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Assessment of Children in Need and Their Families, 2000
Figure 1. Outline of the documents, procedures, guidelines and practises that might by applied to this case study.
About half of those with severe mental illness live with family or friends, and many others receive considerable support from them. Carers of service users, including young carers, should be involved in their own assessment and care planning process, which takes account of the state of their own mental and physical health needs, and ability to continue to care.
A National Service Framework for Mental Health 1999; p.69
The following case study is made under the assumption that the family has only just been referred to social services and no assessments have as yet been made. It starts with a brief individual profile in relation to the situation and an outline of the document areas that best apply to that person in a given scenario. The case study (see Appendix 1) raises the following initial areas of concern:
- support and wellbeing of the children, Nazneen and Karim
- support and wellbeing of the father, Chanu
- support for and from Chanu’s parents
As Figure 1 demonstrates, at this pre-assessment stage it is hard to say which of a number of pathways may be best. The options range from placement of the children (taking into account that Nazneen is 16) in temporary care, supporting them and their father (subject to the psychological assessment) at home, help from the grandparents (taking into consideration their age and mobility issues). Therefore, only the most pertinent policies have initially been selected. However, a range of scenarios and associated documentation will be catered for hypothetically and the major themes identified within these divisions.
Although the focus of the study is choice and alignment of care within a particular scenario, there is also an awareness of the impact of socio-political agenda’s on policies. For example, the shift from institutional care to care in the community as exemplified by the 1990 NHS and Community Care Act (informed in part by the 1989 Caring for People white paper) by necessity has had to develop better means of interagency communication and client support (see Larsen et al, nd). The attempts to better align an interagency, multidisciplinary approach have continued to find expression in papers such as the 1998 DoH Partnership in Action offshoot from ‘The New NHS: modern, dependable’. This includes involvement of community services to support community care as espoused by CM849. Another effect, as pointed out by Armstrong (2002) has been the increase in numbers of young carers in single parent families.
In the supervision of practise section of the Framework for the Assessment of Children in Need and Their Families (DoH 2000) the following criteria are stated:
6.27 It is important that supervision addresses:
- the process of assessment;
- the timing and relevance of making a child and family assessment;
- practice which recognises the diversity of family lives, traditions and behaviours;
- information about the children and the parents or caregivers, and its analysis;
- what further information is needed and how it will be obtained;
- the need for any immediate action or services;
- the plan for work with the child and family, and allocation of resources;
- the provision of services or intervention and their likely impact on child and family members;
- involvement/contact with staff in other agencies;
- the review of progress, of earlier understanding of the child and family's situation and of the action/intervention plan.
The case worker should be bearing in mind this list as a framework of their own procedures.
This section begins with identification of the relevant documents and their sections according to the individual and the family environment. It also outlines the main themes that apply.
Part III, Section 17 of the Children Act 1989 states that the local authority has a duty to ‘safeguard and promote the welfare of children’ through provision of a range of support services.
Nazneen has been acting as carer for the family. Her school work has suffered and the behaviour of her brother has deteriorated. However, it was running out of money that brought matters to a head. Nazneen’s situation needs to be assessed in order to ascertain which criteria best suits her needs and what the best course of action for her is.
1.1. Nazneen as a child in need
Children Act 1989
Nazneen has not been attending school regularly and although not mentioned in the case study, it is likely that keeping the house in order has not allowed her much time for anything else, such as study or socialising.
Part III, section 17.10.a states that a child is in need if
(a)he is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him of services by a local authority under this Part;
Section 17 also requires the local authority to provide the required services for the family in need in their area.
Every Child Matters2004: Common Assessment Framework (CAF) for Children and Young People
An assessment under the CAF would determine what Nazneen’s strengths and areas needing support are. She may need assistance completing her schooling and, should the assessment show a viable home structure, some form of home assistance. If this proves to be untenable, temporary care may be necessary. This is covered by the Children Act 1989 as well as this legislation.
