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3What is integrated working? Integrated working is when everyone supporting children, young people and families works together effectively to put them at the centre, meet their needs and improve their lives.Integrated working aims to help identify needs early and provide support so that any problems do not become more serious.Use the notes below to support delivery and discussion of the slide.Integrated working aims to enable the whole of the children and young peoples workforce to work together effectively to deliver frontline services. It involves the whole workforce:Practitioners, managers and leaders from across the public, private and third/voluntary sectors, for all age groups of babies, children and young people.In all areas of work, including education; health; safeguarding; social, family and community support; youth; justice and crime prevention; sport and culture; play; early years and childcare.By identifying needs early and providing support early, integrated working shifts the focus towards prevention and early intervention and has significant benefits for children, young people and their families. It also has benefits for services, such as the more efficient use of resources at lower levels of need and avoiding duplication. It may also help to improve links through to adult services where appropriate.Integrated working is at the centre of making a real difference to the lives of children, young people, and their families by helping them achieve improved outcomes. When children, young people and families were asked what they wanted support to achieve, they identified five outcomes that were most important to them. These five outcomes form the heart of the Every Child Matters (ECM) agenda, which is looked at next.Links to further informationCommon language glossary (which explains the main terms used in integrated working) –
4Working together to improve outcomes for children and young people Be healthyEnjoy and achieveStay safeAll of the changes in policy, legislation and working practices across services for children and young people – including integrated working – are focused on supporting the achievement of improved outcomes. During consultation on the development of the ECM agenda five outcomes were identified as being most important to children, young people and families. Each of those five outcomes has five more specific aims. Details on the ECM outcomes and their aims are given in the table on the following page.Although ECM and integrated working are focused on children and young people, they do not ignore the vital role that parents, carers and the wider family play in supporting their children and young people and helping them achieve outcomes. The table on the following page indicates just some of the contributions parents, carers and families can make to the ECM outcomes and aims.Make a positive contributionAchieve economic wellbeing
5The policy context for integrated working Every Child Matters and the 5 outcomes.Children’s Trusts.The National Service Framework for Children, Young People and Maternity Services (2004).Youth Matters (2005) and Targeted Youth Support (2007).The Children's Plan (2007).21st Century Schools: A World-Class Education for Every Child (2008).Think Family (2008).2020 Children and Young People’s Workforce Strategy (2008).Recent policy updates.Background to ECMVictoria Climbie, an eight-year-old from the Ivory Coast, died in London in 2000 after months of torture and malnutrition. This led to a public inquiry by Lord Laming who made a series of recommendations. From this, new ways of working (new policy) and new laws (legislation) were developed to help improve the way practitioners and services work to protect and support children and young people.The most important recommendation was that practitioners and services needed to work together more closely, both within services and across service boundaries – this was the beginning of integrated working.Although the Climbie case was the trigger for ECM, the changes in policy and legislation that have followed look at improving practice right across all work with children and young people – from universal services, through prevention and early intervention and on to safeguarding and child protection.The policy was set out in ECM (Green Paper in 2003, followed by Next Steps and then ECM: Change for Children in November 2004).The legislation to support the changes was set out in The Children Act 2004Overview of ECM and the five outcomesAt the heart of ECM is the aim that every child and young person, whatever their background or their circumstances, has the support they need to achieve improved outcomes. The five ECM outcomes (shown previously) were identified through consultation with children, young people and familiesImproving outcomes for children and young people involves changes to culture and practice across the children's workforce. ECM sets out a model for change with integration at every level. It also sets out how services for children and young people need to be coordinated and built around their needs. Everyone in the children’s workforce has a responsibility to support children and young people to achieve the five outcomes – this should be the focus of all work.This means that the organisations involved with providing services to children – from hospitals and schools, to police and voluntary groups – will be teaming up in new ways, sharing information and working together, to help children and young people achieve what they want in life and protect them from harm. Children and young people will have far more say about issues that affect them as individuals and collectively.Children’s TrustsChildren's Trusts bring together all services for children and young people in an area, underpinned by the Children Act 2004 duty to cooperate, to focus on improving outcomes for all children and young people.Every local authority is working with its partners, through Children's Trusts, to find out what works best for children and young people in its area and act on it. They need to involve children and young people in this process, and when inspectors assess how local areas are doing, they will listen especially to the views of children and young people themselves.At the heart of Children’s Trusts is integrated front line service delivery, enabled by integrated processes and tools. This must be supported by integrated strategy and held together by inter-agency governance that will set the framework for the improvement and delivery of effective services.2008 saw the publication of revised guidance on the duty for Children's Trust partners to cooperate and a revised ECM Outcomes Framework. Both of these strengthen the role of effective integration in achieving measurable improvements in the lives of children and young people across all five ECM outcomes.Building on, and sitting alongside, ECM, there is a range of linked policy. Key elements include those outlined below. There are also other linked policies that focus on specific areas, such as early years, which are not covered here.The National Service Framework for Children, Young People and Maternity ServicesPublished in 2004, this sets standards in health and social care for improving service delivery. This is particularly around health and well-being; delivering child-centred services; safeguarding and promoting welfare; supporting those who are disabled or who have complex health needs and promoting mental health and psychological well-being.Youth Matters and Targeted Youth SupportYouth Matters (2005) sets out the vision for empowering young people. Targeted Youth Support (2007) is a key commitment from Youth Matters and is an integral part of the government's approach to reforming young people's services. It set out a vision that every young person at risk of not achieving the five ECM outcomes should be able to access targeted support from their local children's trust.The Children's Plan: Building Brighter FuturesPublished on 11th December 2007, the Children’s Plan is the next step in the implementation of ECM. It sets out a compelling challenge – to make England the best place in the world for children and young people to grow up. This means world-class health outcomes, services of the highest quality, minimising inequalities, and tackling poverty. It states that all Children’s Trusts should “have in place by 2010, high-quality arrangements to provide identification and early intervention for all children and young people who need additional help”. Brighter Futures: Next Steps for the Children’s Workforce (2008) sets a vision of how this may happen. To help achieve the ambitions of the Children’s Plan, each area must have a local Children and Young People's Plan (CYPP). This is the single, statutory, strategic, overarching plan for all services which directly affect children and young people in the area, showing how the local authority and all relevant partners will integrate provision to improve well-being across all five ECM outcomes and focus on specific challenges and priorities. The Children’s Plan: One Year On (2008) and The Children’s Plan Two Years on: A Progress Report (Dec 2009) set out progress made.The Children’s Plan is reinforced by policies aimed at schools and families.21st Century Schools: A World-Class Education for Every ChildPublished in 2008, this document sets out the ambition laid out in the Children’sPlan, that 21st century schools will be hubs for the community, providing access to a range of services for children, young people and families. These might include health, family support, adult learning and leisure activities. This will mean that the entire school system and individual schools will need to look beyond traditional boundaries, be outward facing and work in close partnership with young people, parents, other schools, colleges, universities and with other children’s services.Think Family: Improving the Life Chances of Families at RiskPublished in 2008, this sets out a vision for a local system that improves the life chances of families at risk and helps to break the cycle of disadvantage. The report outlines the key characteristics of a system that ‘thinks family’ at all levels, from governance to the frontline. The Family Pathfinder programme was launched in May 2008 to develop the Think Family approach in 15 local areas. The Think Family toolkit sets out some ways in which practices can be developed on the ground.Support for All: The Families and Relationships Green Paper, was published in January 2010, and sets out a broad cross government strategy on supporting families and relationships. It covers three strands – Supporting relationships; Work-life balance; Family friendly services.In order to successfully achieve these ambitions, the government is committed to the development of a world-class workforce across all Children’s Trusts.2020 Children and Young People’s Workforce StrategyPublished in December 2008, this sets out a vision for a reformed and integrated children and young people’s workforce “where people know when and how they need to work together – and have the skills and capacity to do so.” The strategy describes how government will work with partners to ensure that everyone in the workforce receives the support and development they need to achieve the vision. And it identifies reforms, which need to have impact across the whole of the children and young people’s workforce as well as priorities for development in each part of it.To support these developments, the One Children’s Workforce Framework (OCWF) provides local areas with a framework and vision of what a reformed children and young people’s workforce would look like. It is a simple, easy to use tool designed to help everybody who works with children and young people, to work better together. The framework is in the shape of a rainbow and each colour on the rainbow represents a different theme, each focused on things to do or ways of working that improve children and young people’s lives. Individuals and managers can use the framework to think about personal and team development, and Children’s Trusts can use it to help them develop their workforce.Recent policy updatesIt is important to be aware of ongoing developments in policy in this area. The links below will be useful in keeping up to date.Implementing integrated workingCWDC is responsible for implementing integrated working by closely collaborating with the Department for Children, Schools and Families (DCSF), local and regional organisations across England and the children’s private and third sector workforce. CWDC also works with other partners and sectors skills bodies across the children’s workforce to implement integrated working.To support practice, there are a number of integrated working tools and processes which will help to make sure that a child or young person and their family only has to tell their story once to get the support they need. This is looked at in the next section.
6Integrated working processes and tools Tools and processes that support integrated workingInformation sharingCAF andNational eCAFLead professionaland TACMulti-agency workingContact PointCommon coreImproved outcomes:• Be healthy.• Stay safe.• Enjoy and achieve.• Make a positive contribution.• Achieve economic well-being.Achieving improved outcomes for children and young people is the purpose of integrated working. To help achieve improved outcomes, and to support integrated working, a number of tools and processes have been developed. These tools and processes will help change the way that services are delivered, shifting the focus from dealing with the consequences of difficulties in children and young people’s lives to preventing things from going wrong in the first place. This will help more children and young people to achieve the five ECM outcomes.The key structures, processes and tools are outlined below.Information sharingInformation sharing is the term used to describe the situation where practitioners use their professional judgement and experience on a case-by-case basis to decide whether and what personal information to share with other practitioners in order to meet the needs of a child or young person. Sharing information is vital for early intervention to ensure that children and young people get the services they require. It is essential for safeguarding and protecting the welfare of individuals and for providing effective and efficient services that are coordinated around the needs of an individual or family. It is important that practitioners understand when, why and how they should share information so that they can do so confidently and appropriately as part of their day-to-day practice.There is a set of national guidance to support information sharing for practitioners working with children, young people, adults or families across all sectors:Information Sharing: Guidance for practitioners and managers.Information Sharing: Pocket guide and quick reference guide.Information Sharing: Further guidance on legal issues.Information Sharing: ‘How to…’ a set of four short guides.Information Sharing: Case examples.The guidance offers clarity on when and how information can be shared legally and professionally, in order to achieve improved outcomes. The guidance also explains how organisations can support practitioners.Common Assessment FrameworkThe Common Assessment Framework (CAF) is a key part of delivering frontline services that are integrated and focused around the needs of children and young people. It is a framework to help practitioners working with children, young people and families to assess children and young people’s additional needs for earlier, and more effective services, develop a common understanding of those needs and work together to plan, implement and review work to meet those needs.There is a set of national guidance for the CAF:The Common Assessment Framework for Children and Young People: A guide for practitioners.The Common Assessment Framework for Children and Young People: A guide for managers.National eCAFNational eCAF is a secure IT system for storing and accessing information captured through a CAF. It enables authorised, trained practitioners from across the children’s workforce to electronically store and share CAF information quickly and securely, and to work together to build a holistic picture of a child or young person’s needs. The system reduces the need for children, young people and families to repeat their story for different services. In order to gain access to CAF information held on National eCAF, practitioners need explicit consent from the child or young person who is the subject of the CAF (or their parent/carer where appropriate).ContactPoint (see below) holds an indicator for whether a CAF already exists and before beginning a new CAF on National eCAF, the practitioner should search ContactPoint to check whether a CAF already exists. When a new CAF is created on National eCAF, it will automatically notify and update ContactPoint. However, it is not possible to search National eCAF to see if a CAF already exists and there will be no access to National eCAF from ContactPoint.Guidance and training for National eCAF is being developed.Lead professional and team around the child (TAC)Lead professionals work with children and young people with additional (including complex) needs that require an integrated package of support from more than one agency or service. The lead professional takes the lead to coordinate provision and act as a single point of contact for a child or young person and their family. The lead professional role is a key element of effective frontline delivery of integrated children’s services. It ensures that professional involvement is rationalised, coordinated and communicated effectively. More importantly, it provides a better experience for children, young people and their families involved with a range of agencies.TAC is a model of multi-agency service provision. The TAC brings together a range of different practitioners from across the children and young people’s workforce to support an individual child or young person and their family. The members of the TAC develop and deliver a package of solution-focused support to meet the needs identified through the common assessment. The model does not imply a multidisciplinary team that is located together or who work together all the time; rather, it suggests a group of practitioners working together as needed to help a particular child or young person. TAC places the emphasis firmly on the needs and strengths of the child or young person. The TAC model also applies to young people and some areas refer to the team around the young person (TAYP).There is a set of national guidance for the TAC and lead professional:The Team Around the Child (TAC) and the Lead Professional for Children and Young People: A Guide for Practitioners.The Team Around the Child (TAC) and the Lead Professional for Children and Young People: A Guide for Managers.Multi-agency workingMulti-agency working brings together practitioners from different sectors and professions within the workforce to provide integrated support to children, young people and families. It is an effective way of supporting children, young people and families with additional needs, helping to secure improved outcomes and preventing problems occurring in the first place.There are a number of different models of multi-agency working, including:Integrated services or teams which acts as a service hub for the community by bringing together a range of services, usually under one roof, whose practitioners then work in a multi-agency way to deliver integrated support to children, young people and families (for example, extended services or Sure Start centres).Multi-agency services which are provided by agencies acting together, drawing on pooled resources or a pooled budget, and a joint plan.A multi agency team is when practitioners are seconded or recruited into a team, share a team identity and are generally managed by the team leader, though they may maintain