disciplinary staff working with children/young people and their families

Final Version
Updated 24/06/09
REFERRAL POLICY FOR MULTI-
DISCIPLINARY STAFF WORKING WITH
CHILDREN/YOUNG PEOPLE AND
THEIR FAMILIES
Lord Laming Multi-Disciplinary Working Group
Children and Young People’s Services
26 February 2009
Date of Review: February 2010
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Policy Checklist
Name of Policy:
Purpose of Policy:
Referral Policy for Multi-Disciplinary staff working with
children/young people and their families.
The policy will assist multi-disciplinary/agency staff working
with children, young people and their families to make,
process and classify referrals as well as determine levels of
intervention.
Directorate responsible for Policy Children & Young People’s Directorate
Name & Title of Author:
Laming Multi-Disciplinary Working Group
Does this meet criteria of a Policy? Yes
Staff side consultation?
Yes
Equality Screened by:
Francesca Leyden and Mary McIntosh
Date Policy submitted to RM&PC: 12 March 2009
Members of RM&PC in Attendance:
Policy
Approved/Rejected/Amended
Communication Plan required?
Training Plan required?
Implementation Plan required?
Any other comments:
Date presented to SMT 21 October 2009
Director Responsible
SMT Approved/Rejected/Amended
SMT Comments
Approved
Date returned to Directorate Lead
for implementation (Board
Secretary)
Date received by Board Secretary
for database/Intranet/Internet
Date for further review
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POLICY DOCUMENT – VERSION CONTROL SHEET
Title
Supersedes
Title: Referral Policy for Multi-Disciplinary staff working with
children/young people and their families
Version: One
Reference number/document name:
Supersedes: None
Description of Amendments(s)/Previous Policy or Version:
Originator
RM/Policy
Committee & SMT
approval
Circulation
Name of Author: Laming Multi-Disciplinary Working Group
Title: Referral Policy for Multi-Disciplinary staff working with
children/young people and their families
Referred for approval by: Mary McIntosh
Date of Referral: 12 March 2009
RM/Policy Committee Approval (Date)23 March 2009
SMT approval (Date)
Issue Date:
Circulated By:
Issued To: As per circulation List (details below)
Review Review Date: February 2010
Responsibility of (Name): Laming Multi-Disciplinary Working Group
Title:
Circulation List:
• Members of Trust Child Protection Panel; for dissemination to own
agency.
• Members of RIT Project Board; for dissemination to own agency.
• Each Trust Director; for dissemination to all staff who may make
referrals to CYP Gateway teams.
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CONTENTS PAGE
Section
1. Introduction
2. Background
3. Function of Referral
4. Principles
5. How to make a Referral
6. Classification of Referrals
7. Action on receipt of Referral
8. Allocation of Referrals: Child Protection
9. Computer and Manual Records
10. Allocation of Referrals: Child in Need
11. Confirming Referrals
12. Unallocated Cases
13. E-Mailing Referrals
Appendix 1
Appendix 2
Freedom of Information
UNOCINI: Family & Child Care: Thresholds of
Intervention
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Referral Policy
1.0 Introduction
This document outlines the policy of the Southern Health & Social Care
Trust for the management of referrals to Children’s Social Work Gateway
Teams.
The policy sets out a framework which will assist social work and multidisciplinary
staff working with children, young people and their families to
make, process and classify referrals as well as determine appropriate
levels of intervention. This policy outlines the key legislative
requirements, policies & procedures as well as guidance pertaining to
referral processes.
The Children (NI) Order 1995 outlines a wide range of powers conferred
on Trust’s in respect of children living within their geographical area. It
also outlines a Trust’s obligation in terms of safeguarding and promoting
children’s welfare and defines Child in Need as well as legal thresholds
for intervention. For example;
Article 17 of The Children (NI) Order Part IV Support for Children & Their
Families defines child in need. Article 18 sets out the General Duty of
Authority to provide personal social services for children in need, their
families and others.
Part V & VI sets out the criteria for legal intervention where children have
suffered significant harm or deemed to be at risk of significant harm and
in need of protection.
