SCOPE OF THIS CHAPTER
This is an extract from Oxfordshire’s Integrated Support Service’s Practitioners’ Toolkit. A copy of the Toolkit in full can be found elsewhere on the Intranet
CHILDREN IN NEED THRESHOLDS
In order to be able to describe the different levels of children’s needs professionals in statutory and voluntary agencies in Oxfordshire have developed a Threshold Criteria Matrix for the Assessment of Children in Need.
This should be read in conjunction with the Assessment Framework Guidance.
Contents
1. Pyramid of Needs
The pyramid provides a useful way of conceptualising the levels of need and service response.
Click here to view Pyramid of Needs
Children will obviously move into / out of and between these levels of vulnerability according to their particular circumstances. The aim of early identification, referral and service provision is to ensure that children are prevented from moving up the pyramid and wherever possible concerns are reduced such that they move down. The divisions between the levels should not be conceived of as ‘hard and fast’. There will need to be some flexibility around the boundaries.
The Threshold of Needs Matrix expands on the level of need pyramid with specific examples structured around the domains and dimensions of the Framework for the Assessment of Children in Need and their Families.
2. Limitations of the Threshold of Needs Matrix
It is intended that the matrix be used as a tool to enable agencies to communicate their concerns about children using common language and understanding of the level of concern or risk. It is also intended as a tool to enable practitioners to complete a needs map to assess children/family’s strengths and needs.
The matrices are not intended to be an exhaustive list of all likely or possible concerns or risk factors; they are merely indicative and should not be rigidly applied.
The presence of single or multiple combinations of factors, the age of the child and protective factors will all need to be taken into account and the professional judgement and assessment of the invitation by the agency representatives concerned is of paramount important in deciding on the appropriate response. It should also be noted that children may move in / out and between the levels of concern in ranging timescales depending on the nature of their particular circumstance.
3. Threshold Criteria
Definitions of Levels of Need
Positive or Universal or Oxfordshire Level 1
These are children and young people who make good overall progress in all areas of development. Broadly, these children receive appropriate universal services, such as health care and education. They may access leisure and play facilities, housing or voluntary sector services.
At times, within this universal level, children may have some relatively small extra needs, or signals of needs, which trigger a professional from a universal service to a time limited enhanced intervention. However, overall their outcomes are good. Intervention would normally be on a single agency basis.
See Section 4, Oxfordshire Threshold of Needs Matrix (Positive Universal Level 1 Strengths) for detail
Example: A child is frequently late for school, the teacher’s approach to parents has not succeeded. The HSLW contacts parents and discovers difficulties in getting child and younger siblings along to school. Parents’ consent to a charity application and a double buggy is purchased.
Vulnerable or Oxfordshire Level 2
A child identified as vulnerable can be defined as needing some additional support without which they would be at risk of not reaching their full potential. This additional support may relate to health, social or educational issues. If ignored more issues could develop and lead to poorer life chances and the need for more intrusive interventions.
Intervention at this level is on single agency or multi-agency basis. It is expected that agencies other than the Children, Young People and Families Directorate will provide assistance, advice and information, although consultation can be sought from CYPF.
See Section 4, Oxfordshire Threshold of Needs Matrix (Vulnerable Level 2 Needs) for detail
Where a level of need is identified, the practitioner will initiate an assessment using Integrated Common Assessment Form (ICAF) and Needs Map, completing it with input from the parent/carer and if appropriate, from other agencies involved with the child. This is an assessment tool, which assists those involved to analyse and arrive at an agreed plan of action to address the child’s needs.
Example: 13 year old with behavioural problems is proving difficult for mother to manage. Parents recently separated, financial pressures, younger sibling with severe asthma who creates major anxiety for mother. Health visitor and HSLW work together with the family to access benefits, manage asthma, create support network locally (including baby-sitter) and enable mother and 13 year old to attend nurturing/parenting programme. After 8 weeks progress is reviewed by mother, HSLW, Health visitor (Lead Professional) and parenting group worker.
To carry out this assessment and develop the plan, evidence should be gathered, with agreement from the child and the parent, on each of the topics or ‘dimensions’. Concerns should be openly discussed within the positive context of working together with the family to maximise their strengths and resolve difficulties, offering help/support where appropriate. The ICAF Needs Map should provide a brief analysis of the family’s circumstances. The action plan should describe the different tasks agreed and be focused on resolving the concerns.
The action plan entails setting timescales on its different elements. The co-ordination of the plan should be carried out by the Lead Professional i.e. the practitioner who has the most prominent role with the child and family, or the practitioner who is best placed to co-ordinate/communicate with those involved.
