3.12 Procedure for undertaking joint visits and assessments by Social Workers, Health Visitors and Midwives, for children under 5

SCOPE OF THE CHAPTER

This procedure details best practice for social workers, health visitors and midwives when a statutory assessment under the Children Act 1989 is required for a child under 5 (including pre-birth assessments). It should be read in conjunction with Working Together 2015 and the NSCB Local Protocol for Assessment and where relevant the NSCB Pre-birth protocol. The aim of the procedure is to promote partnership working and embed the ethos of joint assessment, the sharing of professional analysis and shared understanding of the child and family’s strengths and risks to inform joint decision making around the need for further assessment and planning of interventions to support the child and family.

AMENDMENT

This joint procedure was introduced in January 2014 following a review by the Local Authority and Norfolk Community Health and Care Trust that examined the quality and effectiveness of joint working and decision-making in health and social care for children under 5. It was reviewed in March 2016 to include Midwifery Services.

1. Purpose of Statutory Assessment

A statutory assessment is required by law under the Children Act 1989 when children are considered to be ‘in need’ or suffering/at risk of suffering ‘significant harm’. It is the responsibility of Local Authority Social Workers to undertake assessments of the needs of individual children to determine what services to provide and action to take.

The purpose of the assessment is:

  • To gather important information about a child and family
  • To analyse their needs and/or the nature and level of any risk and harm being suffered by the child
  • To decide whether the child is a Child in Need (Section 17) and /or is suffering or likely to suffer Significant Harm (Section 47)
  • To provide support to address identified needs to improve the outcomes for children and to make them safe. This may include ‘stepping down’ to planning within a Family Support Plan Framework.
  • 2. The rationale for joint visits and assessments

    Every statutory assessment should draw together relevant information gathered from the child and their family and from relevant professionals using the Assessment Framework. In Norfolk, Signs of Safety is used as the mechanism for collecting and analysing the information. The aim is to use all the information available to identify worries, harm, and any complicating factors as well as developing a picture of the strengths and safety factors for the child.
    For children under 5 (including neo-natal visits) the expertise of the health professional is key to assessing the child’s health and development and the full involvement of the health visitor or midwife in the statutory assessment has long since been regarded as best practice. Following a review in 2013, it was decided that Norfolk procedures should reflect this best practice.
    This benefits of joint visits and assessments include:

  • Ensuring assessments are rooted in child development
  • Continuity of service for the child and family irrespective of the outcome of the assessment
  • Reducing the ‘fear factor’ of social worker assessments. Often the Health Visitor or midwife will be a familiar face
  • The ability to share thinking and jointly analyse what is happening for the child
  • Improving co-working and information sharing within the locality.
  • In order to support joint visits and assessments, each locality will arrange monthly meetings between Team Leaders and Team Managers in Health Visiting, Midwifery Services and Social Care Assessment Teams to discuss joint visiting and assessment arrangements.

    3. Planning the joint visit

    Where emergency action is required, for example where a joint investigation with police is required, it may be inappropriate to involve the health visitor or midwife in the assessment until immediate safeguarding work has been concluded. In all other cases, following the receipt of the referral from MASH the Assessment team social worker will:

  • Make contact with the family to advise them that a joint visit will be arranged with the Health Visitor (or midwife in the case of pre-birth assessments)
  • Contact the Health Visiting/Midwifery Team to provide an overview of the concerns relating to the referral. Information should be shared between the practitioners and a time arranged to undertake a joint visit to the family
  • The Social Worker should contact the family to confirm the time of the visit
  • The Social Worker will review CareFirst to ascertain any background information including starting or reviewing an integrated chronology as required
  • Where possible the Health Visitor/Midwife known to the family should undertake the visit. If this is not possible the visit should be undertaken with the duty Health Visitor
  • The Health Visitor will review SystemOne for background information and tick the vulnerable child / at risk box triggering the national ‘vulnerable child’ status and add a high priority alert
  • Where possible the Social Worker and Health professional will undertake a pre meet prior to the home visit to plan the visit. The planning should include a review of the referral, sharing of background information/chronology, discussion around which practitioner will lead the visit with an agreement how the visit will be facilitated. The lead practitioner for the purpose of the visit will be determined by whether the family is known to either practitioner. In the event of neither practitioner knowing the family, the social worker will be the lead practitioner.
  • 4. Undertaking the Joint Visit

  • Following introductions to the family the lead practitioner will outline the reasons for undertaking the assessment, explain how the joint assessment process works and clarify how the outcome of the assessment will be shared with the family
  • Confidentiality and information sharing should be fully explained to the family and relevant consent obtained
  • The practitioners will explore the issues facing the family using the domains of the Assessment Framework (Department of Health 2000) and the Signs of Safety Framework. Harm, complicating factors, strengths and safety should all explored in detail, and a genogram should be undertaken
  • Where there are immediate safety issues, the practitioners should remain in the home unless to do so would put them at risk and seek further advice and/or contact emergency services as appropriate
  • Where follow up actions or further visits as required, including the social worker seeing any older children on their own, these will be arranged with the family.
  • 5. Agreeing actions following the joint visit

  • Following the joint visit the Social Worker and Health practitioner will have a debrief to discuss their initial analysis of the family’s situation. This will be based on the information known and the observation and discussions from the assessment visit
  • Actions and interim plans should be agreed, which may include seeing children on their own, visiting the family again for the purpose of further assessment, visiting absent parents or family members, and gathering information from other professionals/agencies
  • Both parties should be clear about who will do what and how further information will be shared that contributes to the assessment
  • Where there are specific concerns relating to neglect, agreements should be made about who will undertake the Graded Care Profile with the family
  • Practitioners are responsible for reporting their analysis of the initial visit and any follow up visits and multi-agency information to their Team Leader/Team Manager. They will keep each other informed about any actions resulting from their respective supervision.
  • 6. Assessment outcomes and further action

  • Assessments are rarely straight forward and often it takes a number of visits in order to fully assess the situation for a child and their family. Communication and collaboration is important throughout the assessment process
  • The focus must always be on the child’s lived experience and the level of risk and harm to the child. Discussions should include whether a strategy meeting is required to consider initiating a Child Protection Conference, or whether a Child in Need Meeting or Step-down meeting is required
  • In the event of a professional disagreement around the type of plan required for the child or children, the case should be discussed between the Team Leader/Team Manager and NSCB policy for Resolving Professional Disagreements followed as required
  • Both practitioners will make records in accordance with their organisation’s record keeping policy. The Social Worker is responsible for the production of the assessment but its content, analysis and actions should be informed by the information provided by the Health Visitor/Midwife and any other professionals involved. Consideration can and should be given to jointly producing a report to share with the family
  • The social worker is responsible for planning any type of multi-agency Signs of Safety meeting to agree plans and services to be put in place. Where no further action is required, the social worker is responsible for informing the family and sharing the assessment with them and any other professionals involved. This should be jointly undertaken with the Health Visitor/Midwife where appropriate
  • The social worker will be the lead for any resulting Child in Need or Child Protection Plan
  • With consent from the family, the Health professional will be the lead for any resulting Family Support Plan.
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