links with their home agencies through supervision and training.A multi-agency panel is a group of people from different agencies that meet regularly for short periods of time to discuss children and young people with additional needs who may require multi-agency support. Members of multi-agency panels remain employed by their home agencies (for example TAC and locality teams).Multi-disciplinary services or teams where a set of people work to a common aim, drawing on a range of professional disciplines, within a single agency or across a number of agencies.A web-based resource is available to support managers and practitioners in developing multi-agency working models, providing working solutions and good practice examples (see the links that follow).ContactPointContactPoint is an online directory which provides a quick way for practitioners to find out who else is working with the same child or young person, making it easier to deliver faster, more coordinated support. ContactPoint holds the following information:Name, address, gender and date of birth of child or young person and an identifying number for all children in England (up to their 18th birthday).Name and contact details of parents or carers; educational setting (eg school); primary medical practitioner (eg GP practice); other service providers (eg health visitor, social worker or lead professional); and an indicator for whether a CAF exists. Please note these will be added to the system over time.Authorised ContactPoint users will be able to use ContactPoint to see if a CAF already exists and if there is a lead professional. However, the CAF itself is not accessible from ContactPoint. ContactPoint only provides name and contact details to enable practitioners to contact each other. When contact is made between practitioners, they will still need to use their professional judgement and follow information sharing guidance on what information should be shared and how.Access to ContactPoint is strictly limited to those who need it as part of their work. Authorised users include those working in health, education, youth justice, social care and voluntary organisations to help ensure more coordinated service provision for children and young people. All users must complete mandatory security checks and training before being granted access.Practitioner training started nationally at the end of Local authorities and National Partners are responsible for the management and delivery of ContactPoint training, and for granting users access to ContactPoint. Responsibilities include ensuring all training is carried out in accordance with statutory guidance, using the agreed materials (provided by DCSF). Local authorities are working with partner organisations to identify which individuals need to use ContactPoint as part of their work. The timescales for training will be determined by each local authority and National Partner.Common coreThe Common Core of Skills and Knowledge for the children’s workforce sets out the six basic skills and knowledge areas needed by all people (including volunteers), whose work brings them into regular contact with children, young people and families. The six key areas of skills and knowledge in the Common Core are:Effective communication and engagement with children, young people and families.Child and young person development.Safeguarding and promoting the welfare of the child.Supporting transitions.Multi-agency working and integrated working.Sharing information.A ‘refreshed’ version of the common core, accompanied by guidance, will be available from the CWDC website from March 2010.Other areas to be aware of:Leadership and management – The ECM agenda challenges leaders and managers to build integrated teams that put the child and family at the heart of all that they do, lead colleagues from other professional backgrounds and find common ground to unite team members who bring together different working practices and expectations. Championing Children and Leading and Managing Children’s Services in England: A National Professional Development Framework offer guidance and support for leaders and managers, including those working in integrated settings.Integrated Qualifications Framework – The Integrated Qualifications Framework (IQF) is a framework for making sure that qualifications for the children and young people's workforce reflect an integrated working culture. When a qualification is on the IQF it is fit for purpose, meets regulatory requirements and reflects the Common Core of Skills and Knowledge. It shows how qualifications link to each other.Common induction – CWDC has developed set of induction standards that set out what new workers should know, understand and be able to do within six months of starting work. The standards are supported by workbooks and training.Links to further information
7A continuum of needs and services Children, young people and families will experience a range of needs at different times in their lives and will benefit from access to support from a range of services, depending on their needs. Needs and services lie along a continuum, from no additional needs to complex needs, as shown in the diagram. This diagram is commonly called the ‘windscreen’, and similar to a wiper on a windscreen, there could be movement in both directions – needs can increase, but they also get less, especially with the right support.Note that the sections are not to scale in terms of numbers. A larger version of the diagram is available in the practitioner guidance for the CAF and the team around the child and lead professional.No identified additional needs – The section on the leftAll children and young people need access to high quality universal services (such as schools and GPs). These children and young people have no identified additional needs – meaning they are progressing well and likely to achieve the 5 outcomes.They do not require a CAF or a lead professional. However, they will be listed on ContactPoint. Information will be shared, where relevant and with consent, to make sure progress continues.Additional needs – The section in the centreSome children and young people have additional needs, meaning that they need some additional targeted support to help them progress, in order to achieve the 5 outcomes. All children and young people with additional needs are likely to benefit from a CAF being undertaken with them and this should be offered. These young people will also be listed on ContactPoint. Information will be shared, where relevant and with consent, to make sure progress continues.A CAF assessment may identify a range of additional needs that require different responses:Where the additional needs can be met by a single practitioner working with universal services, a lead professional or TAC is not required (eg where a CAF assessment shows a young person is progressing well towards most outcomes but has asthma that is not well managed at home and is impacting on his attendance, his concentration and his ability to take part in sport. An asthma nurse, linking with the family and the school can probably progress this without requiring a lead professional or TAC, but the CAF will help build a full picture of need and plan the way forward).Where the additional needs require integrated support, then a lead professional and a TAC are necessary (eg if in the case above his attendance declines further and he begins to get involved in minor vandalism as he is not involved in sport, an education welfare representative and someone from a youth project may need to be involved. All those involved would need to work together in an integrated way using TAC and a lead professional should be appointed).Complex needs – The section on the rightA small number of children and young people will have significant or complex needs (see 1.10 of the CAF practitioners guide for full list). They will require integrated support from statutory or specialist services. These children and young people are likely to require a specialist assessment. This specialist assessment may sit alongside, be informed by or feed into a CAF assessment (see section 5 of the CAF practitioners guide for more details).For those with complex needs, good practice or statute already indicates who should take on the lead role (eg a child who is looked after will have a specialist assessment and a named social worker will take the lead on their support). It would also be good practice to form a team around the child to support those with complex needs – but arrangements for this already exist in many cases.These children will also be included on ContactPoint. Information will be shared where relevant and with consent, to ensure that they get the support they require.The boundary between the CAF and specialist assessments, and how each can inform and feed into the other, is looked at in section 5 and Annex C of the CAF practitioner guide. It should be noted that:It is not always necessary to undertake a CAF following a specialist assessment – though it may be helpful in some circumstances (see section 5 for more details).You do not to need undertake a CAF following a specialist assessment if it is clear (from the specialist assessment) that the child or young person’s needs can be fully met by the assessing service/organisation.If a CAF is already in existence, the information in it may support a referral and/or feed into a specialist assessment.Links to further informationCAF practitioner guide section 1.8 to 1.10, Figures 1 and 5, 4.15, Section 5 and Annex C.
8The benefits of integrated working Earlier, holistic identification of needsIt is what is best for the children that counts and we feel this new way forward is absolutely the best for our children and young peopleEarlier, more effective interventionYou can’t be an expert in everything. We now have a tool to consult others – this saves huge amounts of time trying to become an expert in every subjectImproved information sharing across agenciesBetter service experience for children, young people and familiesUse the notes below to support delivery and discussion of the slide.The quotes in the speech boxes above come from the CWDC Share! Project. Launched in , CWDC Share! was developed to discover real-life stories which demonstrate how integrated working can really help improve the lives of children, young people and families. It outlines the issues and barriers that organisations encounter and overcome in implementing integrated working.Some of the main benefits of integrated working are outlined below.Earlier, holistic identification of needsBeing able to identify more completely, accurately and speedily the additional needs of children and young people is the critical first step towards meeting those needs at an early stage and preventing problems escalating.Earlier, more coordinated and effective interventionIntervening early and in a manner that maximises the available resources (eg by avoiding duplication of activities, by building on earlier interventions, by working together as a team) secures better outcomes for children and young people.Improved information sharing across agenciesBeing able to identify other practitioners working with a child or young person and sharing information legally and professionally is vital for early and effective intervention and for safeguarding. Improved practice in information sharing has many benefits, including:More complete and holistic assessment of needs.Less duplication of effort and fewer gaps in services.Improved understanding of service delivery options.Better quality and more appropriate referrals.Better service experience for children, young people and familiesIntegrated working will deliver a better service experience that is less stressful to children, young people and families through providing:Child, young person and family-centred approach.Improved access to information, advice and support.Fewer assessments and less repetition.Easier, less bureaucratic access to a range of services.Faster access to targeted and specialist services (where appropriate) and with less stigma as a result of closer links between these targeted and specialist services and universal services.More effective practice for practitioners and organisationsThere are also significant benefits for practitioners and organisations:Increased confidence in making decisions about sharing information, gained from following clear national guidance, with local support.Less time spent on administrative processes, due to improved access to information on services and practitioners working with children (through tools such as ContactPoint and National eCAF).Improved access to services through reduced bureaucracy.Improved quality of referrals received, as they will be more accurately targeted and more evidence-based.Improved response to referrals, due to improved quality of referrals made.More effective use of capacity and resources, including:Increased skills, knowledge and resources.Avoiding duplication and wasted resource deployment.Improved services for children, young people and their families.Increased resource base for practitioners and services.Everything is so exciting, but what is most exciting is that all our new pieces of work are now linkedMore effective practice for practitioners and organisations
9Guiding principles for the workforce Everyone in the children and young people’s workforce should:Work in partnership with children, young people and families.Work in partnership with other practitioners.Work in a child and young person centred way.Share information appropriately and effectively.Use a holistic approach.Focus on strength as well as need.Consider all potential sources of support.Be proactive and accountable.Promote the well-being of children and young people and safeguard them from harm.There are a number of guiding principles for the workforce embedded in ECM, other policies and integrated working. These are outlined below.Work in partnership with children, young people and familiesPractitioners should explain to children, young people and families from the outset, openly and honestly:What has happened or will happen next, check their understanding and gain their consent to the process.Why, what and how information will be shared and seek their consent to share.The different possible courses of action, involving them in any decisions.The exception to seeking their consent and involving them in decisions, where to do so would increase risk of harm.Working in partnership with children, young people and families involves:Working closely together with active participation and involvement.Sharing power.Acknowledging complementary expertise.Agreeing aims and process.Negotiating.Having mutual trust and respect.Working together with openness and honesty.Communicating clearly.Being willing to challenge in an appropriate way, when necessary.Practitioners may need to consider the use of a privacy notice (also called ‘fair processing notice’). This is the statement that tells people who is collecting information about them and what it will be used for. Privacy notices take a number of forms, for example a notice on a website or a script read out over the telephone. A privacy notice should be in clear language and must be truthful. A privacy notice should say who is collecting information; what it’s going to be used for; and whether it’s going to be shared with other organisations. This is the legal minimum. However, privacy notices can be used to tell people about other things, such as the right of access to information relating to them; how to get inaccurate information corrected; and the organisation’s security arrangements. Practitioners should ensure they are clear about local arrangements with regard to privacy notices.Work in partnership with other practitionersIntegrated working requires practitioners to work in partnership with each other, both within and across service boundaries. The elements involved in good partnership with children, young people and families (see above) also apply to partnership working with other practitioners. ContactPoint supports partnership working by providing authorised practitioner users of the system with a quick way to find out who else is working with the same child, making it easier to deliver faster, more coordinated support, where appropriate.Work in a child and young person centred wayPractitioners should work in a child and young person-centred way, with the needs of the child/young person at the centre of all discussions. This means that all practitioners should be:Focusing on child or young person-identified priorities, desires, needs and wishes rather than just on service or agency priorities and targets.Working in a way that focuses on the child’s or young person’s rights, choices and decisions rather than solely on practitioners’ aims.Using approaches that empower and enhance competence and promote and enhance the child or young person’s ability to function well.Giving the child or young person choice and the right to make decisions, at all levels of intervention.Sensitive to family, cultural, ethnic and socio-economic diversity.Share information appropriately and effectivelyThis is vital for early intervention and is essential for protecting children and young people from harm. Statutory guidance in the Children Act 2004 makes it clear that local authorities and their partners must ensure that information sharing becomes an integral way in which practitioners fulfil their duties and is a key feature of effective arrangements to safeguard and promote the welfare of children. Good information sharing is key to successful collaborative working and for the effective use of integrated working processes and tools, such as the CAF and lead professional.Use a holistic approachDevelopment of children and young people includes emotional, physical, intellectual, social, moral and character growth and these elements can all affect one another. Assessment of the needs of a child or young person therefore has to consider as much of the wider picture as possible in order to get the most accurate picture of the needs and ensure that the most appropriate support can be provided.Focus on strength as well as needPractitioners should always look for what a child, young person and family do well, alongside their needs. Any support should look to build on strengths as a basis for supporting needs and all plans should include what the child or young person and their family can and will do for themselves.Consider all potential sources of supportOnce needs have been identified, practitioners should consider what can be provided from their own service and what can be provided by working in partnership with other services. Where necessary, consider referral to other services. It is also important to understand and encourage what the child and family can do for themselves.Be proactive and accountableOnly by practitioners recognising concerns early, taking responsibility and initiating actions will early assessment and early intervention be achieved, with the associated improvements in outcomes. Practitioners also need to be accountable for their own actions, whilst knowing where to go for support and advice when needed.Promote the well-being of children and young people and safeguard them from harmThe Children Act 2004 gives the local authority a leadership role, however the duty to cooperate and to safeguard operates not just at the strategic level but also at the front line. All organisations need to listen and be responsive to the diverse needs of children, young people and their families and to recognise that safeguarding children and young people from harm must be everyone’s business. This must include culture, sports and play organisations and the voluntary and community sector as well as the statutory sector. The integrated working processes and tools do not override existing statutory duties and procedures. It is vital that, if at any stage, there are concerns that a child or young person is suffering, or at risk of suffering, significant harm then the appropriate LSCB procedures should be followed immediately.