The child and their parent/carer should have a clear understanding of the plan, who is doing what and by when. A date will be agreed for the family and practitioner(s) to come back together to review the outcome. The review should be co-ordinated by the Lead Professional.
The ICAF details the outcome of the plan at the review.
There are three possible outcomes:
- The child’s needs have been met, the concerns have been resolved, and no further action is required.
- New needs have emerged or original issues remain which indicate either continued support at this level, or a referral to another agency.
- The child requires a referral to the Intensive Support Service Team.
Whatever the outcome, the child and parents/carers should be invited to record theirs views. Their consent must be sought to share information and/or make a referral to another agency or to the Integrated Services Forum.
Child in Need or Significant or Oxfordshire Level 3
These are children pre birth to 19 whose needs are very complex. There is specific or severe cause for concern. Information suggests that they are considered to be at risk of social and/or educational exclusion. Their health welfare, social or educational development is being impaired. They may move into high priority category without the provision of services.
In some circumstances these children should be referred to Children Young People and Families (CYPF). See Critical/High Level of Need - Level 4 of the Threshold of Needs Matrix for circumstances in which referral to CYPF is necessary. If unsure always consult with the local CYPF Assessment Teams for consultation, referral and agreed plan of action. However, if circumstances do not warrant a direct referral to CYPF, the practitioner should refer the family to the Intensive Support Service Team (ISS) .
In order to refer to ISS the threshold must be met and the following criteria apply:
- The child requires a multi-agency response to their identified needs.
- The child requires further multi-agency assessment to identify their needs.
- Referring practitioners have utilised the services and resources of their own agency and the concerns/needs remain.
- Referrers have, where appropriate, consulted the ISS Area Co-ordinator and/or other agencies that have offered support and advice which has not reduced the concerns or needs of the child/family.
- The child is of sufficient age and understanding and has given his/her consent to the sharing of information at the forum.
- The parent/person with Parental Responsibility has given his/her consent to the sharing of information at the forum.
These children should be referred to the Integrated Support Service (ISS) Team via the Integrated Common Assessment Form (ICAF). See next section for further information
Example: Children are inadequately dressed with poor hygiene. Father has regular episodes of mental illness, mother has mild learning difficulties. The children’s school attendance is poor and they are emotionally needy and ravenously hungry when they do attend. They lack discrimination and readily trust any friendly adult. Parental supervision on their estate is a major concern. There are a number of professionals aware of the family e.g. community psychiatric nurse (CPN), education social worker (ESW), health visitor, special educational needs coordinator (SENCO) and HSLW, and it is a closed case to Children, Young People and Families. The SENCO can see the professionals are uncoordinated in their approach and the mother is confused about what is expected of her. The case needs assessing and a joint plan needs developing with the family and professionals. At the moment little is improving for the children. The SENCO and HSLW work together to complete ICAF and refer the case to the Integrated Support Team, with parental consent.
Oxfordshire Level 4 or Critical or Complex High Level Needs
There are children whose needs are complex and enduring and cross many domains.
They are children who are:
- At risk of or suffering from Significant Harm.
- Looked After
- Live in families with serious family dysfunction.
- Beyond control.
- Living with parents who are unable to exercise their responsibilities.
There may be single or multiple combinations of factors which place children at risk of experiencing the above.
Most children who experience critical needs will require referral to Children, Young People and Families. All children whose needs fall within this category will require consultation with Children, Young People and Families to establish whether referral to them is necessary.
4. Oxfordshire Threshold of Needs Matrix
Positive Universal Level 1 Strengths
These are children including disabled children who make good overall progress in all areas of development. Broadly, these children receive appropriate universal services, or some specialist disability services such as health care and education. They may also use leisure and play facilities, housing or voluntary sector services.
At times within this universal level, children may have some relatively small extra needs which trigger a professional from a universal service to a time limited enhance intervention.
Health, e.g.
- Adequate diet / hygiene / clothing
- Developmental checks / immunisations up to date
- Regular dental and optical care
- Health appointments are kept
- Developmental milestones met
- Speech and language development met
Education, e.g.
- Acquired a range of skills/interests
- Experiencing success/achievement
- No concern around cognitive development
- Access to books/toys, play
Emotional & Behavioural Development, e.g.
- Feelings and actions demonstrate appropriate responses
- Good quality early attachments
- Able to express and demonstrate empathy.
- Child with disability care package/support meets child’s needs
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Identity, e.g.
