Principles for Joint Working Across Adult and Children’s Services

Introduction
Scope
Guidance: Working Together, 2010
Parental Difficulties
Effective Joint Working
Referral
Receiving a referral
Assessment
Working Together
Withdrawal/Closing service
Bibliography

Introduction

Failures in multi-agency working especially across children’s and adult services have consistently been identified by serious case reviews in recent years. These failures are due to repeated inability by practitioners to appreciate that individuals, be they a child or adult, do not exist in isolation and are part of wider social and familial networks. The principles here will provide practitioners with a practical framework to improve practice and maintaining a ‘Family Focus’.

Scope

These principles provide an outline for practitioners in adult social care, children’s social care, primary and acute health care and mental health services for working together to ensure that children and young people’s welfare is promoted and safeguarded.

Guidance: Working Together, 2010

Working Together, 2010 provides specific and comprehensive guidance there also exists a specific legal duty in Section 11 Children 2004 which places a duty on Strategic Health Authorities, designated special hospitals, Primary Care Trusts, NHS Trusts and NHS Foundation Trusts to make arrangements to ensure that, in discharging their functions they have regard to the need to safeguard and promote the welfare of children.

All practitioners should appreciate that “everyone shares responsibility for safeguarding and promoting the welfare of children and young people irrespective of individual roles…” (Working Together, 2010 2.1). In particular, Local Authority “children and adult services should be aware of each other’s roles and responsibilities, and service and workforce planning should take account of the family and neighbourhood context in which safeguarding work is carried out” (Working Together 2010, 2.28).

Universal and specialist health services that most often work with adults have specific responsibilities to safeguarding children. In respect to collaboration between Children’s Social Care and Adult Mental Health services “Adult Mental Health Services… have a responsibility in safeguarding children when they become aware of, or identify, a child is at risk of harm (Working Together, 2010 2.102). The approach of practitioners to each others work is of particular importance “Close collaboration and liaison between adult mental health services and children’s social care services are essential in the interests of the children. This may require sharing information to safeguard and promote the welfare of children or to protect a child from harm” (Working Together, 2010 2.104).

A range of services are provided…, to respond to the needs of adults (who may have parental or caring responsibilities) and children who misuse drugs and alcohol… It is important that arrangements are in place to enable children’s social care services and substance misuse (including alcohol) services referrals to be made in relevant cases. (Working Together, 2010 2.107).

Parental Difficulties

The needs and welfare of children are often affected by parental difficulties and issues including:

• Mental ill health;
• Drug and alcohol misuse (can also present as part of dual diagnosis);
• Domestic Violence; and
• Learning Disabilities.

Children can be affected in many complex ways by the issues noted above and these issues can often be present within families at intergenerational levels. The response of practitioner’s who are working with parents who present with the difficulties noted above need to ensure that they are considering the needs of the children and other dependants (disabled and vulnerable adults) in their practice.

A range of parental difficulties can be associated with child maltreatment. Often it is a specific event or incident that brings this to the notice of professionals, i.e. a drunken parent hitting a child. However, professionals should consider what the cumulative effect of the parents difficulties are on the child and their day to day experience.

Children’s Social Care services are often considered to be reactive and crisis focused, by service users and other agencies (Horwath, 2007). Intervening at a point of crisis and then withdrawing services leaving families isolated and bereft. A more seamless multi-agency approach to supporting families will enable an approach to families that is designed to prevent and reduce the cycle of crises and provide a more coherent support network to be developed. Maintaining a focus of the needs of the all family members will enable the work undertaken by all agencies to be more effective.

Effective Joint Working

Joint working between agencies and professionals should consider the following:

• sharing of information between practitioners and agencies;
• joint assessments to identify the needs of all family members;
• shared complementary multi-disciplinary work that addresses the needs of all family members;
• clear management responsibility and accountability within a multi-agency context;
• regular monitoring and reviews of interventions and support to families to ensure a co-ordinated approach to long term multi-disciplinary work, ensuring that children are protected and parents are supported to parent effectively;
•  the provision of advice, support and sign posting to professionals who may be concerned about a child.
• That all professionals have a common understanding of the terms used to describe each other’s processes and meetings – their purpose and how this relates to the work to be undertaken

All services use a similar process of referral – assessment – intervention. There are some differences dependent on the nature of the service and when it becomes necessary to involve more specialist services.

The following actions should be taken at each point in the process.