The courts also have the power to grant an Article 56 Order in any family
proceedings where a question arises with respect to the welfare of any
child, when it appears to the court that it may be appropriate for a Care
or Supervision Order to be made, the court may direct the appropriate
authority to undertake an investigation of the child’s circumstances.
More recently Human Rights Legislation has influenced child care
practice particularly Article 6 Right to a Fair Trial and Article 8 Right to
Family Life. Balancing children’s rights to family life and parent’s rights
has exercised the minds of all those agencies working with children and
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families. This legislation has reinforced the need for openness and
transparency, as well as the Trust’s obligation to provide services, to
enable families to care for children where this is compatible with
safeguarding a child’s welfare.
Purpose and Aims
The Policy will assist multi-disciplinary/agency staff working with
children, young people and their families to make, process and classify
referrals as well as determine levels of intervention. The Policy outlines
key legislative requirements and policy and procedural and guidance
pertaining to the referral process. The Policy aims to provide
compliance with the recommendations of Lord Laming’s inquiry into the
death of Victoria Climbie.
Policy Statement
Everyone who works with children and families should be able to
recognise, and know how to act upon, indicators that a child may be in
need or that a child’s welfare or safety may be at risk. They should
know how to refer any such concerns to Social Services and Social
Workers need, in turn, to know how to classify, process and act on all
referrals received.
This Policy provides a broad basis for the principles, processes and
procedures involved in making and receiving a referral in respect of a
child.
Scope of Policy
This Policy applies to all Trust staff making a referral to children’s social
work Gateway teams. It also applies to all Gateway social workers,
managers and staff receiving and handling referrals. In addition, the
Trust would wish to invite our partner agency colleagues to use and
adhere to the Policy.
Responsibilities
1. The Trust Chief Executive as Accountable Officer has overall
responsibility for ensuring the aims of this policy are met.
2. Lead responsibility for Policy Monitoring and Review lies with the
Director of Children & Young People’s Services.
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3. It is the responsibility of the Director of Children’s Services to
distribute this Policy to all other Directorates within the Trust. It is
then the responsibility of those Directorates to make their staff
aware of this Policy and to adhere to it when making a referral to
children’s Gateway teams.
4. It is the responsibility of the Assistant Director Safeguarding and
Family Support to distribute to all agency colleagues on the Child
Protection Panel and the RIT (Reform Implementation Team)
Project Board.
5. It is the responsibility of all managers in Children’s Services
Directorate to make staff aware of this Policy and ensure adherence
to it.
6. It is the responsibility of all relevant staff to be familiar with this
Policy and adhere to it.
Legislative Compliance, Relevant Policies, Procedures and
Guidance
This Policy is based on the legislative principles and procedures from
the following Guidance/Legislation:
• The Children (NI) Order 1995.
• The Protocol for Joint Investigation by Social Workers and Police
Officers of Alleged and suspected Cases of Child Abuse – Northern
Ireland, 2004.
• The ACPC Regional Child Protection Policy and Procedures 2005.
• The UNOCINI (Understanding the Needs of Children in Northern
Ireland) Guidance 2008.
• The Human Rights Act 1998
Equality and Human Rights Consideration
Following completion of the Equality and Human Rights Screening
Template, no significant equality implications have been identified.
Alternative Formats
Alternative formats can be made available for staff on request.
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Records Management
The supply of information under the Freedom of Information does not
give the automatic right to re-use it in any way that would infringe
copyright. Permission to re-use the information must be obtained in
advance from the Trust.
Sources of Advice
Line Managers should be contacted in the first instance, in relation to
any specific queries on Policy content. Line managers should then
escalate queries which they are unable to address, to the Policy
Authors.
2.0 Background
The creation of 5 new Trust’s, the establishment of Gateway Teams and
the roll out of the Single Assessment Framework (UNOCINI) should lend
itself to achieving consistency in relation to the processing and
classification of referrals. A comprehensive guidance 1 for all
professionals using the UNOCINI framework is now available and can
be downloaded from www.dhsspsni.gov.uk. This guide is aimed at all
multi-disciplinary/agency practitioners and their managers who provide
services to children, young people and their families, and who contribute
to Pathway Assessments under the UNOCINI framework. The guide will
also assist managers to provide guidance to support staff to meet the
needs of children through a comprehensive process for assessment
leading to action. The introduction of the new structures within Trusts
and the single assessment framework should help to establish
commonalty in terms of risk assessment, analysis of needs,
comprehensive assessment, and threshold for intervention and delivery
of service.
