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OxfordshireChildren's Services Procedures Manual

Children's Disability Service and the Multi Agency Priority Panel Process - Eligibility Criteria and Service Allocation Guidelines for Community Support/Short Break Care

Contents

  1. Scope
  2. Referral Processes
  3. Eligibility for Disability Service Support
  4. Assessment Processes
  5. Service Allocation
  6. Priority Panel
  7. Unmet Need
  8. Review/Appeal Process

1. Scope

1.1 Background and Philosophy

The purpose of the Oxfordshire County Council's Children’s Disability Service is to work with others to provide a service for disabled children under 18 years whose families live within the county of Oxfordshire.

1.2 Legislation

Children Act 1989
Education Act 1996 Code of Practice
Disability Discrimination Act 1995
Chronically Sick and Disabled Children Act 1970 Section 2
Disabled Persons Act 1981
Human Rights Act 1998
The Carers and Disabled Children Act 2000
The NHS and Community Care Act 1990
Carers (Equal Opportunities) Act 2004
Children Act 2004
Children's National Service Framework 2004

1.3 Values

Disabled children are children first. The County Councils' Children’s Disability Service views a child or young person's disability within a social model of disability, recognising that disabled people are disabled not by their impairment but by social factors and attitudes that create barriers and deny opportunities to disabled people. These factors include prejudicial attitudes and constitutional discrimination faced by disabled people.

Wherever possible, families with disabled children, like other families, should be able to access practical support services easily without having to pass through too many professional 'gateways'. The Council is aiming to work with other partners in the statutory and voluntary sector to provide a range of accessible affordable services for disabled children that will support their families in their caring role. High cost specialist individual support packages can be provided to families whose children have particularly complex needs which cannot be met through other local services.

2. Referral Processes

2.1 First Referral

When families initially ask the Council for specialist services to support them in caring for their Disabled Child their first contact is their local CAFAT or the CAFAT at the Children's Hospital. 

The CAFAT duty officer will discuss what the family are seeking by way of support and record basic information about the child's needs and the professional network supporting them. The CAFAT duty officer may signpost the family to other sources of support available from Early Support (under 5s) or the Early Intervention Services, the Family Information Service or open access short breaks services. Most families with Disabled Children should have had support via a TAC/TAF before they seek specialist support from the Social Care. If families are clear they want a specialist assessment of their child and family needs, the duty officer should discuss the referral with the Disability Team Manager and a social worker from the Disability Team will undertake the Child and Family Assessment. If the family with a disabled child are in crisis and requesting the child is accommodated or there are Child Protection concerns, the CAFAT will undertake the assessment and a social worker from the Disability Team may assist with this.

2.2 Referral to Adult Disability Services

Older children may be referred directly to specialist transition social workers within the Children’s Disability Teams by local School Leavers’ Panels if professionals consider they may be eligible for help from the Adult Disability Service and they require support in moving successfully into adult life. School Leavers’ Panels review all children who have Education, Health and Care Plans for 0-25 years when they are in Year 9 when they are around 14 years.

2.3 Re-assessment

When children are receiving a service from the Disability Service and changes to care packages are felt to be necessary, workers from the Disability Service will complete the reassessment.

3. Eligibility for Disability Service Support

The overriding aim of Oxfordshire County Council's specialist Children's Disability Service is to provide for children and young people with permanent and substantial disabilities who require attention and supervision substantially in excess of that normally required by a child/young person of the same age.

Generally children are eligible for help from this specialist service if they have a moderate to severe learning disability and/or a significant physical disability. Children with particularly complex chronic health conditions (e.g. uncontrollable epilepsy) which are substantially disabling can also be eligible for specialist service provision.

NB Disabled children with other impairments who do not meet the criteria for support from the Disability Social Work Teams may be eligible for support from other Social Care Teams/Services and assessing social workers will refer them to those teams for help.

3.1 Notes to Assist Decision Making

3.1.1
Moderate to Severe Learning Disability

This is a difficult area to define but would include children who:

  • Are working to P scales;
  • Have formally diagnosed IQ level of 50 or below;
  • Attend specialised resource education provision (not EBD);
  • Have formally diagnosed global developmental delay;
  • Have significant verbal communication difficulties;
  • Have significant limited self-care skills.
3.1.2
Significant Physical Disability

This includes children who have permanent substantial impairment including:

  • Wheelchair users; or
  • Those whose walking severely is restricted; or
  • Those whose level of disability prevents management of self-care skills.
3.1.3
Sensory Impairment

Children with sensory impairment will only be offered a service from the Children's Disability Service if in addition to their impairment they have another moderate to severe disability.