11The CAF as part of integrated working Tools and processes that support integrated workingInformation sharingCAF andNational eCAFLead professionaland TAFMulti-agency workingCommon coreImproved outcomes:• Be healthy.• Stay safe.• Enjoy and achieve.• Make a positive contribution.• Achieve economic well-being.Participants will have looked at each of the elements on the slide before, as part of An introduction to integrated working that all participants should have covered prior to this training. Give a brief reminder as necessary and appropriate to the group – using the notes from An introduction to integrated working. Remind them that TAC stands for team around the child (the model also applies to young people and some areas refer to the team around the young person or TAYP).Also remind participants that integrated working is when everyone supporting children, young people and families works together effectively to put them at the centre, meet their needs and improve their lives.The focus here is to briefly emphasise that the common assessment framework (CAF) is just one element of the tools and processes that support integrated working. For the CAF to be effective it needs to work with all of the other elements and within the context of integrated services.Emphasise that all of the work that staff in the children and young people’s workforce undertake is about improving outcomes for children and young people and that the CAF has an important part to play in achieving this.NOTE: There is an optional slide at the end of the slide pack which shows the national training journey for practitioners and managers. Trainers may choose to use this at the start of the course, making any relevant local adaptations.Link to guidanceCAF practitioner’s guide – 1.8; Section 4.
12What is CAF?Using the CAF will help us develop a common understanding of strengths, as well as needs and how to work together to meet them.The CAF will help us assess children and young people’s additional needs for services, earlier and more effectively.The CAF is a shared assessment and planning framework to help us in our work with children, young people and families.Give an overview of what the CAF is, focusing in on the key words.Any good assessment builds a picture of what is going on in a child or young person’s life. However, many assessments in the past have only looked at one area of a child/young person’s life and from the point of view of one practitioner or service. For many individuals there were often several (perhaps incomplete) pictures of what was going on, but these pictures did not join up.The CAF aims to build a single shared picture of what is working well in a child/young person’s life and where some support might be helpful. This picture is built by bringing together information gathered through discussion with the child/young person and their family as well as any relevant practitioners and services. This single shared picture is then used to plan a way forward.The CAF is focused on assessing additional needs. Children and young people with additional need are those who would benefit from some targeted support (in addition to what all children and young people receive from universal services) to help them achieve improved outcomes.The CAF aims to assess additional needs earlier, shifting the focus from dealing with the consequences of difficulties in children and young people’s lives to preventing things from going wrong in the first place. It focuses on both strengths and needs.The CAF both encourages and enables practitioners to work together more effectively and in a more integrated way. CAF has a common process, supported by a common approach to recording information. This improves communication, encourages the development of common language and supports information sharing.CAF can be used by every practitioner across the children and young people’s workforce in England and with children and young people from pre-birth to 18 (its use can be extended beyond 18 where appropriate, to enable a smooth transition to adult services. For example, Connexions can use the CAF with young people up to the age of 19, and up to the age of 24 where a young person has a learning difficulty or disability).The CAF is not for use when there are concerns that a child or young person is suffering, or at risk of suffering harm. In these cases the Local Safeguarding Children Board (LSCB) safeguarding procedures must be followed without delay.The CWDC research document Use of Team Around the Child (TAC) model for the year age group considers the use and impact of TAC, as well as CAF and lead professional. It is available fromShort discussion: Ask why they think the CAF has been introduced. Try to ensure the following key points are covered:Most children and young people do well – but some do not.The best way to identify additional need early and act effectively is to all work together – the CAF helps us do this.The CAF covers all needs, not just those that, individual services are most interested in, so there is less chance of children and young people ‘falling through the gaps’ between services.By using a common process and form CAF encourages and helps practitioners to work together, communicate better and share information more effectively.The CAF means that children, young people and families only have to tell their story once and it increases the chances of their needs being identified and met effectively.Link to guidanceCAF practitioner’s guide – Forward; Executive summary; 1.1; 1.3 to 1.6.SuggestionThis is not included in the general timings, but if you can fit it in, ask what impact participants think the CAF has already had locally.Try to focus on positive impacts and discuss what can be done to build on these.If negative impacts come up, record them and come back to them at an appropriate point later in the training. Some concerns will be removed by information given later. If concerns remain at the end, discuss what can be done locally to minimise any potentially negative impacts.
13The CAF principles Focused on strength as well as needs Holistic Voluntary and only undertaken with consentA standardised process supported by a formChild and young person centredAble to improve links to specialist assessmentsCoordinated(only ever one active CAF episode per individual)Not something services can require before access to provision – but is able to inform better referralsExplain that the CAF is underpinned by some key principles, which are shown on the slide.The notes below are provided as a summary to inform trainers. However, trainers need to think about how best to present the information to participants. This could include discussion as well as the use of activity 1.Child and young person centred –The CAF is jointly owned with children/young people and families and it must be completed in partnership with them at all stages (it is done with, not at, or on them). The needs of the child/young person must be at the centre of all discussions and they must have a copy of all information recorded through the CAF.A holistic assessment – The CAF looks at all areas of a child/young person’s life – not just the focus of a single service. All practitioners must look beyond just the presenting issues and know who to contact for additional support if necessary (see guide 1.11, 5.1). The CAF is not a specialist assessment and does not require specialist skills and knowledge to undertake it (though appropriate local CAF training will be required).Focused on strengths as well as needs – The CAF will assess what a child, young person and family do well, alongside their needs. Delivery plans developed from the CAF assessment will look to build on strengths as a basis for supporting needs. All delivery plans must include what the child/young person and their family can and will do for themselves.Voluntary and only undertaken with consent – The child/young person or the parent carer must agree to take part in the CAF process and provide their consent. If they do not consent, CAF can not go ahead. Practitioners need to consider how best to explain the CAF and it benefits to each individual, tailoring explanations to meet the needs of the child. Leaflets about CAF aimed at young people and at parents are available form the Every Child Matters integrated working website. The better the explanation the higher the chances of gaining consent. A young person aged 16 or over, or a child under 16 who has the capacity to understand and make their own decisions, may give (or refuse) consent for the assessment to take place and for information to be shared with others. All practitioners should have attended training on information sharing (including consent) before this CAF training. More information on consent and information sharing is in section 7 of the CAF practitioner guide as well as in the information sharing guide and training. (see guide 2.11 to 2,14; 2.18; 6.9; Section 7).A standardised process supported by a form – The CAF process (which is looked at later) offers the opportunity to have a discussion with a child/young person and/or their parent/carer, to identify and agree needs and strengths and plan a way forward. The CAF process is not focused on the filling in of forms. However, through the CAF process a standardised range of information will be gathered and recorded (this is looked at later). The information may be recorded on paper forms, on local IT systems or through National eCAF. The CAF form (whether paper or electronic) simply provides a standardised way of recording the outcomes of the CAF process and supporting the sharing of information (with consent).Able to improve links to specialist assessments – Information from the CAF will help inform specialist assessment where appropriate and vice versa. (see slide and notes on A Continuum of Needs and Services). However, the CAF will not replace specialist assessments which have a specific purpose and are usually undertaken by specific staff only. There is detail on the links between the CAF and specialist assessment in section 5 and Annex C of the CAF practitioner guide. Participants should be pointed to this, but it is not explored during this training. Trainers should also note that there is ongoing ( ) research and work looking to better understand and strengthen the links between CAF and other assessments. CWDC research is available fromCoordinated so there is only ever one active CAF episode (see definition below) for an individual child or young person – Each area must have arrangements for coordinating the CAF process. Practitioners can (and should) ask the young person/family if a CAF already exists but there also needs to be a formal system. Every practitioner needs to be able to easily and quickly:Check if a CAF already exists for an individualIf it exists, who undertook it and how they can be contactedIf it does not exist and the practitioner plans to undertake one, they can log that they are undertaking one so others will know if they check.This may happen through ContactPoint, National eCAF or other arrangements made locally (It is not possible to search National eCAF to see if a CAF already exists. However, National eCAF provides a facility to link to ContactPoint, with appropriate training and access, to see if a common assessment already exists and who is already involved.) Whatever the system used locally it must ensure there is only ever one active CAF episode for an individual (though they may have had previous CAF episodes that are now closed).A CAF episode is one complete journey through the CAF process, from identifying need early through to all identified needs being met (or the episode being closed for another reason). It describes the assessment of a child or young person’s strengths and additional needs and the actions taken to meet those needs. A child or young person can have more than one episode at different points in their development but never more than one at any given time. Coordinating the CAF process is looked at in more detail as part of the 4-step process later.Not something services can require before access to provision – but is able to inform better referrals. Services should not require a CAF assessment to be undertaken before services can be accessed. Services may require certain information and suggest that a CAF assessment would be the best way of gathering and sharing that information (and in many cases this will be the case). However, a CAF assessment has to be voluntary and undertaken with consent. If a CAF assessment has been refused, there must be other ways to access services that children and young people need, where usual access criteria are met. (see guide 5.14, 5.15). However, a CAF is able to inform better referrals (where referral is appropriate). The CAF assessment is not a referral form and should not be used as such. However, if the outcome of a CAF assessment indicates that a referral to targeted or specialist services is appropriate as part of the delivery plan to meet need, then the CAF assessment can provide the information to back up the referral (if there is consent to share).Although not noted in the slide, it will also be important to note that the CAF cannot guarantee service provision. Since resources for services are finite, completing a common assessment cannot guarantee that services (especially those involving another agency) will be delivered. Practitioners cannot make recommendations or promises for the delivery of a service from another agency but they can make an appropriate request for service or referral with relevant information (see guide 2.8, 5.14, 6.22).Link to guidanceCAF practitioner’s guide – information on the points on the slide are throughout the guide – see specific links in the text above.
14Who will use CAF and when? Any practitioner can use the CAF with an individual child or young personUse the CAF when:There are concerns about progress or wellbeing.Needs are unclear and not being met.Needs are broader than your service can address.Do not use the CAF when:Progress is good.Needs are identified and already being met.Needs are clear and all can be met by one service.There is no consent.Briefly talk through the points on the slide – but explain that participants will explore this in more depth in the activity that follows.The CAF can be used by any practitioner in the children and young people’s workforce. The diagram at figure 2 in the CAF practitioner’s guide gives a comprehensive list.A child, young person or parent can also request that the CAF is used with them.The CAF is for use with an individual child or young person. The CAF should not be used to assess the needs of groups or several family members. However it may be useful (with consent) to bring together information from CAF assessments for individuals within a family.Emphasise the link to the five ECM outcomes.Mention the pre-assessment checklist and if appropriate show them a copy. The pre-assessment checklist may help when deciding whether or not to use the CAF with an individual.Link to guidanceCAF practitioner’s guide – Section 2.If, at any time, there are concerns that a child may be at risk of harm, then follow LSCB procedures without delay
15Holistic Family Assessments - REFERRAL Review the action plan to measure outcomes for the family until they are back to universal servicesProduce a multi-agency action plan to ensure a shared approach to information sharing and improving outcomesTeam around the family (TAF) meeting to agree action plans and agree roles, responsibilities and timescales, agree Lead ProfessionalUndertake a holistic family assessment to identify family needs and services required to support better family outcomesIdentify initial concerns regarding family outcomes – consider need for pre-assessment or signpost to other services
16ACTIVITY ‘TO CAF OR NOT TO CAF!’ Introduce the pre assessment checklist.
17Scenario 1 – ChantelleChantelle moved to the area a month ago, with her brother and her mum, Karen. They moved closer to Karen's mum, who now looks after the children when Karen is at work. They do not have much money and are currently living in a small one bedroom, 8th floor flat that Karen says is a little damp. Chantelle has not yet started at a new education provider since the move. Chantelle seems small for her age and has a rash on her arm that she scratches a lot. Karen says it has been there a few weeks and she will take her to the doctors once they register with one. Chantelle is quiet and does not talk much.
18Scenario 2 – CarlosCarlos has a serious stutter that sometimes makes it hard for others to understand him, but he is working with a language therapist. Other than that, he is healthy, intelligent and popular – but a little shy. He lives with his mum and dad and 2 siblings in a 4 bedroom detached house.
19Scenario 3 – Tammy and her baby Tammy is 15 and lives with her Grandmother. She has recently given birth to a baby girl. She says she wants to go back to school as soon as possible so she can get an education and a good job to support her baby. Her Grandmother is supportive, but Tammy says she is considering applying to move into a flat once she is 16 so she and the baby can begin life as a proper family.
20Scenario 4 - PravinPravin is having a few difficulties in education. He is not keeping up with his peers and says he is being bullied. The home situation seems loving and supportive. Both Pravin and his parents say they do not want a common assessment to take place
21Scenario 5 – Paulette and Mickey Paulette (14) and Mickey (3) live with their mum and her boyfriend. Both Mum and her boyfriend are regular heroin users and deal from the flat to support their habit. Mickey has signs of bruising on his back and Paulette has what appears to be a cigarette burn on her arm. Both seem undernourished and are dirty.
23What does the CAF consist of? Through the process standard information will be gathered and recorded:Basic/background information.Consent, at various stages.Assessment in three domains (see below).Initial action plan.Delivery plan and review.Parents and carersAssessment domainsFamily and the environmentGive a brief overview of the main elements of the CAF.The CAF is a 4-step process, which is looked at in more detail with the next slide. This slide just contains a small version of the process diagram.Through the CAF process a standard range of information will be gathered. It will cover the following standard areas:Basic and background information such as name, address, ethnicity, home situation, who is undertaking the CAF, services working with the individualConsent to use the CAFAn assessment summary under three domains or assessment areas, each covering a range of elements (these will be looked at in activity 3)Conclusions, solution and an initial action planConsent to store and share informationDelivery plan and review arrangementsRevisiting and renewing consent.It is recommended that practitioners complete all fields marked with an asterix to obtain basic identifying data when completing the CAF form.The information gathered through the CAF process may be recorded in a range of ways, such as:On paper formsOn local electronic formsUsing National eCAF (when available).Link to guidanceCAF practitioner’s guide – Executive summary and 1.2, 5.2.Development of the child or young person
24A good CAF discussion should… Build on existing information to avoid repetitionBuild on effective engagement and communicationLead to a better understanding of strengths and needs, and what can be done to helpNot be too formal or a big eventFully involve the child or young person and their familyCover relevant areas but look beyond the surfaceBriefly discuss the points on the slide, emphasising that this is a part of each of the four steps of the CAF process.For ‘Build on effective engagement and communication’, emphasise that effective engagement and communication is the key to effective discussion and assessment through the CAF. Practitioners should engage and undertake the CAF discussion using a method and style that suits them and the child/young person. The CAF process and recording the information gathered should not impact negatively on engagement and communication. The CAF process should serve and support engagement and communication rather than engagement just being about ‘filling in the CAF form’.Short discussion: How can practitioners make sure that their CAF discussions build on their existing good practice in terms of engagement?Link to guidanceCAF practitioner’s guide – 6.7; 6.9.