Forthcoming Reform Implementation (RIT) 2 products concerning
Caseload Management, Supervision, Recording, Information Sharing
and Quality Assurance should assist in guiding, quality assuring and
standardising social work practice and improving outcomes. All RIT
documents can be downloaded from: http:www.dhsspsni.gov.uk
1 UNOCINI Guidance: Understanding the Needs of Children in Northern Ireland November 2008
2 Reform of Children’s Services 2006
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In addition, the ACPC Regional Child Protection Policies and
Procedures (May 2005) and amended guidance outline various
agencies’ and professional’s roles and responsibilities when dealing with
referrals.
3.0 Functions of a referral
The UNOCINI Guidance (page 55) provides advice on how to make a
good referral and the elements that are required to do so. The UNOCINI
Threshold of Need Model (Appendix 1) 3 and Thresholds of Intervention
(Appendix 2 4 ) will assist in providing a basis for better use of multidisciplinary
consultation and enhancement of professional judgement.
The Threshold of Need Model should be used to enable practitioners
and their agencies to communicate their concerns about children using a
common format, language and understanding of the levels of need,
concern or risks presenting.
The Threshold of Intervention Model outlines the type of statutory social
work services most likely to be allocated at levels 1 to 4 of presenting
need and risk in line with the Thresholds of Needs model.
The referral and information record has three main functions within the
integrated children’s system.
• To record the source and reason for the request in keeping with
the Single Assessment Framework.
• To record the response of social care and other relevant agencies
to a referral or request for a service.
• To provide a record of essential information about a child or young
person within the family. Information supports the key processes
of assessment, planning, intervention and review.
Any referral policy should ensure due consideration is given to the
following objectives:
• Common Threshold Model for accessing services (UNOCINI).
• Uniform approach to assessment and the management of risk
(UNOCINI).
• Ensuring competent staff allocated at the front door (Gateway
Teams) and throughout the referral process.
3 UNOCINI: Thresholds of Need Model November, 2008
4 UNOCINI: Family and Child Care Thresholds of Intervention, November 2008
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• Common approach to assessing and analysing information
(UNOCINI).
• Services to become outcome led and effectively maintained.
At the heart of good practice is effective recording and this starts at the
point of referral or entry to the social work process for all children and
families. It is important to consider the guiding principles and
standards 5 , which inform good practice and ensure staff compliance with
legislative and regulatory requirements. Some of the key principles are:
• The explicit outcomes for children are integrated into plans and
progress against these is monitored
• The records are child centred
• Key information is made readily available, i.e., summaries, case
transfer, chronologies
• The UNOCINI Assessment Framework is used appropriately, i.e.
using all 12 domains to undertake initial and Pathway
assessments
• There is a discernible link between information, analysis and
planning
• Assessments are multi-disciplinary/agency
• Supervision records relating to case discussions are placed on
case files 6
• Case records are monitored regularly by management
4.0 Principles
There are 5 key principles which staff should take cognisance of from
the point of referral to closure of social work involvement.
4.1. Paramountcy
The principle is that the child’s welfare is paramount, this overrides all
other considerations. A proper balance must be struck between
protecting children and respecting parent’s rights. Where there is
conflict the child’s interests are paramount. This is enshrined in the
Children (NI) Order 1995 and the Regional Child Protection Policy &
Procedures.
5 Administrative Systems, Recording Policy, Standards and Criteria RIT/DHSSPS 2008.
6 Supervision Policy, Standards and Criteria (2008). RIT/DHSSPS
SHSCT Consent Policy
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4.2. Consent
Information sharing between agencies is a vital element in the
preparation of assessments, making referrals, ensuring children with
additional needs get the service they require and to protect children from
harm or abuse. Personal information held within agencies about
children and families is subject to a legal duty of confidence and should
not normally be disclosed without consent. However, the law does
permit the disclosure of confidential information if it is necessary to
safeguard a child or if it is in the public’s interest. Forthcoming regional
guidance produced by the Reform Implementation Team on Information
Sharing aims to provide clarity on the central issue of lawful information
sharing for practitioners, managers and organisations.