3.1.4

 

Autistic Spectrum Disorder

This is a difficult area. The Children's Disability Service however will not offer a service to children with:

  • ADHD;
  • Aspergers;
  • High Functioning ASD;
  • Dyslexia;
  • Dyspraxia.

Unless someone with one of these diagnoses also has a moderate/severe learning disability.

If children do not meet the criteria for services from the specialist Disability Service they may be eligible for support from other Children, Education and Families’ teams/services and assessing social workers will refer them to those teams for help. Disabled Children with HF Autism or Aspergers who access their allocated short break care via direct payments will have their care arrangements reviewed by direct payment support workers who are managed by a Disability Team Manager.

4. Assessment Processes

4.1 Child and Family Assessment

Following an initial referral, a social worker from the Assessment Team will visit the family at home to conduct the assessment. Services are allocated on the basis of a Child and Family Assessment. (Parents/carers are also invited to complete a carer’s assessment about their own caring needs (see Section, 4.3 Carers Assessment).

The Child and Family Assessment is carried out in accordance with the Framework for the Assessment of Children in Need and their Families and addresses:

  • The needs of the individual child;
  • The capacity of the parents to meet the child’s needs and the needs of the other children in the family;
  • The social and environmental factors that make it easier or more difficult for individual families to meet their children’s needs.

The social worker will share with the family the principles and detail of the assessment framework. S/he will seek contributions from all people who care for the child, paid or unpaid wherever possible. Where children have particularly complex health needs, consideration should be given to a specialist nurse who knows the child well undertaking this section of the assessment.

The assessment is designed to be carried out in partnership with families. The family including the disabled child, where possible, are actively encouraged to participate in the process.

Parents should contribute to the reports. Their comments and contributions should be contained within the body of the report. They are entitled to contribute and should be encouraged to do so wherever possible. The social worker should discuss options with the family as to how this might be achieved i.e. the social worker could record the family’s views or an independent person could be asked to contribute on behalf of the family. The family could also provide their own written comments and can ask for other reports to be considered as part of the assessment.

This comment should include whether they believe the report to be an accurate record of what they have said and if they agree with the analysis and conclusion of the report.

There is an expectation that children should be seen as part of the assessment and helped whenever and however possible to contribute to the report.

4.2 Re-Assessment

When changes to care packages are needed, re-assessment will be conducted using the same format as the Child and Family Assessment. These assessments however will be completed by staff from the Children's Disability Service. (In certain cases, where all agree this is the most helpful way of proceeding, reassessment may be completed by other professionals who know the child/family well, e.g. the respite nurse). Parents can request a reassessment if their circumstances change and they believe they need a different level of support. if they feel this is helpful, they can provide an independent report detailing the needs which can be considered as part of the statutory assessment. Social workers or other professionals may also recommend a reassessment if they believe that a more up to date assessment of the child and their family circumstances is needed.

4.3 Carers Assessment

This is to be completed from the parents’/carers’ perspective.

Although the parents’ perspective forms a crucial part of the assessment report, separate carers’ assessments should be completed unless parents say they do not want this. Practitioners should establish if parents need help or require help in completing the carers’ assessment and provide that assistance if needed.

4.4 Young Carers’ Assessment

If siblings undertake substantial amounts of care or are substantially affected by having a disabled sibling, a young carer's assessment should be completed with and at the family's request.

5. Service Allocation

Detailed assessment will reveal many different needs, some of which will not be eligible for service. On completion of an assessment which includes the family's and child’s views, some families receive social work support whilst others might be offered practical support or be signposted to other services/support systems that might be helpful e.g. specialist parenting programmes, holiday playschemes.

6. Priority Panel

6.1 Purpose

Most individual funded specialist care packages are allocated via a multi-agency Panel that meets monthly. The aim of the Panel, which has a moderation role to ensure families are treated fairly, is to work in partnership to provide services that:

  • Give priority to those most in need;
  • Support children to live safely in their own families and communities;
  • Are responsive to their needs, culture and disability.

Ensures young people are supported as they grow into adulthood and need to access adults’ services.

The Panel recommends the level and type of care that should be offered taking into account the documentation presented to the Panel and the individual needs and circumstances of the child. Panel will also signpost families to other services that might offer support, e.g. specialist CAMH Services, parenting classes etc. Play and leisure services are allocated by provider organisations not by Panel but Panel may signpost families towards these resources.