25What makes a good CAF assessment? Using an approach that is:• Empowering.• Accessible.• Developmental.• Transparent.Leading to…An assessment that is:• Focused on strengths as well as needs.• Valid and accurate.• Clear and uses appropriate language.• Inclusive.• Unbiased.• Authentic.• Professional.• Solution focused.• Practical.• Evidence based with opinion recorded as such.Briefly discuss the slide, emphasising that this is about step 2 of the CAF process.In relation to the use of appropriate language, point out that it should be:Plain simple English.Understandable by the child and/or their parent.Understandable by all other practitioners.Free from jargon and with any acronyms explained.Emphasising that common assessment is undertaken with the child/parent at the centre of the process.Supportive and encouraging.Lead into the activity that follows, reminding them to keep the principles on the slide in mind.Link to guidanceCAF practitioner’s guide – 3.1 to 3.3; 6.6; 6.7; 6.10; 7.6.
26Holistic Family Assessments - ASSESS Review the action plan to measure outcomes for the family until they are back to universal servicesProduce a multi-agency action plan to ensure a shared approach to information sharing and improving outcomesTeam around the family (TAF) meeting to agree action plans and agree roles, responsibilities and timescales, agree Lead ProfessionalUndertake a holistic family assessment to identify family needs and services required to support better family outcomesIdentify initial concerns regarding family outcomes – consider need for pre-assessment or signpost to other services
27Activity Completing A CAF Activity 3: Doing a CAF AssessmentTime: 50 minutesMaterialsBlank copies of the CAF assessment (this is likely to be a paper copy for the purposes of training, but would work just the same with electronic recording).Participant sheets A, B, C and D for the activity.CAF practitioner’s guide – one per participant.NotesPart 1: Explanation and set up (5 minutes)This activity is an opportunity for participants to explore the CAF assessment and the language used within it. We will look at planning and review in a later activity.Give each participant a blank copy of the CAF assessment (or refer them to annex E of the CAF practitioner’s guide). Point out that annex D of the CAF practitioner’s guide gives definitions of each assessment element.Emphasise that this activity is very artificial – it is not intended to model how a CAF assessment would be undertaken in practice. Remember that in reality – the CAF assessment would be undertaken as a discussion with the child or young person and/or their parent. The activity is designed simply to give participants the opportunity to experience working with the CAF assessment domains and elements, using a case study. The focus is not on the actual skills of assessment that participants should have already.The case studies may lack some detail (which in reality would be gained by asking the person) so participants may need to fill in gaps by using an educated guess. There will not necessarily be information relating to every element of the CAF assessment, so participants should focus on completing elements that seem most relevant and for which they do have information.There are four case study options for this activity. Give participants the option to choose which case study they look at (so they feel it has some relevance to their role) and put them into groups accordingly. Try to make sure that group sizes are between three and six people. It is OK if not all case studies are looked at – or if more than one group looks at the same case study. Some people may not have a preference so should be allocated to a group.Emphasise that they should not be put off by some of the language used on the form, especially in the element details. These terms are used in existing assessment frameworks and aims to make the CAF compatible with these, so other agencies can build on the CAF rather than starting again. However, if the details under the element heading might damage engagement they should be explained in words appropriate to the individual, trying to focus on the positive.Part 2: Group work (40 minutes)Give each group copies of the participant sheet for their chosen case study and ask them to follow the instructions at the top of the sheet.Leave the previous slide displayed so they can refer to what makes a good assessment, including appropriate language use.Allow the majority of the time for groups to work through instructions 1, 2, and 3. on their participants sheet (ie focusing on the assessment part on pages 4, 5 and 6 of the CAF form). With around five minutes left, prompt groups to move on to instruction 4. (ie identifying strengths and needs and focusing on the conclusions, solutions and actions part on pages 7, 8 and 9 of the CAF form).At the appropriate point, bring them back together for discussion and feedback.Part 3: Whole group discussion and feedback (15 minutes)Ask each group to share the two strengths and two needs they have identified for their individual and record these on a flipchart at the front (alternatively, ask each group to record their responses on a flipchart and display it near their table).Discuss how they found it to use the form and how the form helped them identify the strengths and needs.Discuss how they can use the strengths they have identified to help build solutions for the needs – focusing on what the family can do for themselves.Discuss how they would use the form in practice. They should always use it in a way that suits the engagement. For example, if working with a cooperative adult it may be appropriate to fill in the form, in order, at the time. However, if working with a teenager it may be more appropriate to have the discussion focusing on key areas, then fill the form in later, checking it is OK with the young person before it is shared.Discuss their use of language when filling in the form and how well they have reflected the principles given in the notes for the previous slide. It may be appropriate to ask each group to read out, exactly as written, what they have put in one element boxes. Their use of language can then be discussed, looking to see how it could be improved.Note that we will look at planning and review nextLink to guidanceCAF practitioner’s guide – Section 6; Annex D; Annex E: CAF form.SuggestionThis is not included in the general timings, but if additional time is available locally the following activity could be added to explore examples of completed CAF assessments. However, it should be noted that practitioners should already have the skills and knowledge to undertake a good assessment – this is not assessment skills training.In small groups, get participants to look at a range of examples (between two and five) of completed CAF assessments. These could be real examples (with identifying details removed) or created especially for this purpose. The examples should include a range of quality.Groups look at the assessment and rate them (very good; good; acceptable; poor – possibly with a score for each) in terms of a range of quality points (such as how effectively it identifies need and strength; how effectively it informs actions necessary; how complete it is; how appropriate the language used is; how child/young person centred it is etc).Compare opinions across the groups.Consider what can be done to improve the quality of the CAF assessments they rate as not very good.Sum up by asking each group to come up with five ‘top tips’ for a quality CAF assessment.
28Most Excluded Families Family risk factors for assessmentPoverty and debtWorklessnessEducation and skillsCrime and ASBAlcohol and drugsPoor housing and homelessnessEconomic wellbeingMost Excluded FamiliesCommunities & staying safeHealth and family structuresDomestic violenceRelationship conflictMental and physical health
30What makes a good CAF plan? CAF initial plan and delivery plan should:Build on strengths and help meet needs identified through the assessment.Not promise support on behalf of others.Agree who will do what by when and when review will happen.State anticipated outcomes and how progress will be measured.Record consent to record and share.Good action planning is:Comprehensive.Efficient.Inclusive.Informative.Focused.Logical.SMART.Transparent.Briefly discuss the slide, emphasising that this is part of step 3 of the CAF process.Good action planning has four stages moving from information gathering, to undertaking the assessment, to analysis and then developing a plan.The CAF has an initial action plan (page 8 of the national CAF form) which identifies the immediate actions that people present at the assessment will take, including the child or young person and family.Where a multi-agency response is required, a Team Around the Child (TAC) will be formed. Actions identified from the assessment should be taken forward into the CAF delivery plan (on page 10 of the national CAF form) and agreed and added to by the TAC (this process is supported by National eCAF). The details of TAC are covered by the TAC and Lead Professional Training’Both the CAF initial plan and the CAF delivery plan should fulfil all elements in the boxes on the slide. Plans must also be copied to the child or young person and family and consent revisited as necessary.Progress against the delivery plan will need to be monitored and reviewed (using the review form). Review is looked at next.Link to guidanceCAF practitioner’s guide – 3.4 to 3.7; end of 6.10; 6.21 to 6.24; Annex E: CAF form.Gather informationUndertake assessmentAnalysePlan
31The CAF review The CAF review should gather and record: Who is present.Progress against each of the actions in the CAF delivery plan.Next steps.Review notes.Child/young person and parent comments and where necessary, additional consent .Outcomes of the review could be one of the following:Briefly discuss the slide, emphasising that this is part of step four of the CAF process. Discuss the information on the slide.Note that review was formally added as part of the CAF process in 2009.The CAF assessment and delivery plan need to be monitored and reviewed regularly to identify further actions and support the child or young person. In the case of multi-agency responses, this will involve meetings and liaison between the members of the TAC.The CAF has a review form (page 11 of the national CAF form) that should be used to support the review process.CAF does not pre-set a review date. The assessment will inform the review date, but good practice would indicate that review should happen within 3 months – though may be a lot less as necessary and appropriate to the individual case.Consent should be reviewed and gained again at each review stage. Additional consent forms can be downloaded from the ECM website.If there is time, it will add value to discuss when they feel it might be appropriate to reassess an individual.Note that closing a CAF is looked at in the next slide.Lead into the activity, which will look at both planning and review.Link to guidanceCAF practitioner’s guide – 6.25; Annex E: CAF form.CAF closedNew actions agreed and review date setNew assessment needed
32Activity The CAF Plan Doing a CAF delivery plan and review Time: 20 minutesMaterialsThe CAF assessments completed by the groups during activity 3.NotesLeave participants in the same groups as for the previous activity.Ask them to return to the agreed group completed CAF assessment and to consider the strengths and needs they identified in the previous activity.Ask them to look at the CAF delivery plan and review (pages 10 and 11 of the national CAF form).Working as a group again they should decide on:At least two (preferably more) desired outcomes for their individualThe actionWho will do it (child, young person and family and universal services as well as targeted services)By when.They also need to decide which of the 25 ECM aims (five for each of the outcomes – see Annex B of the CAF guide for details) their action will contribute to.They should record their decisions on the CAF delivery plan and review form.Remind them to keep the principles of a good plan in mind.Now ask them to look at the CAF review and decide:When they think review will be necessary? Why?Who should be present at the review? Why?If a TAC is likely to be necessary? Why?Take brief feedback and discuss the use of the CAF delivery plan and review in practice.Link to guidanceCAF practitioner’s guide – 2.13; 2.14; Annex B: ECM outcomes and aims; Annex E: CAF form.
33Closing a CAF A CAF can be closed for many reasons, including: Additional needs met.Child or young person has moved to another area.Child or young person has made the transition into adult services.CAF assessment superseded by specialist assessment.Consent withdrawn.Others?A CAF should not be left open indefinitely. The CAF process should be followed and at review a decision may be taken to close the current CAF episode.In most cases, a CAF will be closed because the needs have been met. This is a positive and desirable reason to close a CAF and should always be worked towards.However, there may be other reasons to close a CAF episode, including those shown on the slide (National eCAF provides a dropdown menu of possible reasons for closure).Note that when a child/young person moves areas it is likely that the CAF episode will be closed in one area and reopened (as necessary) in the new area. This will not be necessary with National eCAF, which facilitates easier sharing across borders.Also note that if consent is withdrawn, and cannot be regained, the CAF episode can not continue.Discuss what might indicate that a CAF episode should be closed. It may add value to use the case studies from activities 3 and 4 as the basis for the discussion.Ask if there are any other circumstances in which they think a CAF episode would need to be closed.Link to guidanceCAF practitioner’s guide – 6.25; Annex E: CAF form.
35The team around thefamily (TAF) and thelead professional
36Holistic Family Assessments - TAF Review the action plan to measure outcomes for the family until they are back to universal servicesProduce a multi-agency action plan to ensure a shared approach to information sharing and improving outcomesTeam around the family (TAF) meeting to agree action plans and agree roles, responsibilities and timescales, agree Lead ProfessionalUndertake a holistic family assessment to identify family needs and services required to support better family outcomesIdentify initial concerns regarding family outcomes – consider need for pre-assessment or signpost to other services
37Tools and processes that support integrated working Lead professional and team around the child as part of integrated workingTools and processes that support integrated workingLead professionaland TAFInformation sharingCAF andNational eCAFCommon coreMulti-agency workingImproved outcomes:• Be healthy.• Stay safe.• Enjoy and achieve.• Make a positive contribution.• Achieve economic well-being.Remind them that TAC stands for Team Around the Child (the model also applies to young people and some areas refer to the team around the young person or TAYP).Also remind participants that integrated working is when everyone supporting children, young people and families works together effectively to put them at the centre, meet their needs and improve their lives.The focus here is to briefly emphasise that TAC and lead professional are just elements of the tools and processes that support integrated working. For TAC and lead professional to be effective they need to work with all of the other elements and within the context of integrated services.Emphasise that all of the work that staff in the children’s workforce undertake is about improving outcomes for children and young people and that TAC and role of the lead professional have an important part to play in achieving this.NOTE: There is an optional slide at the end of the slide pack that shows the national training journey for practitioners and managers. Trainers may choose to use this at the start of the course, making any relevant local adaptations.Link to guidanceTAC and lead professional practitioner’s guide – 1.11; Section 2.
38The Team around the family (TAF) The TAF is a multi disciplinary team of practitioners established on a case by case basis to support a child or young person and their family.The model does not imply a team that is located together or who work together all the time.Practitioners in the TAF can come from across the workforce and will focus on strength as well as need.Use this slide to briefly introduce the concept of the TAC. More detail will be covered later.A TAC should be set up when a CAF assessment indicates that a range of practitioners are required to meet the assessed needs. Once set up, the members of the TAC will then work together to meet the needs identified through the CAF assessment.A multi-disciplinary team is a set of people working to a common aim drawing on a range of professional disciplines (They usually, but not always, come from a number of agencies or services). You may refer back to An Introduction to Integrated Working that looked at multi-agency working.Link to guidanceTAC and lead professional practitioner’s guide – 1.5 to 1.7.
