
Protocols provide an opportunity to re-affirm or establish new procedures for different agencies and professions to work together on assessments, planning intervention and review. It will be important to set up mechanisms for the following situations:
- where an assessment is being carried out by adults’ social services and expertise concerning children’s developmental needs is required
- where an assessment is being carried out by children’s social services and expertise concerning the parent’s additional support needs is required
- where input from another agency, for example, midwifery or education, is required to properly assess the child’s and family’s needs.
The case examples included in this guide illustrate ways in which protocols can assist with determining responsibilities and in fostering coordination and cooperation between services.
Where assessments, planning and reviews are jointly carried out by adults’ and children’s social services, the protocol will need to set out:
- the criteria for deciding which service provides the coordination or lead professional/key worker
- the arrangements for ensuring effective communication and involvement of the relevant services and professions throughout the assessment process, service provision and review.
Mechanisms for coordinating assessments, planning intervention and review may include appointing a care coordinator/key worker/lead professional, holding multi-agency meetings and organising joint supervision of the family by children’s and adults’ social services. Norfolk County Council's protocol, for example, uses 'professional consultation’. In other words, children’s and adults’ services have appointed named officers who are available at all times of the day or by call-back facility the same day, to enable professional consultation between partner agencies about specific named disabled parents and/or children of disabled parents.
Guidance may also be required, within the protocol, on the contribution and role of services such as midwifery, health visiting, Supporting People services, housing, schools and children’s centres. Where representatives from these services are involved in developing the protocol it is an opportunity to coordinate referral and assessment processes and to take account of different services’ eligibility criteria.
Some parents and children will require communication to be in accessible formats and/or their preferred languages. Others will want to be fully involved and to understand what is going on. In some circumstances it will be appropriate to ensure that parents or children have access to an independent advocacy service. Protocols will need to set out responsibilities, including financial responsibility, for the provision of these important services. Practitioners and managers responsible for implementing the protocol will find it helpful if there are arrangements in place for providing information about services which can put information in accessible formats, assist with communication and/or provide independent advocacy.
Some localities use family group conferencing as an important method of involving all family members in identifying and responding to needs (see Resources, organisations and references for contact details to find out more information about this method). In these instances, local procedures for family group conferences will also need to be referred to in the protocol.
It is useful to include in the protocol agreements about relationships between adults’ and children’s services when responding to assessed need. Clarity may be required where:
- adults’ and children’s services are jointly commissioning service responses to a child and family’s needs
- adults’ services (when responding to eligible parental needs under Fair access to care services) wish to use services that are normally commissioned by children’s social care (such as foster carers, shared care, child care agencies and family support workers)
- children’s social care (when responding to children’s needs under Section 47 of the Children Act 1989) wish to use services that are normally commissioned by adults’ social services (such as support workers, short-break services and home care agencies).
Protocols should also highlighted the requirement to offer direct payments in lieu of services if this is what the family wishes and support their use.
Responsibilities of agencies when children are considered to be at risk of harm and/or are accommodated by the local authority
This part of the template should make links between the protocol and:
- local Safeguarding Children Boards and local arrangements for implementing Working together to safeguard children (7)
- vulnerable adults’ policies - it is important to recognise that it is not only children who may be at risk of harm in some family circumstances.
Sorting out the responsibilities of agencies when children are considered to be at risk of harm is also an opportunity to recognise that the local authority is one legal entity and that agreement is necessary between its divisions - that is, children’s and adults’ social services. This is particularly important when legal proceedings are involved. It is also important to specify within the protocol parents’ and children’s entitlements, from the perspective of legislation and local policies, to independent advocacy and the arrangements for providing access to such advocacy, including financial arrangements.
Finally, this section of the protocol should set out the responsibilities of children’s and adults’ social care when children are accommodated by the local authority. Agreement will need to be reached on who has responsibility for:
- supporting parents to maximise the chances of being reunited with their children
- facilitating contact between parents and children, as appropriate
- enabling parents and children, where appropriate, to be fully involved in child protection conferences and reviews
- referring parents to independent sources of advice, information and counselling support.
Protocols will also need to set out clearly the financial responsibilities of children’s and adults’ social services respectively, including provision for joint funding. The starting point for good practice is as follows:
- Financial responsibility rests with adults’ services where an adult has eligible assessed parenting needs.
- Financial responsibility rests with children’s services where children are assessed as being 'in need’ or where there are safeguarding concerns (Section 47 of the Children Act 1989).
- Where parents and children are assessed as having eligible needs financial responsibility is shared.
In reality it is not always possible to neatly separate children’s and adults’ needs and local authorities who demonstrate good practice have found it necessary to be flexible.
Where children and adult(s) within a family have eligible needs, there are three options:
- pool budgets, with agreed contributions from adults’ and children’s social care, to fund service responses where joint assessments have been carried out
- make equal contributions from adults’ and children’s services to each plan where joint assessments have been carried out
- specify within the protocol the respective responsibilities of children’s and adults’ services for meeting assessed need and ensure financial contributions are made accordingly.
Procedures will also need to be put in place for resolving differences about funding responsibilities.
Services provided under community care legislation may be charged for (unless they are provided as care under the Mental Health Act). In contrast, services provided under Section 17 of the Children Act 1989 may not be charged. It is therefore important that the protocol sets out the procedures to be followed when a care package involves contributions from children’s and adults’ social services.
Commissioning social care services (at the local population level) is the process of specifying, securing and monitoring services to meet an identified need. There are four stages to the process:
- identifying needs and mapping existing service provision
- allocating resources
- developing services
- monitoring and reviewing service provision.
Localities are likely to already have commissioning strategies for children’s services and adults’ social care. They may also have parenting or family support strategies. However, these strategies may not identify disabled parents in any needs analysis and the mapping of existing services may not consider capacity in relationship to particular groups of parents.
The protocol is therefore an opportunity to carry out a needs analysis of additional parental support needs in the locality and a mapping of services available to meet these needs. It is also an opportunity to ensure that future needs analyses and service audits carried out by children’s and adults’ services identify disabled parents.
Commissioning strategies should include universal, targeted and specialist services, taking into account, for example, health services and the extent to which they are able to respond to specific needs. Strategies will also include the role of the voluntary sector, particularly as many parenting support services are delivered by voluntary organisations.
Parents and children should be consulted and involved at all stages of the commissioning process and have a particularly important role to play in the development and monitoring of services.
Where it is necessary to commission specialist services to support disabled parents it will often be appropriate to consider pooling budgets from different agencies. Pooling budgets helps to promote a more integrated approach to commissioning, eligibility and individual plans, and service provision. More importantly, pooling budgets should prevent disabled parents’ needs from failing to be met by either children’s or adults’ social care, as each attempts to protect their resources.
Section 31 of the Health Act 1999 makes possible the pooling of health and local authority resources to meet the needs of a particular population group. There are no restrictions on local authorities’ adults’ and children’s services pooling resources and children’s services authorities may also pool resources with 'relevant partners’ such as district councils under Section 10 of the Children Act 2004.
The principles of good practice identified earlier should also underpin commissioning practices.
Most of the good practice protocols provide a visual representation of the procedures to be followed in determining eligibility and the role of the respective agencies. These pathways are a key aid for staff to see at a glance the procedures to be followed. Some protocols also provide case studies, based on anonymised real cases, to illustrate to staff how the protocol should be implemented. A number of fictionalised case examples illustrate the potential of inter-agency protocols.