1.2 Nazneen as a young carer
Should Nazneen demonstrate the necessary desire and maturity to fulfil this role, considerable support will be required. Studies (Green 2002, Glasgow Association for Mental Health, 2002) have shown that young carers can suffer educationally, economically, emotionally and socially when acting as carers. Those caring for parental mental illness have particular stresses and have also only recently been taken into consideration as carers (Armstrong 2002).
Framework for the Assessment of Children in Need and Their Families, 2000
As a 16 year old, Nazneen may be entitled, following an assessment, to assistance as a carer for both a sibling and a vulnerable adult. Sections 3.61-3.63 of the Framework for the Assessment of Children in Need and Their Families outline the importance of assessing a young carer’s family situation. The stress is on the development of the young person and their wellbeing and that they should not miss out on education and normal pursuits. 3.63 requests that they also be considered under the children in need section of the Children Act 1989.
Carers and Disabled Children Act 2000 & Carers (Equal Opportunities) Act 2004
Carers and Disabled Children Act 2000 : A practitioners guide to carers’ assessments” (Department of Health, 2001)
This gives guidance in assessing the needs of a young carer. In the promoting and safeguarding the welfare of carers age 16 or 17 sections 1 to 5, it states that
Young carers should not be expected to carry out inappropriate levels of caring which have an adverse impact on their development and life chances
(DoH 2000, promoting and safeguarding the
welfare of carers age 16 or 17, section 5)
The appropriate work load which must not be equal to that expected from an adult parent (section 12; p.4). Whilst this act will only be used in some circumstances, it also states that local authorities are responsible to providing for the young persons needs. It also talks about issues such as direct payments:
‘ the Government has given local councils the power to make direct payments to carers (including 16 and 17 year old carers receiving support under the Act) to meet their own assessed needs’ (Section 5; p.1).
It also advocates a multidisciplinary approach, for example Part 1, section 7-11 encourages the involvement of Connexions for a young carer and also notes the importance of the young carers input with regard to their family situation.
Direct payments for people with mental health problems: A guide to action (2006)
This states that 16 to 17 year olds have been eligible for direct payments since 2001. The emphasis is on a joint, flexible approach to determining eligibility between Primary and Mental Care Trusts, Local Authorities, care co-ordinators and managers.
Fairer Charging Policies for Home Care and other non-residential Social Services Guidance for Councils with Social Services Responsibilities, Section XIV Carers
Guidance in assessing charges.
At this stage, it appears that the disruption caused by his father’s illness is having a significant impact on Karim’s behaviour. His behaviour at school is becoming violent and his attendance is poor. Clearly a multi-service approach and intervention plan is required to both understand and assist him with his school and home life. As well as involving the Local Education Authority, the 2004 National Service Framework for Children, Young People and Maternity Services may suggest involvement of a CAMH (Children and Adolescent Mental Health) professional.
Every Child Matters2004: Common Assessment Framework for Children and Young People
The Common Assessment Framework (CAF) pre-assessment checklist indicates the need for an assessment. The CAF itself promotes a holistic approach that aims at determining what support is required across agencies and care providers.
Framework for the Assessment of Children in Need and Their Families, 2000
Section 6.16 to 6.18 give guidelines on the commissioning of specialist assessments. This is particularly for Karim with (both in regard to school and home life) in order to establish the root of the problems he is experiencing. Should the situation be untenable then it may be of benefit for Karim to attend a different form of education, such as a boarding school. However, dispersing the family would not be the favoured option unless it is compatible with a best practise final result and also compatible with the young person’s best interests.
It may be that an assessment brings out the necessity for a supervision order under Part IV, section 35 of the Children Act 1989 may provide the necessary support for him on a one-to-one basis to back up school counselling.
Children Act 1989: Guidance & Regulations Family Support, Day Care and Educational Provision for Young Children Vol. 2
This covers both the provision of schooling and extends into available before and after care for Karim should an assessment show this is favourable.