- Positive sense of self and abilities
- Demonstrates feelings of belonging and acceptance
- An ability to express needs
Family and Social Relationships, e.g.
- Stable and affectionate relationships with caregivers
- Good relationships with siblings
- Positive relationships with peers
Social Presentation, e.g.
- Appropriate dress for different settings
- Good level of personal hygiene
Self-Care Skills, e.g.
- Growing level of competencies in practical and emotional skills, such as feeding, dressing and independent living skills.
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Basic Care
- Provide for child’s physical needs, e.g. food, drink, appropriate clothing, medical and dental care
Ensuring Safety
- Protect from danger or significant harm, in the home and elsewhere
Emotional Warmth
- Show warm regard, praise and encouragement
Stimulation
- Facilitates cognitive development through interaction and play
- Enable child to experience success
- Consistent parenting providing appropriate guidance and boundaries
Guidance and Boundaries
- Provide guidance so that child can develop an appropriate internal model of values and conscience.
Stability
- Ensure that secure attachments are not disrupted
- Provide consistency of emotional warmth over time
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Family History and Functioning
- Good relationships within family, including when parents are separated
- Few significant changes in family composition
Wider Family
- Sense of larger familial network and good friendships outside of the family unit
Housing
- Accommodation has basic amenities and appropriate facilities
Employment
- Parents able to manage the working or unemployment arrangements and do not perceive them as unduly stressful
Income
- Reasonable income over time, with resources used appropriately to meet individual needs
Family’s Social Integration
- Family feels integrated into the community
- Good social and friendship networks exist
Community Resources
- Good universal services in neighbourhood
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Vulnerable Level 2 Needs
These are children including disabled children whose needs require some additional support from a targeted service without which they would be at risk of not reaching their full potential.
Health
- Emotional and behavioural difficulties but they are not significantly impairing health or development
- Slow in reaching developmental milestones
- Starting to default on health appointments / immunisations / checks
- Minor concerns re dirt / hygiene / clothing
- Susceptible to minor health problems
- Low level substance misuse
- Not registered with GP/Dentist
- A E attendance giving some cause for concern
- Early sexual activity
Education
- Have some identified learning needs that place him/her on school action or ‘School Action Plus’ of the Code of Practice
- Has statement of educational needs
- Poor punctuality
- Occasional school absences
- Sudden or sustained drop in achievement
- Not always engaged in learning e.g. poor concentration and low motivation and interest
- Not thought to be reaching his / her educational potential
- Reduced access to toys and books
- Truants with peers
Emotional & Behavioural Development
- Some difficulties with peer group relationships and with adults
- Some evidence of inappropriate responses and action
- Signs of disruptive or challenging behaviour
- Can find managing change difficult
- Starting to show difficulties expressing empathy
- Victim of crime
Disabled child requires additional care/support package or review of care package to meet child’s needs |
Identity
- Some insecurities around identity expressed e.g. low self-esteem
- May experience bullying discrimination or harassment due to ethnicity sexual orientation or disability
- Previously happy child becomes sad/withdrawn/quiet/ argumentative/aggressive
Family and Social Relationships
- Some support from family friends
- Has some difficulties sustaining relationships
- Child has caring responsibilities which impact on education or development
Social Presentation
- Can be over friendly or withdrawn with strangers
- Can be provocative in appearance and behaviour
- Personal hygiene starting to be a problem
Self-Care Skills
- Not always adequate self care e.g. poor hygiene
- How to develop age and appropriate self-care skills
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Basic care
Parent has:
- Mental or physical health needs or other health problems but they do not appear to significantly affect the care the child
- Substance misuse that does not appear to significantly affect the care of the child
- Poor maternal health / not accessing post/ antenatal care
- Inability to recognise health care needs for self or child
- Inappropriate anxiety regarding child health
- Parental engagement with services is poor
- Parent requires advice or parenting issues
- Professionals are beginning to have some concerns around child’s physical needs being met
- Condoned absence from school
Ensuring safety
- Some exposure to dangerous situations in the home or community
- Parental stresses starting to affect ability to ensure child’s safety
Emotional warmth
- Poor parent/child relationships
- Inconsistent responses to child by parent(s)
- Child able to develop other positive relationships
Stimulation
- Child spends considerable time alone e.g. watching television.