39Forming the TAFWhere a multi-agency response to the CAF assessment is required, a TAF should be arranged by the person who initiated the CAF assessment.The child or young person and/or their parent/carer must be a full and active part of the TAF at all stages and be invited and encouraged to attend meetings.Invite relevant practitioners, as identified through the CAF assessment.TAF practitioners might include those from statutory as well as voluntary/third sector organisations and include:Universal services.Targeted services.Specialist statutory services, if appropriate.The TAC is a part of steps 3 and 4 of the 4-step CAF process.In step 1 of the CAF process, needs are identified early.In step 2 of the CAF process, those needs are assessed.In step 3 of the CAF process, integrated services are delivered. Where a multi-agency response to the CAF assessment is required, a TAC meeting should be arranged by the person who initiated the CAF assessment.The child, young person and family should be fully involved in deciding who is a part of the TAC, who is the lead professional and what their role will be. The CAF assessment will be key in identifying who should be a part of the TAC. They should also be invited and encouraged to attend TAC meetings.Those practitioners invited to be a part of the TAC will vary from case to case, as it will depend on the needs and age of the child or young person. However, consideration should be given to inviting:Practitioners from relevant universal services (eg health visitor for under fives; Children’s Centre; School; Connexions; Youth support etc).Relevant targeted services (eg additional health services such as occupational therapist or speech and language therapist; education support services, such as educational psychologist or education welfare; substance misuse services; housing etc).Specialist statutory services, if appropriate (eg If the situation is considered to be close to the threshold of requiring statutory intervention, such as safeguarding concerns, serious mental health issues, or offending behaviour). This should be discussed with the appropriate agency to decide whether they should be present at the TAC meeting.This should include anyone that the parent/carer/child/young person deems to be relevant to the assessment or supportive.Services may be from the statutory or voluntary/third sector or private sector.If an invited agency is unable to attend the TAC meeting, then information should be gained from that service prior to the meeting.In step 4 of the CAF process, progress is monitored and reviewed. This is looked at in a later slide.Link to guidanceCAF professional practitioner’s guide – 6.20 to 6.26.
40TAF meetings Initial meeting Review meetings Share information to gain a fuller pictureDiscuss progressInitial meetingShare any new informationAgree a lead professionalUpdate planAgree achievable goalsAgree achievable goalsAgree and record actions to meet goalsAgree new actions, OR close, stating reasonsThe following should happen at the initial TAC meeting:Make sure the child or young person and/or their parent/carer are a full and active part of the TAC. They must understand what will happen to the information they provide and give consent to any sharing.Share the CAF assessment with each member of the TAC, along with any other relevant information held by TAC members. This information sharing will be with the consent of the child, young person or their family as they will have consented to the specific service being part of the TAC (National eCAF has a drop down menu of services to help this process). Through sharing each TAC member will gain a fuller picture of the needs and strengths of the child or young person.A lead professional will be agreed (using the selection criteria looked at previously). This is not necessarily the person who initiated the CAF assessment or arranged the initial TAC meeting.Agree achievable goals (both short and longer term as appropriate) with the child/young person/parent/carer (linked to the ECM aims and outcomes)Agree and record the support and actions (what, by who and by when) to meet the needs and achieve goals, from each member of the TAC.Record agreed actions on the CAF delivery plan.Set a review date.At the agreed review date, the TAC members meet again and the following should happen:Discuss and check progress against each of the actions in the delivery plan and share any new information.Update the plan and involve any new services as required. Additional consent will be required to involve and share with any additional services.At the end of the review meeting, the CAF should either be closed and the TAC wound up, or where necessary, further actions identified and another review date/TAC meeting agreed (at this point, it may be necessary to remind participants about what they covered during the CAF training, on closing a CAF).Record the review on the CAF review form.Overall, the review process involves the following:The common assessment and delivery plan are regularly reviewed by the TAC to monitor progress toward agreed outcomes. The review identifies any unmet or additional needs for the child or young person’s smooth transition between universal, targeted and specialist services. In the case of multi-agency responses, this will involve further multi-agency meetings and liaison between the members of the TAC.A review date should be set at the time of each TAC Meeting. Reviews should take place within three months, but in some circumstances, it will be necessary to review the case more frequently, depending on the complexity of the child’s needs or if things are not going to plan.The review should ideally take place in the form of a TAC but could also be undertaken by the lead professional with the family, with information provided by the other practitioners involved. The CAF review form supports this process.The review process should focus on:Any changes in circumstances or emerging issues.What support is currently being provided.What measurable progress has been made regarding each of the goals (referring to the CAF form re the needs originally identified and goals set).Whether future action is still deemed necessary and whether the CAF process needs to continue. If so, then future targets, actions and review dates to be set.The views of the child/young person/family regarding the process.Ensuring consent is reviewed and updated as necessary.It may be at the review that just the CAF review form needs to be completed. However, if there are major changes in circumstances or new information emerging, then it may be that the CAF plan needs to be updated, or even a new CAF assessment undertaken. If the CAF assessment needs to be updated, then the lead professional should ensure that this is undertaken, making sure that the new version is dated, consent is gained and a version number added. (This process can be supported by National eCAF).It is important, that the lead professional distributes the completed CAF review, and if relevant also the updated CAF assessment, and revised consent form, to the family and to all relevant practitioners as agreed with the family (including any central CAF or integrated working team as agreed locally).Link to guidanceTAC and lead professional practitioner’s guide – 1.8 to 1.10; 2.7.CAF professional practitioner’s guide – 6.20 to 6.26.Set date for review meeting (within three months is recommended)
41Convening an initial TAF Meeting ActivityConvening an initial TAF MeetingConvening an initial TAF meetingTime: 30 minutesMaterialsPost-it notes (three different colours or shapes).Notes:Tell participants that the activity will allow them to explore what is required to ensure an effective process around convening and running an initial TAF meeting. The activity focuses on the role of the person convening the meeting, but will also briefly consider the role of those who are invited.Divide the participants into three groups (if necessary, divide the room in half and have six groups – ie two sets of three).Prepare three flipchart sheets with the following headings:What needs to be done before the initial TAF meeting?What needs to be done at the start of and then during the initial TAF meeting?What needs to be done after the initial TAF meeting has ended?Give one flipchart sheet to each group along with a set of post-it notes (preferably a different colour or shape to each group, so they can identify their contributions later on). Tell participants that they need to convene a TAF meeting for a child or young person. They can think generically (as the elements will be the same for all cases). However, if it helps to focus their thinking, they could look at convening a TAF for those children in the case scenario's previously used (or think about a real case of their own).Give the groups a suitable amount of time (probably no more than eight minutes) to consider their heading and to come up with as many actions as they can. They should write each action onto a separate post-it note. Once they have come up with as many actions and they can (or the trainer allocated time has run out), ask them to stick the post-its to the flipchart sheet in the order they think the actions should happen. Once stuck on, they should number their post-its in order (this allows them to see if any other group changes their order later).Ask each group to swap their sheet with another group. They should look at what the previous group has come up with and add their own ideas. They should add any other action on post-its. They may also choose to reorder the actions. After a suitable amount or time (probably no more than five minutes), ask the groups to swap for the last time and repeat the process.Once all groups have seen and contributed to all three sheets, bring the group back together. Display the three sheets at the front and discuss the outcomes. Can they agree on a set of actions and an order that the whole group would see as good practice? Could they use this as the basis for a local check-list?At the end, point out that the exercise has focused on the role of the person who convenes the initial TAF. Go back to the list and consider which of the actions might also apply to practitioners who are invited to the initial TAF meeting. Are there any additional and/or different actions at each stage for practitioners who are invited to the TAF? What actions might be needed from the child, young person and family?If there is time, it might add value to consider actions at a TAF review meeting.
42Holistic Family Assessments - PLAN Review the action plan to measure outcomes for the family until they are back to universal servicesProduce a multi-agency action plan to ensure a shared approach to information sharing and improving outcomesTeam around the family (TAF) meeting to agree action plans and agree roles, responsibilities and timescales, agree Lead ProfessionalUndertake a holistic family assessment to identify family needs and services required to support better family outcomesIdentify initial concerns regarding family outcomes – consider need for pre-assessment or signpost to other services
43TAF practitioner responsibilities The lead professional coordinates delivery of the plan.Each practitioner in the TAF is responsible/accountable to their home agency for the services they deliver.Jointly responsible for developing/delivering the CAF delivery and review planResponsible for delivering the planned activitiesResponsible for monitoring and keeping TAF informed about their progressAttend TAF meetings and contribute to taking minutes, chairing and other tasksSupport the lead professional, including providing information and offering guidance and adviceContribute actively and positively to problem solving and resolving difficulties in a child centred wayThis slide outlines some of the key responsibilities of practitioners who are part of the TAC. Although the lead professional has a coordinating role – it is a TEAM around the child and each member of the TAC has an important role to play in ensuring that the needs of the child or young person are met.The child, young person and parents also have a responsibility to undertake the actions they agreed to as part of the CAF delivery plan.Every member of the TAC has a responsibility to deliver the CAF action plan.Link to guidanceTAC and lead professional practitioner’s guide – 1.8 to 1.10.CAF professional practitioner’s guide – 6.20 to 6.26.Remember the ‘T’ in TAF stands for team
44Holistic Family Assessments - REVIEW Review the action plan to measure outcomes for the family until they are back to universal servicesProduce a multi-agency action plan to ensure a shared approach to information sharing and improving outcomesTeam around the family (TAF) meeting to agree action plans and agree roles, responsibilities and timescalesUndertake a holistic family assessment to identify family needs and services required to support better family outcomesIdentify initial concerns regarding family outcomes – consider need for pre-assessment or signpost to other services
45The role of the lead professional The lead professional is a set of functions to be carried out as part of the delivery of effective integrated support, when a range of services is involved with a child or young person following a common assessment.The lead professional will:Act as a single point of contact for the child, young person or family.Coordinate the delivery of the actions agreed by the practitioners involved.Reduce overlap and inconsistency in the services received.Evidence from practice suggests that having a practitioner take the lead is central to the effective frontline delivery of integrated services for children with a range of additional needs. Delivered in the context of multi-agency assessment and planning, underpinned by the CAF, it ensures that professional involvement is rationalised, coordinated and communicated effectively.The lead professional is not a job title, but a set of functions to be carried out as part of the delivery of effective integrated support.The CWDC research document Use of Team Around the Child (TAC) Model for the Year Age Group considers the use and impact of TAC, as well as CAF and lead professional. It is available fromThere are three core functions of the lead professional, as per the slide. In many cases, practitioners are already delivering these functions – the lead professional guidance and practice aims to build on and spread existing good practice. The functions of the lead professional have to be embedded across the children’s workforce as a core aspect of service delivery for all children with additional needs requiring an integrated response, to ensure more consistency, higher quality and improved outcomes.NOTE: This training, as well as the TAC and lead professional guidance, focuses solely on the generic lead professional functions. 16 local authority areas were involved in a pilot of a related concept called the Budget Holding Lead Professional (BHLP). The national BHLP pilot report is available from:
46“Myth Busting” – the lead professional Does not have to be an ‘expert’ in everythingIs not automatically the person who initiated the CAFDoes not need any particular qualificationsWill not be expected to work outside their usual remitIs not responsible or accountable for actions by other practitioners or services in the TAFWill have support mechanisms in place to resolve any issuesDoes not become responsible for the needs of the entire familyMay use more time in one area, but save time elsewhereThe slide highlights some points to remember about the lead professional – in many cases they are common myths that need to be ‘busted’. Some of the issues may already have been covered through previous slides (or the suggested activity, if used) and some will come up again later – but this slide serves to focus attention and clarify some important points before moving on.Does not need any particular qualifications – The lead professional needs certain skills and knowledge, which will be looked at later, but a particular qualification or job role is not required.Does not have to be an ‘expert’ in everything – The lead professional will work with others, often as part of a TAC, so different practitioners and services will share skills and knowledge and each will do what they do best.Is not automatically the person who initiated the CAF – The practitioner who initiated the CAF assessment is responsible for convening the initial TAC meeting (where a multi-agency response is needed). The lead professional then will be agreed from those who are part of the TAC. (Selecting the lead professional is looked at later). The lead professional sits alongside and is intrinsically linked to the CAF.Is not responsible or accountable for the actions of the other practitioners or services within the TAC. The lead professional is accountable to their home agency for delivering the lead professional functions and the service provision and actions they have agreed. Agreeing a plan of action places responsibility and expectations not only on the lead professional but on every practitioner involved in supporting the child or young person. The lead professional will be responsible for gathering people together to review progress but it is up to the individuals to deliver on their agreed actions. This takes a commitment and recognition from everyone involved that the process is a shared one.Will have support mechanisms in place to resolve any issues – for example, other services failing to deliver on agreed actions. Support and management is looked at later.Will not be expected to work outside their usual remit – Undertaking the functions of the lead professional will not involve practitioners working outside of their usual remit. For example – if a practitioner is employed to work with young people aged 13 to 19 they will not be expected to undertake work with five-year-olds. If a practitioner is employed to support young peoples learning needs in school, they will not be expected to provide specialist input on issues such as drugs. Getting practitioners to work beyond their remit – and beyond their areas of personal and professional expertise – is neither safe nor desirable.Do not become responsible for the needs of the entire family – The strengths and needs of children and young people may often be linked strongly to the family context. Practitioners should consider the family context, however, the focus of the work should remain on the child or young person – bringing in and referring on to other support as necessary and appropriate for the adults. Some families may have more than one lead professional attached to them (eg for a five-year-old and a teenager). In these cases the lead professionals should communicate appropriately with each other and where possible coordinate TAC meetings to make things easier for the family. Where the children or young people are of similar ages (and similar needs) and fall within the remit of one practitioner, they could be lead professional for more than one child in a family. eg a Connexions personal adviser acting as lead professional for a 14-year-old and his 16-year-old sister, both of whom have a range of needs related to their attendance and achievement at school.May use more time in one area, but save time elsewhere – Time may well be the major concern for practitioners when it comes to being the lead professional. This is looked at in more detail later, under capacity and workload, as part of management support.Link to guidanceTAC and lead professional practitioner’s guide – 1.4.SuggestionTrainers may choose to add some ‘myths’ that are particularly local in nature and take the opportunity to discuss and ‘bust’ the local myths.