6.2 Membership

6.2.1
Chair - Service Manager, Children's Disability Services

Role: Agency Decision Maker for Council-funded provision. Joint decision maker for care at the jointly funded residential short break care centres.

6.2.2
Children's Community Matron/Lead Nurse for Children with Complex Health Needs, Oxfordshire OCCG

Role:

Joint decision maker for care agreed at the jointly funded residential short break centres. Advice on community health resources and the best way to support children with complex health needs. Advice on the availability/duration of respite nursing support. Advice on the availability of health funding for post operative care support. Continuing care assessor (for those cases which require this).

6.2.3

 

Barnardo’s Short Break Centre Manager

Role:

Advice on suitability of individual children for placement and on current availability of support from the residential Short Break Centre. Advice on health issues especially around placement support.

6.2.4

 

Manager, Children and Family Care Services

Role:

Advice on availability and suitability of community services, e.g. behavioural support work service, home care, relief to care.

6.2.5

 

Team Managers, Oxfordshire County Councils' Children's Disability fieldwork teams

Role:

Advice on cases from a social work and family perspective.

Advice on management of risk.

Provide interface between social work staff and Panel to inform both of key issues arising in fieldwork and at Panel.

 

6.2.6

 

SEN team leader

Role:

Advice on special education needs and support for disabled children in school/college.

6.3 Legal Framework

Priority Panel makes its recommendations to the Council under the guidance of the legislation referred to in Section 1.2.

The Panel is also mindful of the requirements of the United Nations Convention on the Rights of the Child.

6.4 Panel Processes

Panel is held monthly.

Reports are to be sent to the Disability Service Manager’s PA a week before Panel meets so that there is time for them to be sent out to all Panel members in advance.

Emergency care packages from the Council can be allocated on a short-term basis between Panel meetings with the approval from the chair or agreed deputies within Oxfordshire County Council. Emergency health packages can be agreed by the health decision maker from the Oxfordshire OCCG. Emergency/crisis care at the short break centres can be agreed by either the County Council or Health decision maker in conjunction with the relevant Barnardo's centre manager.

Reports are sent out to Panel members in advance of the Panel meeting so that Panel members have time to consider their content, analysis and recommendation. At Panel, each report and any views from parents and accompanying documentation are considered.

6.5 Service Allocation

The level of service allocation depends on the family’s assessed needs. Detailed assessment will reveal many different needs, some of which will not be eligible for service. A family’s current level of support from family, friends and other services will be taken into account when deciding the size of a care package. Families will be encouraged to access support from other community provision where this is available and suitable for their needs. Care packages aim to support parents in their caring role, and to help meet the physical, emotional and social needs of disabled children and their siblings. There is an expectation that parents will fund the cost of their children attending targeted short break care, like holiday playschemes and after school clubs/activities, unless they demonstrate that they cannot pay. The additional support disabled children may need to attend this provision (e.g. around staffing) is already subsidised by the Council and there are some other budgets which can help children/families overcome barriers to access e.g. if parents cannot pay.

6.6 Direct payments

See also Direct Payments Procedure.

Direct payments are a way of arranging services for disabled children and their families. A person with Parental Responsibility for a Disabled Child is given money to pay for services instead of the local authority arranging them on their behalf.

Social workers or Assessment Team workers should discuss direct payment options with parents/ carers at every assessment and review. Where there is no allocated social worker, service providers e.g. from the Relief to Care Service may discuss the option of direct payments with parents at reviews. Where parents decide they want to access all or part of their care via direct payments, the family should be referred to the Direct Payments Information and Advice Support Service for further advice.

Parents can receive all or part of their allocated care packages by direct payments. Direct payments can be revised if there are reasons why allowing care to be accessed in this way would not be safe for the child; decisions about this are made by the senior Oxfordshire County Council manager.

6.7 Types of Service Available

6.7.1
Emergency Care

Families with disabled children including those with complex autism can request emergency support if they urgently need care for their child because of a personal crisis. Examples of emergencies where help could be provided would include where a parent has to be admitted to hospital in an emergency, where a parent injures themselves so they cannot manage a child's basic care or where a close relative is taken ill and requires immediate attention. Care can be provided in an emergency without the completion of a full assessment but needs to be authorised by a Disability Manager.