Referral

Making a referral

Any agency making a referral should ensure that the following issue are considered:

• have information sharing protocols been considered, is there a need to share information without parental permission;
• do you have all the information that the receiving agency will need?
• Referrals to adult services should indicate whether the adult has any caring (parenting) responsibilities;
  • does the adult/family have any cultural/communication needs;
  • the degree of urgency in any expected response and the reasons why;
  • any child protection, child in need, parenting capacity or child care issues and what other agencies are involved to address these needs (ensure you provide names, addresses and contact numbers);
  • concerns about non-compliance with care or treatment (current/in the past);
  • How aware is the adult of the referral being made?
  • If there is a Health Visitor or school nurse involved they should always be notified of the referral.
  • The GP should also be identified
  • Referrals to children’s social care should specify
    • the child/ren and family details;
    • any cultural/communication needs for the family (these could vary within the same family);
    • the reason for the referral;
    • what sort of response/intervention is being requested and in what time-frame;
    • what other services are involved and with which family members? (i.e. Mother may have a CPN, child may attend school/nursery);
    • concerns about non-compliant behaviour from the parents;
    • is the family aware of the referral have they given consent or has this been overridden?

Receiving a referral

Any agency receiving a referral should check the following information is recorded:

• basic information;
• are there dependants (children but also vulnerable adults, older relatives who are dependant upon their adult child for their care needs);
• is there any information in the referral that indicates that there are child protection, child in need or parenting capacity concerns;
  • where this is not clear the referrer should be contacted to clarify if this is the case.
• referrals received by children’s social care should consider whether there are parental difficulties and what these are; if so,
  • establish if any other agency is involved with the parent (i.e. drug treatment services, mental health services);
  • how are these difficulties are causing concerns regarding their parenting and child care

Assessment

All agencies undertaking an assessment should consider the following:

• Where an assessment is being undertaken by adult services;
  • is the adult being assessed is a parent or has a significant role for a child or is living in a household with children (i.e. older sibling); if so
    • establish and record details of the children in the household and the caring arrangements;
    • if indicated, establish what other agencies are currently involved;
    • consider the adults role as a parent and impact of their current difficulties on the children;
    • consider whether parental actions or behaviour present any child protection concern;
    • does the parents difficulties mean they would meet the definition of a disabled parent;
    • consider the possibility of a joint assessment with children’s social care;
    • consider the involvement of other agencies;
    • consider the needs of children in the family as possible ‘young carers’.
• Where an Initial Assessment is being undertaken by children’s social care and there are parental difficulties but no services being provided consideration should be considered to involving the relevant service, an assessment should consider;
  • is the parent able to undertake the basic parenting tasks associated with day to day living (providing a home, food, warmth, clothing);
  • what is the quality of family relationships, are they impacted on by the parental difficulties (lack of warmth, high levels of criticism, level of lack of emotional availability and capacity of parent;
  • roles and expectations of family members including whether children taking on inappropriate caring roles, school attendance);
  • are communications clear and direct
  • behaviour control: is there a palpable threat of parental violence or of behaviours, i.e. self-destructive acts, domestic violence, drug use in front of the children;
  • careful consideration of issues of gender, ethnicity, disability and sexuality.

Working Together

Where there are a variety of agencies involved in working with a family, following referral and assessment, the following principles should be applied:

• all practitioners should ensure that they know which other professionals and agencies are providing services to;
  • Parents; and
  • Their children

And how to contact them;

• Regular liaison with other professionals (Children’s Social Workers, Adult Social Workers, Mental Health Professionals, Adult Drugs Workers…etc.) to ensure that relevant information is shared. Joint visits and sessions can be particularly valuable in also providing clarity of purpose and role.
• Attend meetings and reviews (Care Planning meeting, Child in Need reviews, Child Protection Conferences, Core Group meetings) to be involved in the planning and delivery of multi-agency care.
• Clarify frequency of contact with parent/child and wider family members and the focus of work to be undertaken by all agencies involved.
• Ensure that there is a key person to contact should their be any concerns or difficulties.

Withdrawal/Closing service

When a decision is made by one or other agency to withdraw or close a service provision to a parent or child it is not acceptable to make these decisions in isolation. There should always be consultation and discussion with other agencies involved and the parent/child.

Whenever a service is to be withdrawn and this is agreed by other agencies the following should occur:

• A letter confirming that the service is to be withdrawn and why should be provided to the parent and child, and a copy sent to all other agencies that are or have been involved with them.
• The letter should provide contact details should further concerns or needs arise, so that families understand how they might seek help in the future.

Where there is a significant disagreement between agencies, other involved practitioners or parent/child, the team managers who are in disagreement must seek to resolve this directly. Where this is not possible the ‘Resolution of Professional disagreements in work relating to the safety of children – Escalation Policy’ should be followed.

© Devon Safeguarding Children Board, 2009

Bibliography

Working together to safeguard children: A guide to inter agency working to safeguard and promote the welfare of children, 2010

Information Sharing Protocol, 2006

Horwath, Jan. (2007) Child Neglect: Identification & Assessment (Palgrave Macmillan, Basingstoke)