47Who can be a lead professional? All practitioners in the children and young people’s workforce can be a lead professional, with appropriate training (ie this training or something equivalent).The diagram on the slide is Figure 4 in the TAC and lead professional practitioners guide and it illustrates the broad range of practitioners within the children and young people’s workforce who may, at some time, take on the lead professional role.Although it rarely happens, it is possible that a young person, parent or carer may be the lead professional. In these cases the person would still require help from the TAC to carry out the role.Link to guidanceTAC and lead professional practitioner’s guide – 3.1 and 3.2; Figure 4; 3.6.
48Core tasks of the lead professional Be a single point of contact for the child, young person and familyBe a single point of contact for all practitioners working with the childBuild a trusting relationship to secure engagementContinue support if appropriate, if specialist assessments are neededConvene the TAF meetings to enableintegrated multi-agency supportIdentify where others may need to be involved and broker involvementSupport the child/young person through key transition pointsEnsure a safe and planned ‘handover’ if a different LP is agreed and more appropriateCoordinate delivery of solution focussed actions and ensure regular reviewsTo meet the lead professional functions, there is a range of core tasks that a lead professional may need to carry out. Some examples are shown on the slide.Briefly discuss the tasks – they will be explored in activity 1.Briefly ask participants if they think there are any other tasks needed to fulfil the lead professional functions.
49Knowledge and skills of a lead professional Knowledge – understand:CAF and integrated working.How to access services.The child/young person’s strengths and needs.Information sharing, consent and confidentiality.Safeguarding.Boundaries of own knowledge.Skills – ability to:Establish relationships.Support, empower and challenge children and young people.Convene inter-agency meetings.Work with practitioners from a range of services.Knowledge and skills underpinned by:Effective communication.Planning, organisation and coordination.Critical and innovative thinking.Whatever the practitioner’s background, emerging practice suggests there is a key set of knowledge and skills needed to deliver the lead professional functions. These are summarised on the slide and in Table 1 in the guide.Briefly discuss the knowledge and skills – they will be explored in activity 1. In general, the knowledge and skills of a lead professional are core professional skills and knowledge that most practitioners already have and use on a day-to-day basis.The lead professional is not expected to be an expert in all areas – some lead professionals may need help in improving some of the skills and acquiring some of the knowledge. The list can form the basis for a discussion between practitioners and managers about strengths and areas for development. The list could also form part of a learning and development plan, linked to the Common Core of Skills and Knowledge for the Children and Young People’s Workforce. The Common Core sets out the knowledge and skills all practitioners need to work effectively with children, young people and families.Link to guidanceTAC and lead professional practitioner’s guide – 3.3 to 3.5 especially table 1.
50Exploring the Lead Professional task, knowledge and skills ActivityExploring the Lead Professional task, knowledge and skillsExploring lead professional tasks, knowledge and skillsTime: 25 minutesMaterialsHandouts of the previous two slides – or leave the slides projected during the activity. Or point them to 1.3 and Table 1 in the guide for details.NotesPut participants into small groups (preferably from similar services) and ask them to look at the ‘Core tasks of the lead professional’ – either on the projected slide, or with the slide as a handout, or just direct them to 1.3 in the TAC and lead professional practitioner’s guide.Ask participants to briefly discuss the ‘tasks’ and to identify which ‘tasks’ (if any) they do not do as part of their current role and/or feel they would benefit from some support to do effectively.Bring the groups back together and ask each group to feedback their thoughts. Record them on a flipchart at the front.Next, ask the groups to look at the ‘The knowledge and skills of a lead professional’ – either on the projected slide, or with the slide as a handout, or just direct them to Table 1 in the TAC and lead professional practitioner’s guide.Ask participants to briefly discuss the ‘knowledge and skills’ and to identify which ‘knowledge and skills’ (if any) they do not feel they have at the moment and/or would benefit from some support to develop.Bring the groups back together and ask each group to feedback their thoughts. Record these on the flipchart at the front.Discuss the overall findings and highlight the fact that practitioners will already be involved in the majority of the tasks required of the lead professional as well as having the majority of the knowledge and skills. Reemphasise that in many cases the lead professional role is not an entirely new way of working and practitioners should feel confident in their abilities to be the lead professional.Sum up and point out that lead professionals also need to be able to engage partner agencies and practitioners. Some suggestions for doing so are given in 3.5 of the guide. If there is time, these could be discussed and additional ideas generated.NOTE: There is a suggestion for an additional activity at the end of the training that links back to the skills and knowledge they do not feel they have at the moment, and asks them to think about what can be done to help develop them.Link to guidanceTAC and lead professional practitioner’s guide – 1.3; 3.3 to 3.5 especially Table 1.
51Criteria for selecting a lead professional Criteria for selection could consider:The wishes of the child or young person, and their family.Any statutory responsibility to lead on the work.The level of trust built up.Any previous or potential ongoing relationship.Who has primary responsibility for addressing the needs.The main needs (as assessed through the CAF).The skills, ability and capacity to provide leadership and coordination in relation to other practitioners involved.The ability to draw in and influence universal and specialist services.An understanding of the surrounding support systems.As already noted, many practitioners in the children and young people’s workforce can be a lead professional, with appropriate training. However, it is helpful to have clear criteria for choosing lead professionals and a simple process to facilitate this.Deciding who is best placed to be the lead professional is done most effectively when all parties, including the child and family, discuss the identified needs, agree the intended outcomes and agree the contribution that each will make in achieving the intended outcomes.If it is not clear who is best placed to be the lead professional, it may be helpful at the initial meeting to discuss the issues and find a solution. In cases where an agreement can not be reached, the situation may need to be discussed by managers across agencies to agree a strategic approach.The criteria need to be used flexibly. The order of the criteria on the slide does not imply any particular priority. In many cases the best person to be the lead professional will only meet some of the criteria. However, the criteria should help to ensure that the lead professional will be the practitioner who is most relevant to the child or young person’s plan, and who has the skills to carry out the lead professional functions. The practitioner most appropriate to be the lead professional for a particular child may change over time.NOTE: The TAC meeting, resolving disputes and transfer of the lead professional role are all looked at later in the training.Link to guidanceTAC and lead professional practitioner’s guide – 3.6 to 3.9.
52Selecting a Lead Professional ActivitySelecting a Lead ProfessionalSelecting a lead professionalTime: 40 minutesMaterialsParticipant sheet A for exercise 4 (John).Participant sheet B exercise 4 (Lettia).NotesMention to the group that you have two case studies – six-year-old John who is having issues at school and 17-year-old Lettia who is six months pregnant. Ask them to choose which case they would like to do and then subsequently divide them into equal groups within their chosen case study. (Mixed agency groups of four to six people preferably).Tell them that they will be looking at a case study, exploring key issues around selecting a lead professional.Give out the relevant participant sheets and ask them to read the case study and as a group select the most appropriate person to be the lead professional. They will have around 15 minutes to agree upon the choice and have a reason for the decision. They should write their chosen lead professional on a post it and give it to the trainer.Prior to going through feedback of the exercise give out a copy of the other participant handout to groups and allow them a minute or so to read through so they can have some awareness of the case being covered by the other groups.Once the post its have been collected reveal the decisions to the whole group.Discuss the decision made and the reasons given. Ask them to explain why they chose the lead professional they chose. Also ask them to explain why they rejected the other possible choices. Make frequent reference to the selection criteria on the slide.The trainer should carefully facilitate the discussion. The aim is not to give the impression that there is only one possible choice (as there are a few people who could potentially be the lead professional) but to discuss the criteria and the decision making process. These case studies have been designed to make the choice difficult, to prompt discussion. In practice the choice is likely to be much clearer in most cases.The table on the next page may help in facilitating the discussions.Once one case study has been discussed, follow the same process with the other one. Sum up the discussions and consider how the criteria will help in practice – in conjunction with the CAF and the TAC meeting.Link to guidanceTAC and lead professional practitioner;s guide – 3.6 to 3.8.
53Management for lead professionals and the TAF Lead professionals should expect managers to ensure:Lead professional responsibilities are taken into account when setting caseloads.Performance in delivering the lead professional functions is recognised and recorded.Clear communication between agencies to support lead professional practice.Appropriate and up to date training and supervision is provided along with coaching and mentoring where appropriate.Emphasise that good and supportive management arrangements are essential to help practitioners work more effectively as a lead professional and to play their part within a TAC.Realistically, in some cases, undertaking the functions of the lead professional will need some additional time. However, it is important that practitioners remember that in the vast majority of cases where they may be the lead professional, they would already be the person with most input into the child or young persons needs/life and so already committing a reasonable amount of time. Also, it is about trying to invest time in prevention – some time spent effectively addressing additional needs at an early stage will, in most cases, prevent the needs from becoming more severe. This will save time overall. Effective coordination also saves time for the child and the family as well as for other practitioners making the whole system more effective. Practitioners must also remember that there will be some children and young people they work with, where another practitioner is acting as the lead professional – they can save time on these cases.Clear communication is particularly important where staff work part-time in a multi-agency setting or part-time in their home agency, so the individual is not overwhelmed with lead professional and caseload responsibilities.Link to guidanceTAC and lead professional practitioner’s guide – 4.1; 4.4 to 4.9.TAF practitioners should also expect support to fulfil their responsibilities53
54Supervision for lead professionals Line management supervision for lead professionals:ManagerialFocused on effective delivery of services and the lead professional functionsSupportFocused on reflection and evaluation of lead professional practice (could be from line manager and/or local support functions)Training and developmentFocused on continuously assessing strengths and identifying training and development needs for practitioners acting as the lead professionalEmphasise that good supervision arrangements will help a practitioner work more effectively as a lead professional.All practitioners undertaking the lead professional role (whether working full-time or part-time) should receive regular line management supervision. This can be supplemented and enhanced through peer supervision, informal supervision and the opportunity to meet up with other lead professionals to share best practice.Supervision can have different meanings in different agencies. In the context of the lead professional, line management supervision covers what is on the slide.During supervision, the lead professional may wish to discuss issues such as the impact on their workload in relation to taking on the lead professional role; professional development and training needs in relation to the role; help in reflecting upon their intervention and support in tackling any problems that may arise in the role.
55Resolving disagreements and disputes Could arise over:Selection of the lead professional.Roles and responsibilities of TAF members.The need for action and by whom.Communication.Others?Resolve problems quicklythrough clear local systems:Between the parties.Line manager support and/or other local support systems.Negotiation between agencies at senior management level.Children’s Trust coordinated arrangements at strategic level.Director of Children’s Services.It is possible that disagreement and disputes may arise for the lead professional and for those working within the TAC. The slide suggests some possible causes of disagreement and dispute. Ask the group if they can think of any other possible areas of likely disagreement and disputes. Stress that throughout the process of addressing disputes the focus must be on the needs of the child or young person.Where disputes arise between the lead professional and another practitioner or between members of the TAC, they should first try to arrive at a resolution at practitioner level. Add that it may be possible for conflicts to arise between the lead professional and parents/child/young person, for example not agreeing over action plans for the child. As always the lead professional must have the child or young person’s interests as the central focus that determines his/her actions while keeping parents empowered and involved.Where issues cannot be resolved at practitioner level, the lead professional should contact their manager or other local support person (eg CAF coordinator) and advice and support should be sought. If it is not resolvable at this level than it can be taken further, as the slide suggests.A clear line of accountability for lead professionals runs from the practitioner, through line management in the home agency, through coordinated arrangements in the Children’s Trust, and ultimately to the Director of Children’s Services (DCS) on behalf of the local authority. This line of accountability will provide support for the lead professional and provide a mechanism for resolving any issues with non-delivery of agreed actions.Link to guidanceTAC and lead professional practitioner’s guide – 3.9.