Change of residence for the children
Should an assessment show that Nazneen and Karim need removing from the family home then the following documents are available for consultation:
DoH (2002) Fostering Services National Minimum Standards: Fostering Services Regulations London: Stationary Office
DoH (2002) National Standards for the Provision of Children's Advocacy Services London: Stationary Office
DoH (1991) Children Act 1989: Guidance & Regulations Court Orders Vol. 1 London:HMSO
Chanu’s mood swings from euphoria to depression appear to indicate a bipolar disorder and he has recently taken a turn for the worse. The case is now in the hands of the local Adult Mental Health Team and Chanu is awaiting a visit from the community psychiatric nurse for an assessment. However, as the social worker for the family an awareness of what is happening and what options are available needs to be maintained.
National Service Framework for Mental Health 1999.
Whilst this provides an ‘organisational framework for providing integrated services and for commissioning services’ it also explores support for carer's of those with mental illness. A third element that may contribute is the emphasis on improving services for Black and minority ethic groups supported by the 2005 DoH publication Delivering race equality in mental health care: An action plan for reform inside and outside services and the Government’s response to the Independent inquiry into the death of David Bennett.
Fair Access to Care Services guidance on eligibility criteria for adult social care (LAC(2002)13
The eligibly frameworks for community care assistance places Chanu in a high risk area in that he appears to be unable to carry out vital personal care or domestic routines, he is isolating himself and currently ‘vital involvement in work, education or learning cannot or will not be sustained’ ( section 16; p.4).
DoH (2004) Executive Summary, National Service Framework for Children Young People and Maternity Services
Standard 2, p14 states that:
‘Parents with specific needs such as relationship conflict, mental health problems, addiction to drugs or alcohol, teenage parents or parents of disabled children, have their needs identified early and are provided with effective multi-agency support’.
4. The Grandparents
Both grandparents suffer from arthritis and have mobility issues. As well as their concern for their son and grandchildren, they themselves may benefit from help. As the first stage is to assess the family’s immediate welfare, they should be consulted on their wishes to see what level of involvement they may feasibly take. Should they be in a situation to do so, help with care of the children, especially if Chanu is hospitalised, would require support from the care services.
The Carers and Disabled Children Act 2000 : A practitioners guide to carers’ assessments” (Department of Health, 2001)
As with Nazneen, the grandparents may be entitled to an assessment if they are to contribute to Chanu or the children’s care (see Right to Assessment, p5)
Carer's and Disabled Children Act 2000: Carer's and People with Parental Responsibility for Disabled Children: Policy Guidance
It may be that care homes need to be looked into for the grandparents however this will be a consideration for the future.
Each of these sections shows the importance of working within the whole environment of the family in order to assess a way forward for them. Naturally, the first stage is to ensure the safety of those involved and run an initial assessment of what help is required and from where, as outlined in the 1999 Working Together to Safeguard Children. However it is the functioning of the whole family as a unit that may provide the best outcome and therefore a holistic balance should be bourn in mind.
Research supports this interagency and holistic approach (eg Green 2002; DH 1998), however hard this may be to achieve. However this balance has proven hard to achieve. As section 2.6 of the 2004 National Service Framework for Children, Young People and Maternity Services, Standard 9 (The Mental Health and Psychological Well Being of Children and Young People) states:
‘The lack of provision in one service may impact on the ability of other services to be effective. Partnership working is an essential requirement of high quality service provision’.
In order to best assess how to assist this family, a broad based approach is essential. This needs to take into account the individual, their environment and their wishes as well as the best practise and services available.
The drive to homogenise assessment processes is also evident in government publication. Whilst some indicate the needs of financial control, others appear to be trying to provide simplifications that can form interagency links. The following quote, for example, uses the criteria of eligibility from both a health and social service perspective:
‘Presenting needs are the issues and problems that are identified when adults contact or are referred to social services for help. Eligible needs are those needs that are assessed as falling within a council’s eligibility criteria, and which should be met’.