6.7.2
Relief to Carer Service
This service is designed to allow parents to have a short break from caring. It is provided for parents who cannot access baby sitters because of their child’s high support needs require help from a trained care worker and who cannot access breaks from child care providers as there are none able to meet the child’s needs. relief to carer support is generally provided at a level of between 4 and 12 hours a month, although in exceptional circumstances, e.g. when a child is unable to access school following an operation, it can be provided at a higher level. The amount of care offered depends on the parents’ need for a break; families are more likely to receive 8 or 12 hours a month if they are single parents, have several pre-children, have more than one disabled child or have additional caring responsibilities e.g. for an elderly relative.
6.7.3
Home Care

This service has two main purposes:

  • To undertake key caring tasks which the parents cannot manage on their own;
  • To support parents in their caring role when the child requires a great deal of support.

This can include care provided in the home overnight in exceptional circumstances.

6.7.4
Family Based Short Break Care

This service is provided for families whose children require higher levels of care. It is offered to parents who need a longer break from caring in order to catch up on sleep and undertake activities with other children, which are not accessible because of the needs of the disabled child. The service can be offered for a few hours a week, overnight care or a weekend a month, according to the family's level of assessed need.

The service also allows a disabled child to experience staying away from home and to develop greater independence because of this. It can be harder to find carers for older children whose level of physical disability requires adaptations to buildings or specialist equipment or who have high levels of challenging behaviour.

6.7.5
Overnight Residential Short Break Care

Residential short break care is available for families whose children require substantial care at night because of their behaviour or physical care needs. The service assists children with high support needs to socialise safely with others and to develop some independence from their families. The amount of overnight care allocated will depend on the individual family's level of assessed need. Care at residential short break centres is allocated to families who need regular breaks from care because of the intensity and complexity of their children's needs. Without this level of support, they would be unlikely to be able to continue to care for their child at home.

6.7.6
Direct Payments

When families are eligible for a Council funded care package they can choose to access this care via direct payments. This is when a parent/carer of a disabled child is given money to pay for services (e.g. to employ their own care worker) instead of the local authority arranging the services on their behalf. There are variable direct payment rates for different services.

See Direct Payments Procedure.

6.8 Panel Decision

Following consideration and in depth discussion of each case presented, Panel will either:

6.8.1

Set in process the allocation of service/range of services.

6.8.2 Recommend alternative services which Panel members consider more closely meets the assessed needs highlighted in the reports presented to the Panel.
6.8.3 Signpost to more suitable services.
6.8.4 The final decision as to the package of support a family will be offered rests with the relevant agency's decision maker. For solely Council funded provision the decision maker is the Service Manager. Responsibility for other agencies’ provision lies with managers within those agencies.

6.9 Communication of Decision

Following Panel, the Chair will write to parents explaining what care package is being offered to their family. If it has been decided not to offer a care package or to offer a different level of support from that requested by the family, then the Chair will give an explanation of why this has been decided. Letters regarding decisions re the allocation of residential short break care may be sent by either the Health or the County Council's decision maker; sometimes the letter will be signed by both especially where families are being offered mixed packages of care.

7. Unmet Need

If the Council is unable to provide a particular resource due to inability to recruit personnel, Panel will always consider if or how the service required could be provided through different service provision. The managers of the particular services concerned e.g. home care service, family based short break care service keep records of care packages that cannot be met because of recruitment problems.

The Panel Chair keeps within a Panel file copies of all assessment reports, parents' requests for care packages, decision letters with explanations contained as to why a particular package of care was offered or declined. This information is analysed on a regular basis to review the level of unmet need based on requests for service. This information is provided to senior managers within the Council and elected members. The Health decision maker also keeps records for sharing both within the health system and with other agencies.

8. Review/Appeals Process

8.1 If parents consider that their child's and their own carers’ assessment did not give sufficient weight to particular issues they face or that additional information should have been considered they can ask for Priority Panel to review its decision in the light of this information. They can make this appeal in a range of different ways including putting their appeal in writing, attending Panel in person for the appeal or asking an advocate to do so on their behalf. They can also ask to meet with the Council or Health decision makers before or after the panel instead of attending the actual meeting.
8.2 If parents wish to challenge Priority Panel's decision about a particular care package, they can ask for it to be reviewed by a more senior manager with the Council or the OCCG.
8.3 If parents remain unhappy with the decision about the level of care offered, they should be encouraged to use the Council's or Health's statutory Complaints Procedure.