56Transfer and endings for the lead professional Being a lead professional is not a permanent thing:Children and young people’s needs change (in their level, extent and focus).Situations and relationships change.Practitioners change.Children and young people get older.Transfer and endings of the lead professional functions, where appropriate, need to be carefully planned and managed.Explain that being the lead professional is not a situation without an end. As the relationship between the practitioner and children, young people and their families is a professional one, endings are inevitable so they should be discussed and prepared for. Needs change (in their level, extent and focus):A child or young person may be assessed, through CAF, as having additional needs. If they are then supported by a lead professional, their needs may be met. Consequently they may move back to having no additional needs. If this is the case, a lead professional is no longer needed. This is the situation we should always be working towards and a managed ending should take place.Where a child/young person moves from having complex needs to additional needs, it may be necessary for a lead professional to be to appointed or the functions to be transferred. For example, a young person who has had a YOT worker acting as the lead professional may need to have the lead professional functions transferred to someone else (such as the Connexions personal adviser) at the end of their YOT intervention.Even with the effective implementation of CAF and the lead professional, the needs of some children and young people will move from being additional needs into being complex needs. In these cases, it may be appropriate for the lead professional to transfer to someone with statutory responsibilities (eg where a child becomes a looked after child). However, a lead professional should not assume that because a young person has complex needs that they will automatically receive integrated and coordinated support from one person. A managed transition will still be necessary.The focus of work or main priority needs may change, meaning that it may be more appropriate for someone else to be the lead professional.Situations and relationships change: Issues may develop between the lead professional and the child, young person and family that mean the relationship changes and another person may be more effective as the lead professional.Practitioners change: The lead professional may get a new job, move to another area, or change their working pattern, resulting in a new lead professional being necessary.Children and young people get older: Practitioners should not be working beyond their job and experience, particularly in relation to age. For example, an early years practitioner who has been the lead professional will need to transfer the role to an appropriate person once the child starts school.Transfer and endings of the lead professional functions, where appropriate, need to be carefully planned and managed. A lead professional must not withdraw their services until the planned ending has been achieved or a successful transfer completed. This should be with discussion and agreement from the child, young person and/or family. All relevant information should be passed on (with appropriate consent). The practitioner may stay involved, but not as the lead professional.Link to guidance
59Information sharing as part of integrated working Tools and processes that support integrated workingInformation sharingCAF andNational eCAFLead professionaland TAFMulti-agency workingCommon coreImproved outcomes:• Be healthy.• Stay safe.• Enjoy and achieve.• Make a positive contribution.• Achieve economic well-being.Participants will have looked at each of the elements on the slide before, as part of An introduction to integrated working that all participants should have covered prior to this training. Give a brief reminder as necessary and appropriate to the group – using the notes from An introduction to integrated working.Remind participants that integrated working is when everyone supporting children, young people and families works together effectively to put them at the centre, meet their needs and improve their lives.The focus here is to briefly emphasise that information sharing is just one element of the tools and processes that support integrated working. For information sharing to be most effective it needs to work with all of the other elements and within the context of integrated services.It is most important that people remain confident that their personal information is kept safe and secure and that practitioners maintain the privacy of the individual, whilst sharing information to deliver better services. It is therefore important that practitioners can share information appropriately as part of their day-to-day practice and do so confidently.There is already much good practice, but the information sharing guidance aims to provide practitioners and managers with additional clarity and confidence, through clear practical guidance, drawing on experience and consultation from across a spectrum of adult and children’s services.To feel confident about making information sharing decisions, it is important that practitioners understand:Effective information sharing as part of prevention and early interventionConfidentiality and its limitsWhat to do where there is risk and/or harm to children, young people or adultsThe support to expects for employers.There are a number of national drivers for improvements in information sharing, including ECM, the Children’s Act 2004 and the Children’s Plan (2007). There is also a range of supporting policy and guidance (see link below).Emphasise that all of the work that staff in the children’s workforce undertake is about improving outcomes for children and young people and that information sharing has an important part to play in achieving this.NOTE: There is an optional slide at the end of the slide pack which shows the national training journey for practitioners and managers. Trainers may choose to use this at the start of the course, making any relevant local adaptations.It is also important to point out that this training is focused on information sharing and not data sharing.Information sharing refers to front-line practitioners sharing relevant personal information about children, young people and families where appropriate. It is about situations where practitioners have to use their professional judgement to decide whether, when and what personal information to share with other practitioners on a case-by-case basis.Data sharing is about pre-planned or bulk sharing of data between systems or organisations. Data sharing can be planned in advance, with time to consider and consult on all the implications, undertake privacy impact assessments, etc and draw up formal agreements (often called information sharing protocols) that cover all aspects. Information sharing protocols are formal, signed agreements between organisations that relate to a specific information sharing activity. An ISP explains the terms under which the organisations have agreed to share information and the practical steps that need to be taken to ensure compliance with those terms. Information sharing protocols may be useful in data sharing situations but are not appropriate for situations where front-line practitioners have to make case-by-case decisions about whether and what to share. Trying to apply the same processes to information sharing at the front-line where practitioners have to make decisions in short timescales would probably mean that no information was ever shared or at least not within the timescales to make it useful!For front-line information sharing, it is not generally possible to specify in advance what, when and with whom information should be shared. Hence the focus has to be on building the skills and confidence of practitioners in making these judgements and sharing information appropriately and securely – rather than just developing protocols.Link to guidanceInformation sharing guidance – 1.1 to 1.5; 1.19 to 1.21; Annex A.Note: This training is about information sharing and not data sharing
60Sharing information as part of early intervention and preventative services Increased emphasis on integrated working across services to better identify and meet needsEffective partnership working between universal and targeted specialist services.Active processes for identifying those at risk of poor outcomes.Sharing between adult and children’s services.Sharing to support transitions.Success depends upon…There is an increasing emphasis on integrated working across services with the aim of delivering more effective intervention at an earlier stage. Early intervention aims to prevent problems escalating and to increase the chances of achieving positive outcomes.Whether the integrated working is through specific multi-agency structures or existing services, success for those at risk of poor outcomes depends upon effective partnership working and appropriate information sharing between services.Partnership working must include active processes for identifying those at risk of poor outcomes, through use, where appropriate, of the Single Assessment Process (SAP) in adult’s services and the Common Assessment Framework (CAF) in children’s services.Information should also be:Shared between adult and children’s services where appropriate, to put preventative support in place for the children and family. Where an adult receiving services is a parent or carer, sharing information where appropriate with colleagues in children’s services could ensure that any additional support required for their children can be provided early.Shared to support transitions such as a child moving from nursery into primary school; from primary to secondary school; moving into adulthood; or when leaving long-term care, hospitalisation or prison. Information sharing helps ensure that the person gets the support that they require, through and after the transition.Preventative services working in this way will be more effective in identifying concerns about significant harm eg as a result of abuse or neglect. However, in most situations the need will be for additional services in relation to education, health, behaviour, parenting, or family support, rather than for intervention to protect the child or young person from harm, or to prevent or detect serious crime.Before going on, it might help if participants are encouraged to see information sharing along a continuum (using the model developed for children and young people), with preventative services at one end and significant harm at the other (with children with additional needs and children with complex needs in between). This training starts by looking at the two ends of the continuum (ie sharing information as part of preventative services and sharing information where there are concerns about significant harm) then moves on to look at sharing information in the middle sections of the continuum where practitioner judgement becomes increasingly important.Trainer may choose to use the slide ‘A continuum of need’ here. The slide is explored in more detail in the CAF and lead professional training, but it may add value to look at it briefly here. The slide (shown below) is included at the end of the powerpoint slide document, so trainers can choose to use it or not. The diagram (often called the windscreen) is taken from the CAF practitioner guide.Link to guidanceInformation sharing guidance – 1.6 to 1.9.
61Sharing information if concerned about significant or serious harm Practitioners must:Issues to consider:Always consider referring concerns to children’s social care or police, following LSCB proceduresSignificant harm to children and young people or serious harm to adults can arise from a number of circumstancesConfidential information can be shared without consent if justified in the public interestSeek advice if unsure what to doIt is good practice to seek consent and/or discuss concerns, unless this would increase the risk of harmEmphasise that all practitioners MUST be familiar with their Local Safeguarding Children Board (LSCB) procedures and should seek and attend suitable safeguarding and child protection training locally. This training assumes that practitioners understand the key principles of safeguarding and child protection, and these are not covered during the training.While in general, practitioners should seek to discuss any concerns with the family and, where possible, seek their agreement to making referrals to social care; this should only be done where such discussion and agreement-seeking will not place a child at increased risk of significant harm or an adult at increased risk of serious harm. The individual’s safety and well-being must be the overriding consideration in making any such decisions.Significant harm to children and young people can arise from a number of circumstances – it is not restricted to cases of deliberate abuse or gross neglect.Where harm, or risk of serious harm to a vulnerable adult is suspected, appropriate action should be taken in accordance with local codes of practice. Contact should be made with the appropriate person, for example, a safeguarding officer or vulnerable adults’ worker.Significant harm to children and serious harm to adults is not restricted to cases of extreme physical violence. For example, the cumulative effect of repeated abuse or threatening behaviour may constitute a risk of serious harm to an adult. The theft of a car for joyriding or driving with poor eyesight may well constitute a risk of harm to others in the community as well as those in the car.If practitioners are unsure what to do (eg whether what has given rise to the concern constitutes ‘a reasonable cause to believe’.) the concern must not be ignored. They should always talk to someone to help them decide what to do – a lead person on child protection, a Caldicott guardian, or an informal discussion with a trusted colleague or another practitioner who knows the person. The identity of the child or young person should be protected wherever possible until reasonable cause for the belief has been established.Practitioners who work in the youth justice system should also refer to When to share information best practice guidance for everyone working in the youth justice system (DH, 2008). This document can be accessed atLink to guidanceInformation sharing guidance – 1.10 to 1.18.Timely sharing is important in emergency situations
62Information sharing decisions Decisions about information sharing should be based on an assessment of benefits and risks to the child, young person or family.Decision to shareDecision not to shareYou must assess:How would sharing information benefit the child, young person or family?What are the risks if information is not shared?You must assess:What are the benefits of not sharing information?What are the risks if information is shared?There is no set formula for deciding when to share information and what to share – the decision requires the practitioner to make an informed judgement. In order to be confident of their judgement, practitioners need to understand how to share information lawfully and to risk assess their decision.In each individual case, practitioners should always weigh up the benefits and risks if the information is shared against the benefits and risks if the information is not shared. This will be particularly important in cases where there is not consent to share, and sharing is happening as it is deemed to be in the public interest (see slide 16).Consent is the key to information sharing decisions, especially in early intervention. In many cases consent will be a legal requirement. For lawful information sharing, consent must be gained unless the public interest test is met or there is a statutory duty or court order (see slide 7). Consent is more than just good practice.If there is consent to share information then practitioners can be confident that they can share however they still have to consider what is appropriate to share and with whom.
63The Benefits and challenges to information sharing ActivityThe Benefits and challenges to information sharingWord storm with the group the benefits and challengesFor the ‘benefits’ discuss what they can do to build on and publicise the benefits, and how they can be used to help address some of the challenges.For the ‘challenges’ discuss ideas for things that could be done to help take the first step to minimise or remove the challenge. Try to gain ideas practitioners can do themselves, as well as what they might want from management.Ideas for overcoming barriers might include:Implementation of integrated working (including CAF, lead professional, ContactPoint and multi-agency working) will enable and support more effective information sharing.A culture that supports information sharing between and within organisationsInfrastructure and systems to support secure recording and sharing of information, including proactive mechanisms for identifying and resolving potential issues and opportunities for reflective practice.Effective supervision and designated source of advice.Emphasise that tools and guidance enable better information sharing but it is important to remember that it is the changes in culture, organisation and practice that are key to success.It may be necessary to discuss the fact that some challenges may be very difficult to deal with. Many of them may not be new, but have caused difficulty for agencies over a number of years. The aim of this exercise is not to solve all the problems but to acknowledge the challenges that exist and begin to consider ways of approaching them and moving forward.
64Seven golden rules for information sharing Remember the Data Protection Act is not a barrier to sharing information.Be open and honest with the person from the outset.Seek advice where in doubt.Share with consent where appropriate and where possible, respect the wishes of those who do not consent to share (unless there is sufficient need to override the lack of consent).Always consider the safety and well-being of the person and others.Ensure information is accurate and up to date, necessary, shared with the appropriate people, in a timely fashion and shared securely.Record the reasons for the decision – whether it is to share or not.If practitioners are asked, or wish to share information, they must use their professional judgement to decide whether or not to share and what information it is appropriate to share (unless there is a statutory duty or court order to share – see slide 7). The golden rules, when used with the key questions addressed in slides that follow, will help to inform their decision-making.Practitioners must remember that the Data Protection Act is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately.Practitioners must explain to children, young people and families at the outset, openly and honestly, about why, what, how and with whom information will, or could be shared and seek their agreement, unless it is safe or inappropriate to do so. The exception to this is where to do so would put that child, young person or others at increased risk of significant harm or an adult at risk of serious harm, or if it would hamper the prevention or investigation of a serious crime.Practitioners must seek advice where in doubt, without disclosing the identity of the person where possible, especially where the doubt relates to a concern about possible significant harm to a child or serious harm to others.Practitioners must share with consent where appropriate and where possible, respect the wishes of those who do not consent to share confidential information. Consent is the legal basis for sharing. Practitioners may still share information, if in their judgement on the facts of the case, the lack of consent can be overridden in the public interest (see slide 16) or if there is a statutory duty or court order to share (see slide 7). Note that in many cases, consent will be a legal requirement for sharing.Practitioners must base their information sharing decisions on the safety and well-being of the person and others who may be affected by their actions. Where there is concern that a child may be suffering or is at risk of significant harm, the child’s safety and welfare must be the overriding consideration.Practitioners must ensure that the information they share is necessary for the purpose for which they are sharing it, is only shared with those people who need to have it, is accurate and up-to-date, is shared in a timely fashion, and is shared securely.Practitioners must always record their decision and the reasons for it – whether it is to share information or not. If they do decide to share, then they must record what they have shared, with whom and for what purpose.Sum up by re-emphasising that:Sharing information helps to better assess and support the needs of children and young people – therefore it is in their best interests.Consent is the key, especially in early intervention – if children/young people and/or their parents/carers give their informed consent, then information can be shared.Legislation must not be used as a barrier to sharing information – much of the legislation actually supports information sharing rather than restricts it. The challenge is finding appropriate ways to share information whenever possible.Link to guidanceInformation sharing guidance – Section 2; Information sharing pocket guide.
65Key questions to inform decision making Is there a clear & legitimate purpose to share the information?Does the information enable a living person to be identified?Is the information confidential?Do you have consent to share?Is there sufficient public interest to share?Are you sharing information appropriately and securely?In most situations practitioners, informed by Information sharing: Guidance for practitioners and managers and the policies and procedures of their agencies, will be clear about what information to share and when. In most cases (except where it would increase risk of significant harm), gaining consent is the best way forward (even where this is not required).However, there will be less common, but more difficult situations where it is not clear what information to share and when.Information sharing: Guidance for practitioners and managers gives some key questions, supported by a flowchart, which will help practitioners make sound decisions. These questions are shown on the slide in a simplified version of the flowchart in the guidance.The rest of the training explores these key questions one by one, to help practitioners make soundly-based decisions about whether and how to share information. The notes are taken from the guidance. Trainers might choose to talk through the information briefly – but also to refer participants to section 3 of the information sharing guidance. It will be helpful if participants look at the flowchart in the guidance as it gives more details that the slide.The next set of slides looks at each question separately, but an activity later will look at using all of the questions to make a decision in certain situations.Link to guidanceInformation sharing guidance – 3.1 and 3.2 and ‘Flowchart of key questions for information sharing’; Information sharing pocket guide.Have you properly recorded your decision?