LAC (2002)13; p.3
Hopefully, the need for a multidisciplinary approach to assessment and intervention has been a current through the study. One method (demonstrated but not exemplified) of encouraging this has been the provision of generic formats that can be used specifically by different agencies is one of the steps taken towards a more homogenised interagency approach. For example, the 1995 Child Protection Messages from Research finishes with 12 practical scenarios that can be used in a range of situations.
Part 1, section 16 of the Carer's and Disabled Children Act 2000 and Carer's (Equal Opportunities) Act 2004 aims to enable better interdisciplinary approaches between care structures and organisation, as do the majority of the documents used in this study. It states ‘the 2004 Act facilitates joint working between local and other authorities in relation to services provided for the carer and the cared for person’ (2005; p.9).
Generic Case Study Chanu is 35 years old, he was born in Bangladesh and came with his mother and two older sisters to join his father, Mr. Chowdhury, in Sheffield in 1975. Mr. and Mrs. Chowdhury are 71 and 67 years old respectively. They each suffer from arthritis and difficulties with mobility. Chanu is divorced from his wife who has since returned to Bangladesh. Chanu has custody of their two children Nazneen aged 16 years and Karim aged 10 years. All family members are practicing Muslims. Chanu lives in a terraced house with his children and works as a self-employed electrician. His children enjoy spending time with him and they often go hiking together at weekends. Since his early twenties he has experienced quite extreme mood swings ranging from euphoria to acute depression. Over the last few years these abrupt changes of emotional state seem to have intensified. During a single day in August 2004 Chanu decided to get rid of all the contents of the house. His children returned after school to find Recently Chanu has not been going out to work and spends almost all day every day alone in his room. Nazneen has been taking responsibility for all the domestic chores including all the shopping, preparation of meals and ensuring Karim goes to school. But, Nazneen herself has frequently missed attendance at school even though this is her 'O' level year. She has maintained the household secretly on her own for the last two months, which has been possible because Chanu keeps a lot of cash at home rather than putting it in a bank account. But the money ran out earlier this week and Nazneen broke down in tears and described some of what had been happening during a visit to the house by her grandfather, Mr. Chowdhury. Mr Chowdhury is so concerned that he immediately contacts the school to discover that Karim has become extremely disruptive over the last month, at one stage threatening to hit a female teacher, and is very close to being excluded from school. Several letters were sent to Chanu to request a joint meeting with the headmaster and Karim's teacher, but these have gone unanswered. On returning to his own home Mr. Chowdhury and his wife decide to contact Chanu's GP who organise's for a community psychiatric nurse to make a home visit to Chanu. At the same time the GP contacts the Adult Mental Health Team.
Armstrong, C (2002) ‘Behind Closed Doors: living with a parent’s mental illness’, Young Minds Magazine, Issue 61, accessed 8th October 2006, http://youngminds.org.uk/magazine/61/armstrong.php
Department of Health, see DoH
DoH (1995) ‘Child Protection: Messages from Research’, London: HMSO
DoH (1989) Caring for People: Community Care in the Next Decade and Beyond Cm849 London:HMSO (White Paper)
DoH (1991) ‘Children Act 1989’, accessed 4th October 2006, London: HMSO http://www.opsi.gov.uk/acts/acts1989/Ukpga_19890041_en_4.htm#mdiv17
DoH (1991) ‘Children Act 1989: Guidance & Regulations Family Support, Day Care and Educational Provision for Young Children,’ Vol. 2 London:HMSO
DoH (1991) ‘The Children Act 1989: Guidance and Regulations Residential Care’, Vol.4 London:HMSO
DoH (1997) ‘The New NHS: modern, dependable,’ London:HMSO.