- Child is not often exposed to new experience or activities
Guidance and Boundaries
- Inconsistent parenting – difficulties setting boundaries
- Child behaves in anti-social way in the neighbourhood e.g. petty crime
Stability
- Key relationships with family members not always kept up
- May have different carers
- Starting to demonstrate difficulties with attachments
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Family History and Functioning
- Parents have some conflicts or difficulties that can involve the children
- Child has experienced loss of significant adult through separation or bereavement
- Child has caring responsibilities
- Parent has physical/mental health difficulties
- Parent or sibling has received custodial sentence
- Sibling with disability or significant health problem
- Refugee/asylum seeking family
Wider family
- Limited support from friends and family
Housing
Employment
- Parents have limited formal education affecting ability to find employment
- Periods of unemployment of the wage earning parents
Income
Family’s Social Integration
- Some social exclusion experiences
- Family may be new to the area
- Family experiencing harassment or discrimination or are victims of crime
Community Resources
- Adequate universal resources but family may have access issues
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Children in Need/ Significant Level 3 Needs
These are children including disabled children whose needs are more complex, and require support from more than one agency. This refers to the range of needs and depth or significance of the needs. They are at risk of social or educational exclusion. Their health, welfare, social, or educational development is being impaired
Health
- Moderate mental / emotional health or behavioural difficulties
- Concerns re diet, hygiene, clothing
- Missing routine and non-routine health appointments
- Overweight / underweight / enuresis
- Substance misuse potentially damaging to health and development
- Developmental milestones delayed
Education
- On schools Special Educational Needs Register
- At school action or school action plus
- No exams / tests result, record of achievement
- Has a statement of educational needs
- Some fixed term exclusions
- Identified learning needs
- Not achieving key stage benchmarks
- Poor school attendance and punctuality e.g. less than 80%
- No interest / skills displayed
- Serious disaffection with learning and underachievement and significant truancy less than 80% attendance and ESW involvement
Emotional & Behavioural Development
- Finds it difficult to cope with anger, frustration and upset
- Disruptive challenging / offending / anti social behaviour at school or in neighbourhood and at home, involvement of agencies, police, Behaviour Support Service, Youth Offending Team
- Finds change difficult to manage
- Unable to demonstrate empathy
- Behaviour impacting on health and development
- Child young person with permanent & substantial disabilities requires support/care package or care package needs to be reviewed to meet child’s needs
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Identity
- Subject to discrimination e.g. racial, sexual or due to disabilities
- Demonstrates significantly low self-esteem in a range of situations
Family and Social Relationships
- Lack of positive role models
- Misses school or leisure activities
- Peers also involved in challenging behaviour
- Involved in conflicts with peers / siblings
- Regularly needed to care for another family member impacted on education / development
- Young person living independently and not coping
Social Presentation
- Is provocative in behaviour / appearance
- Clothing is regularly unwashed and at times inadequate / inappropriate
- Hygiene problems
Self-Care Skills
- Child precociously able to care for self
- Poor self care for age including hygiene
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Basic Care
- Mental or physical health needs, substance misuse or often health problems such that the majority of parenting responsibilities cannot be undertaken and child’s health and development is likely to be significantly impaired
- Inability to put child’s need before own needs
- Inability to recognise health needs for self or child such that child’s health and development likely to be significantly impaired
- Difficult to engage parents with services
- Parent is struggling to provide adequate care
- Child previously looked after by L.A
- Professionals have serious concerns
- Inadequate care not meeting physical needs
Ensuring Safety
- Child perceived to be a problem by parents
- Child may be subject to neglect e.g. exposed to dangerous situations in the home or community. Experiencing unsafe situations
- Child regularly left alone or unsupervised
- Parental stresses affecting ability to ensure child’s safety
Emotional Warmth
- Receives erratic or inconsistent care
- Child / parent relationship at risk of breakdown
- Has episodes of poor quality care
- Parental instability affects capacity to nurture
- Has no other positive relationships
Stimulation
- Not receiving positive stimulation; lack of new experience or activities
Guidance and Boundaries
- Erratic or inadequate guidance provided
- Parent does not offer a good role model e.g. by behaving in anti social way
Stability
- Child has multiple carers
- Child has been looked after by L.A
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Family History and Functioning
- Incidents of domestic violence between parents
- Acrimonious divorce / separation
- Family have serious physical and mental health problems
- Parent or sibling is in custody
Wider Family
- Family has poor relationships with extended family or little communication
- Family is socially isolated and limited support from extended family
Housing
- Poor state of repair, inadequate temporary or overcrowded
Employment
- Parents experience stress due to unemployment or over working
- Parents find it difficult to obtain employment due to poor basic skills
Income
- Serious debts / poverty impact on ability to have basic needs met
Family’s Social Integration
- Parents socially excluded
- Parents experience stress without support network
Community resources
- Poor quality universal resources and access problems to these and targeted services
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Critical Level 4 Needs
These are children including disabled children whose needs are complex and enduring and cross many domains.