66The law The Human Rights Act 1998 Legislation containing express powersor which imply powers to share:The Children Act 1989 and 2004.Local Government Act 2000.Education Act 1996 and 2002.Learning and Skills Act 2000.Education (SEN) Regulations 2001.Children (Leaving Care) Act 2000.Mental Capacity Act 2005.Protection of Children Act 1999.Immigration and Asylum Act 1999.Crime and Disorder Act 1998.National Health Service Act 1977 and 2006.The Health and Social Care Act 2003.Criminal Justice Act 2003.Adoption and Children Act 2002.The Human RightsAct 1998The common law duty of confidentialityThe Data Protection Act 1998The law is often used as an excuse NOT to share information. However, much of the law actually enables information to be shared and provides a framework within which to share safely and appropriately, with due consideration for peoples rights. Practitioners need to make professional judgements and the law provides information on which to base these judgements.The slide lists the main aspects of the law that impact on information sharing (It may be worth noting that the Freedom of Information Act does not apply to personal information and hence is not mentioned here).Information sharing: Further guidance on legal issues covers the law in some detail, and is available from the Every Child Matters website.Link to guidanceInformation sharing: Further guidance on legal issues.
67What is confidential information? Personal and private or sensitive, and…Not already in the public domain, and…Shared in confidence.Confidential information is…Consent is given by the person who provided the information or the person to whom it relates.ORIt can be shared without consent if justified in the public interest.Reasonable cause to believe that a child is suffering or at risk of suffering significant harmIn the prevention and detection of a crimeOr information is subject to a court orderCan be shared if….Explain and briefly discuss the issues relating to confidentiality, using the information in the guide. Key points are pulled out below.There are different types of circumstances that are relevant to confidentiality:A formal confidential relationship exists, as between a doctor and patient, social worker and client, or counsellor and client. In these relationships all information shared, needs to be treated as confidential.An informal conversation, where a pupil may tell a teacher a whole range of information but only asks the teacher to treat some specific information confidentially. In this circumstance, only the information specific to the pupil’s request would be considered to be confidential.Other circumstances where information not generally regarded as confidential (such as name and address) may be provided in the expectation of confidentiality and therefore should be considered to be confidential information.Practitioners should not make assumptions and should check whether the information being provided is or is not confidential, the limits around confidentiality and under what circumstances information may or may not be shared with others.Information is confidential to the agency/service as a whole, and not to individual practitioners. However individual practitioners should only share in the same agency or team for genuine purposes.Lead into the next slide that looks at what we mean by confidential information.Not all information is confidential. The slide gives a summary of the information that is considered confidential.The following information is confidential:Private information may include anything a person does not want to be widely known. Sensitive information covers issues such as religious beliefs, physical conditions and criminality (see glossary in the guide Annex B).Information that is not already lawfully in the public domain or readily available from another public source can include elements such as addresses.Information that has been shared in circumstances where the person giving the information could reasonably expect that it would not be shared with others may include examples such as – a teacher may know that one of her pupils has a parent who misuses drugs. That is information of some sensitivity, but may not be confidential if it is widely known or if it has been shared with the teacher in circumstances where the person understood it would be shared with others. However, if it is shared with the teacher by the pupil in a 1 to 1 session and asked for it not to be shared, it would be confidential.Confidential does not mean secret. Confidential information can be shared with the consent of the person who provided it or the person to whom it relates. This consent may be provided with limits (eg stating who can see the information and who can not). Where there is no consent, it may still be possible and/or necessary to share, where there is a public interest (see slide 16).
68What constitutes consent? Consent is key to information sharing, it is good practice even where the law does not demand it.Consent:Must be informed.Should be explicit but can be implied in some circumstances.Is preferably written, but can be verbal.Must be willing and not inferred from a non response.Must be sought again if things change significantly.Can be withdrawn and have limits.Should be recorded and stored.When gaining Consent:Explain it at the start, using suitable language.Explain the limits to confidentiality.Be aware of relevant legislation.Follow local policies and procedures.Explain and briefly discuss the issues relating to consent, using the information in the guide. Key points are pulled out below.Consent is the key to successful information sharing, especially in early intervention. Even where the Data Protection Act does not demand it, operating with consent is good practice. If consent is gained to share information – then there is much less need to worry about the legal questions relating to information sharing. If a person has given their consent to information relating to them being shared – a practitioner can share that information with others to better support their needs.Practitioners must be clear about what constitutes consent. Consent issues can be complex and a lack of clarity about them can sometimes lead practitioners to assume incorrectly that no information can be shared.Consent must be ‘informed’ – ie the person giving consent understands why information needs to be shared, what will be shared, with whom, the purpose and the implications of sharing (as well as the implications of not sharing).Privacy notices are used to inform services users of the organisation’s information policies and processes and can help practitioners to ensure that consent is informed. However, just giving a person a privacy notice does not constitute informed consent. The practitioners must make sure the person fully understands what they are consenting to.Best practice is that consent is ‘explicit’ – Explicit consent is consent detailing exactly what the consent is for and in what circumstances it will apply. Explicit consent can be given orally or in writing ie ‘I give my permission for this CAF assessment to be shared with all services named on the plan’.‘Implicit’ or implied consent can also be valid in some circumstances – Implicit consent is where the person has been informed about an action, the purpose for the action and that they have the right to object. Their agreement to the action has been signalled by behaviour rather than orally or in writing. Implicit consent can also be inferred from earlier explicit consent providing there is no change in the relationship with the organisation and the purpose of the action. eg where a GP refers a patient to a hospital specialist and the patient agrees to the referral. In this situation the GP can assume the patient has given implicit consent to share information with the hospital specialist. However explicit consent would be required to share information outside the bounds of the original service.Consent can be expressed either orally or in writing, although written consent is preferable since that reduces the scope for subsequent dispute.Consent must not be secured through coercion, or inferred from a lack of response to a request for consent.If there is a significant change in the use to which the information will be put to that which has previously been explained, or in the relationship between the agency and the individual, consent must be sought again.Individuals have the right to withdraw consent at any time and can state the limits of their consent – eg I want you to stop sharing all new information; OR you can share with ‘service A’ but not with ‘service B’.Consent should be recorded and stored – Consent should be stored locally, using locally agreed systems (which may include individual case notes as well as the use of centralised electronic systems, such as eCAF, which has a consent statement to tick).Withdrawal of consent should also be recorded. (NOTE: With regard to the CAF, refusal to consent to a CAF assessment should only be recorded in individual case notes).The elements in the right hand box of the slide represent good practice in gaining and securing consent.Do not seek consent when required by law to share information through a statutory duty or court order, or where to do so would:Place a person at increased risk of significant or serious harm.Prejudice the prevention or detection of a serious crime (ie crime which causes or is likely to cause significant or serious harm).Lead to unjustified delay in making enquiries about allegations of significant harm or serious harm.Practitioners must also consider whose consent should be sought. This is looked at in the next slide.Link to guidanceInformation sharing guidance – 3.17 to 3.22 and 3.36 to 3.37; Information sharing pocket guide.Information sharing ‘How to…’ guides – ‘Seeking consent’ and ‘Judging capacity to consent’.Do not seek consent where it would increase risk
69Whose consent should be sought? People aged 16 and over – generally presumed to have the capacity to understand and may give (or refuse) consent.Children aged 12 or over – may generally be expected to have sufficient understanding to give (or refuse) consent.Younger children may also have sufficient understanding.Sufficient understanding is indicated if they can:Understand the question.Understanding what might be shared, why and implications of sharing/not sharing.Appreciate and consider alternative actions.Weigh up aspects of the situation.Express clear, personal, consistent view.Practitioners need to consider whose consent is required. Where there is a duty of confidence it is owed to a person who has provided the information on the understanding it is to be kept confidential. It is also owed to the person to whom the information relates, if different from the information provider.Explain and briefly discuss the issues relating to who can give or refuse consent, using the information in the guide. Key points are pulled out on the slide.Practitioners must decide who can give or refuse consent in each individual case. The key is in deciding if the person has sufficient understand to make their own decisions about consent.Emphasise that this is about an individual giving consent to share information about themselves.People aged 16 and over and generally presumed in law to have the capacity to understand and may give (or refuse) consent to information sharing. However, this may need careful consideration if the person ‘lacks capacity’ eg if suffering from a mental disorder or impairment (see guide 3.30 to 3.35).Children aged 12 or over may generally be expected to have sufficient understanding to give (or refuse) consent to information sharing. Younger children may also have sufficient understanding.The criteria given on the slide should be considered in assessing whether a particular child or young person, on a specific occasion, has sufficient understanding to consent, or refuse consent, to the sharing of information about them. When assessing understanding the issues should be explained in a way that is suitable to the individual.If a child is assessed to be competent to give consent to share information then their consent, or refusal to consent is the one to consider, even if a parent or carer disagrees. Where parental consent is not required the practitioner should encourage the child/young person to discuss the issue with their parent(s) unless this would increase risk of significant harm. However the service should not be withheld on the condition that they do so.If a child is assessed as not competent to consent to their information being shared, in most cases a person with parental responsibility should consent on their behalf. However the views of the child should still be sought as far as possible.Practitioners should record that consent has been given, and by whom; and if and when it is withdrawn. In cases of any uncertainty, practitioners should also record the evidence on which the child’s understanding to give/refuse consent was based.It may be worth noting that considerations about whether a child has sufficient understanding are often referred to as Fraser guidelines or the Fraser ruling, or Gillick competent. Fraser/Gillick were formulated with reference to contraception and contain specific considerations fro that issue. For more details on Fraser/Gillick see the Information sharing guidance glossary. The guidance given in the information sharing guidance (summarised on the slide) is relevant to all practitioners and all situations – not just those relating to contraception.Lead into the next activity, which explores issues raised by the previous slides, using short scenarios.Link to guidanceInformation sharing guidance – 3.22 to 3.37; Information sharing pocket guide.Information sharing ‘How to…’ guides – ‘Seeking consent’ and ‘Judging capacity to consent’.Record the decision and try to balance the wishes of the child or young person and the parent/carer
70Activity To share or not to share? Time: 30 minutesMaterialsScenarios for the activity (to read out, or could be put on small cards to give to participants).NotesThis activity explores confidentiality and consent.Display a flipchart sheet in one part of the room that says ‘Share’ and another elsewhere that says ‘Don’t share’.One by one, read out the five short scenarios that follow.Ask participants to make a quick decision based just on the information given. Point out that obviously in reality you may choose to seek extra information on the situation before making a decision – this is just for exploration purposes and the scenarios give enough to allow that.Ask participants to go to stand in the area indicated by the flipchart that represents their answer (ie either ‘Share’ or ‘Don’t share’).Following each scenario discuss the outcomes and ask participants to explain their decisions. The notes that accompany each scenario will help focus and inform these discussions.You may offer people the opportunity to change their minds if appropriate.After the scenarios where it is relevant, ask the participants to briefly consider what information they would share, how and with whom.Sum up the learning from the exercise.Lead into the next slide which looks further at the issue of consent.Link to guidanceInformation sharing guidance – 3.12 to 3.37; Information sharing pocket guide.Information sharing ‘How to...’ guides – ‘Seeking consent’ and ‘Judging capacity to consent’.
71What to share and how to share it Distinguish between fact and opinionShare in secure wayShare only what is necessary for purposeUnderstand the limits of consentCheck information is accurate and up-to-dateShare only with those who need to knowInform person to whom it relates, and/or who provided information if safe to do soRecord reasons for sharing; what shared; with whoEstablish whether recipient will pass to others – ensure they understand limits of consent givenIf the decision is to share information practitioners will need to decide what to share and how to share it.In particular, practitioners must ensure that they follow the points listed on the slide.In deciding what information to share, consideration must be given to safety. If the information you want to share allows another party to be identified, for example, from details in the information itself or as the only possible source of the information, you need to consider if sharing the information would be reasonable in all circumstances. Could your purpose be met by only sharing information that would not put that person’s safety at risk?
72Support for practitioners Practitioners need:A culture that supports sharing.Secure processes for sharing.Processes for explaining information sharing.Effective training, supervision and support.Mechanisms for monitoring, advice and conflict resolution.Organisations should:Fulfil duties under sections 10 and 11 of the Children Act 2004.Establish an information sharing governance framework.Practitioners need to know that they are not alone and will be supported by their organisation. They need to have confidence in the continued support of their organisation where they have used their professional judgement and shared information professionally.The slide lists the key things that practitioners need, in order to be confident to apply the information sharing guidance in practice.A culture that supports information sharing within and across agencies.Processes for explaining to service users how and why information may be shared.Processes, standards, procedures and infrastructure to support the secure sharing of information.Effective multi-agency training, access to supervision and support.Mechanisms for monitoring and auditing practice.Access to impartial advice and conflict resolution.The slide also points out organisational duties.Section 10 of the Children Act 2004 lays out the organisational duties regarding cooperation to improve well-being of children, including duties regarding information sharing. Detailed guidance on section 10 duties can be found in the 2008 document Children’s Trusts: Statutory guidance on inter-agency cooperation to improve well-being of children, young people and their families. All local authorities and “relevant partners” must have regard to this guidance. [Note – This statutory guidance will be updated and replaced in early 2010 following a consultation.]Section 11 of the Children Act 2004 lays out the organisational duties regarding safeguarding and promoting the welfare of children. Detailed guidance on section 11 duties can be found in the 2007 document Statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004.An information sharing governance framework must always recognise the importance of professional judgement and would be expected to include:An Information Sharing Code of Practice.Information Sharing Procedures.Privacy, confidentiality, consent (service users) – processes and documents such as privacy notices and ‘Subject Access’.Information Sharing Protocols (ISP) (see guide 4.7 and 4.8 for more detail).Note that an information sharing protocol (ISP) is a signed agreement between two or more organisations or bodies, in relation to specified information sharing activity and/or arrangements for the routine of bulk sharing of personal information. An ISP is not required before front-line practitioners can share information about a person. By itself, the lack of an ISP must never be a reason for not sharing information that could help a practitioner deliver services to a person (see guide 4.9 to 4.13 for more detail).Note that a fact sheet on embedding good practice in information sharing is available fromA training DVD on consent and a toolkit called Embedding Information Sharing, will be available from January 2010 fromAsk participants what else they feel they need from their employers.Link to guidanceInformation sharing guidance – Section 4.
73Main web linksThe following national websites hold further information and overviews, as well as links through to guidance and training materials, for all of the processes and tools of integrated working:CWDC – or