DoH (1998) ‘Partnership in Action. (New Opportunities for Joint Working between Health and Social Services). Discussion Document’, London:HMSO, accessed 8th October 2006, http://www.dh.gov.uk/assetRoot/04/01/44/88/04014488.pdf
DoH (1999) ‘Code of Practice: Mental Health Act 1983’ London: Stationary Office
DoH (1999) ‘National Service Framework for Mental Health: Modern Standards and Service Models’, London: Stationary Office
DoH (2000) ‘Assessing Children in Need and Their Families: Practice Guidance’, London: Stationary Office
DoH (2000) ‘Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004, Carer's and People with Parental Responsibility for Disabled Children: Combined Draft Policy Guidance’, London: Stationary Office, accessed 7th October 2006, http://www.dh.gov.uk/assetRoot/04/10/23/31/04102331.pdf
DoH (2001) ‘Carer's and Disabled Children Act 2000: Carer's and People with Parental Responsibility for Disabled Children: Policy Guidance’, London: Stationary Office
DoH (2001) ‘National Service Framework for Older People’, London: Stationary Office
DoH (2002) ‘Care Homes for Younger Adults and Adult Placements national Minimum Standards: Care Homes Regulations’, London: Stationary Office
DoH (2002) ‘Children's Homes National Minimum Standards: Children's Homes Regulations’, London: Stationary Office
DoH (2002) ‘Fostering Services National Minimum Standards: Fostering Services Regulations’, London: Stationary Office
DoH (2002) ‘National Standards for the Provision of Children's Advocacy Services’, London: Stationary Office
DoH (2003) ‘Adoption: National Minimum Standards’, London: Stationary Office
DoH (2003) ‘Direct Payments Guidance: Community Care, Services for Carer's and Children's Services (Direct Payments) Guidance England’, London: Stationary Office
DoH (2003) ‘Fairer Charging Policies for Home Care and other non-residential Social Services Guidance for Councils with Social Services Responsibilities’, London: HMSO, accessed 8th October 2006 http://www.dh.gov.uk/assetRoot/04/11/79/31/04117931.pdf
DoH (2004) ‘Every Child Matters: Common Assessment Framework’, accessed 7th October 2006 http://www.everychildmatters.gov.uk/deliveringservices/caf/
DoH (2004) ‘Every Child Matters: Change for Children’, London: Stationary Office
DoH/DfES (2004) ‘National Service Framework for Children, Young People and Maternity Services, Standard 9: The Mental Health and Psychological Well Being of Children and Young People’, London:HMSO, accessed 8th October 2006
DoH (2004) ‘Executive Summary, National Service Framework for Children Young People and Maternity Services’, London: London: HMSO, accessed 8th October 2006, http://www.dh.gov.uk/assetRoot/04/09/05/52/04090552.pdf
DoH (2005) ‘Delivering race equality in mental health care: An action plan for reform inside and outside services and the Government’s response to the Independent inquiry into the death of David Bennett’, London: Stationary Office, accessed 7th October 2006, http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4100773&chk=grJd1N
General Social Care Council (2002) ‘Codes of Practice’ London: General Social Care, accessed 7th October, www.gov.im/lib/docs/dhss/services/Codes_of_Practice.PDF
Green, R (2002) ‘Mentally Ill Parents and Children’s Welfare’, NSPCC, accessed 8th October 2006, http://www.nspcc.org.uk/Inform/OnlineResources/InformationBriefings/MentallyIllParents_asp_ifega26025.html
NHS (1999) ‘National Service Framework for Mental Health, Modern Standards and Service Models’, accessed 7th October 2006 http://www.dh.gov.uk/assetRoot/04/07/72/09/04077209.pdf
LAC (2002) 13 ‘Fair Access to Care Services: Guidance on Eligibility Criteria for Adult Social Care’ Local Authority Circular
Larsen, TP., Daguerre, A & Taylor-Gooby, P. (nd) ‘UK Policy Maps: Working Papers’, University of Kent, accessed 7th October 2006 http://www.kent.ac.uk/wramsoc/workingpapers/secondyearsreports/policymaps/ukpolicymap.pdf
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