Health
Critical level of health Needs Referral to Social & Health Care may be appropriate if other concerns are present e.g. Child:
- Has severe mental or emotional health problems or behavioural difficulties which affect development
- Severe and / or multiple disabilities or serious health problems affecting development
- Substance misuse or self harming damaging health and development
- Developmental milestones unlikely to be met
- Early teenage pregnancy where there are concerns about young person’s ability to parent
- Multiple A&E attendances causing concern
- Failure to thrive
Education
Critical level of Educational Needs
Referral to Social & Health Care may be appropriate if other concerns are present e.g. Child:
- Permanently excluded for school
- Without a school place or not attending school
- Parental prosecution pending
Emotional & Behavioural Development
Child:
- Regularly in anti social / criminal activities / which places self or others at risk of significant harm
- Offending behaviours likely to lead to custody / remand
- Puts self or others in danger e.g. regularly going missing, violence towards others
- Self harming or suicide attempts linked to periods of depression
- Disabled child or young person with permanent & substantial disabilities substantially in excess of that normally required by a child or young person of the same age requires support package or review of package to meet needs
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Identity
- Experiences persistent discrimination e.g. on the basis of ethnicity, sexual orientation or disability. This discrimination places the child / young person at risk or is adversely affecting the child’s health in development
- Is socially isolated and lacks appropriate role models. This places child / young person at risk or is adversely affecting the child’s health or development
Family and Social Relationships
- Concerns about a child who is or was previously looked after
- Family breakdown related in some way to child’s behavioural difficulties
- Suspected non-accidental injury
- Child has suffered or may have suffered physical, sexual emotional abuse or neglect
- Child has caring responsibilities that impact significantly on child’s education / health / development
Social Presentation
- Regularly seen in inappropriate / inadequate clothing
- Hygiene problems causing isolation affecting child’s self-esteem and development
- Child repeatedly presenting as being hungry
Self-Care Skills
- Neglects to use self care skills due to alternative priorities e.g. substance misuse
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Basic Care
- Severe mental or physical health needs, substance misuse or other health problems such that vital parenting roles cannot be undertaken and child at risk of significant harm
- Failure to access adequate health care resulting in serious risk to child’s health (includes unborn child)
- Concerns about a child in a family where parents were unable to care for previous child and child has been removed
- Concerns about parenting of a child who is / or has been looked after or is at risk of becoming looked after
- Concerns about parenting of child. Currently or previously on Child Protection Register
- Child refusing to return home
Ensuring Safety
- Allegation or reasonable suspicion of serious injury / abuse or neglect
- Persistent serious domestic violence such that child is at risk of significant harm
- Parents involved in crime which is affecting parents capacity to provide care or is significantly impacted on child’s development
- Parents unable to keep child safe
- Victim of crime with no support system
- Young child left alone or unsupervised
Emotional Warmth
- Parents inconsistent, highly critical or apathetic towards child leading to concerns of emotional abuse. ‘low warmth high criticism’
Stimulation
- No constructive leisure time or guided play which significantly impacted on child’s development
Guidance and Boundaries
- No effective boundaries set by parents leading to child being beyond parental contact
- Regularly behaves in an anti social way in the neighbourhood leading to risk of criminal prosecution
Stability
- Child is beyond parental control
- Child has no parent or carer / abandoned child or unaccompanied minor
- Parent / carer has rejected child from home or is threatening to reject child from home
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Family History and Functioning
- Imminent family breakdown and risk of child becoming looked after
- Significant parental discard
- Violent towards Siblings / Parents
- Schedule One offender is living in the family
Wider Family
- Destructive/unhelpful involvement from extended family
- No effective support from extended family
Housing
- Physical accommodation places child in danger
- Homelessness is not eligible for temporary housing
Employment
- Chronic unemployment that has severely affected parents own identities and has seriously impacted on their ability to parent (see parenting domain)
- Family unable to gain unemployment due to significant lack of basic skills or long term difficulties e.g. substance misuse which affects their ability to provide basic care and parent (see parenting domain)
Income
- Extreme poverty / debt impacting on ability to care for child and have basic needs met; food, warmth, essentials, clothing
- Family / young person not entitled to benefits with no means of support
Family’s Social Integration
- Family chronically socially excluded
- No supportive network (see wider family)
Community Resources
- Poor quality services with long term difficulties with accessing target population.
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