The UNOCINI Guide (2007) 7 addresses the issue of consent stating that
it is important to record the child’s (if of sufficient age and understanding)
or parent’s consent and any limitations to this.
Guidance is also provided in the Trust Guidance on Sharing of Personal
Information 8 and in the DHSSPS Code of Practice on Protecting the
Confidentiality of Service User Information 9 and the Trust Policy on
Gaining Consent 10 .
There are 2 types of consent ‘implicit and explicit’. Consent needs to be
informed and given freely with full understanding of the consequences.
An interpreter may be required to gain informed consent. To book an
interpreter click and follow link below: http://shsctintranet.hpps.ni.nhs.uk/html/pandp/documents/procedureforbookinginterpretersjan09/pd
f
4.3. Confidentiality
Given the sensitive nature of information about child care concerns, this
will only be shared on a need to know basis. The information can be
shared if:
7 UNOCINI Guidance: Understanding the Needs of Children in Northern Ireland November 2008
8 SHSCT Sharing of Personal Information/Data between Southern Health & Social Care Trust and Other
Organisations
9 Code of Practice on Protecting the Confidentiality of Service User Information DHSSPS January 2009
10 SHSCT Policy on Gaining Consent
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• Consent is either withheld, refused, withdrawn or cannot be
obtained due to parent’s unavailability and information needs to
be shared to safeguard a child’s welfare.
• Informed consent has been given to share the information
• A court order requires the information to be shared.
• There is an overriding public interest in disclosure.
4.4. Public Interest
Information may be shared without consent if it is in the public interest to
do so. There are a number of situations where this may arise for
example:
• To protect a child from harm as a consequence of maltreatment
by others or by his/her own behaviour.
• To prevent a crime and disorder.
The crucial factor in deciding whether or not a public interest arises is
‘proportionality’.
4.5. Proportionality
It is important to exercise proportionality in decision making particularly
where conflict arises between child’s rights and parent’s rights bearing in
mind the paramountcy principle.
5.0 How to Make a Referral by using UNOCINI
A referral can be made by a professional or a member of the public. All
referrals received by professionals must be followed up in writing. A
referral may include requests for services/assessments and reporting of
concerns in relation to children and families.
In certain circumstances it may be clear that a child is suffering or likely
to suffer significant harm (as defined under the Children NI Order and
Regional Child Protection Policy & Procedures). In other situations there
may be concern that a child or family is in need of support. It may not
always be clear at the outset whether a child is in need or is suffering or
likely to suffer significant harm.
5.1 Child Protection Referrals.
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If there are concerns that a child may be suffering, or at risk of suffering
significant harm, then an urgent referral to social services through the
Gateway Teams must be made. The referrer will be required to confirm
the referral in writing on a UNOCINI form within 24 hours. Further
detailed guidance can be found in the ACPC Regional Child Protection
Policy and Procedures.
5.2 Children in Need Referrals
If there are concerns that a child or family may be in need of support, the
referral should be made in writing using the UNOCINI referral and
forwarded to the relevant Gateway Team
5.3 Point of Entry
The point of entry for all new childcare referrals is through the Gateway
Teams using the UNOCINI format. There are 4 Gateway Teams within
the Southern Trust; Armagh/Dungannon locality, Newry/Mourne locality
and Craigavon/Banbridge locality. Each Team is available 9.00am –
5pm Mon - Friday. A Duty Social Worker is available to receive new
referrals throughout the working day. A single telephone number
(0800 783 7745) for the public to gain access to the Gateway service
was launched in November 2007 but for professionals wishing to make a
referral or consult with social worker about concerns, the contact
numbers for the locality based Gateway teams are as follows:
• Dungannon Gateway Team is based at E Floor, South Tyrone
Hospital Dungannon
(Tel 028 87 723101)
• Craigavon/Banbridge Gateway Team is based at Brownlow
Health Centre
(Tel 028 38 343011)
• Newry/Mourne Gateway Team is based at Dromalane Newry
(Tel 028 30 825000)
• Armagh Gateway Team is based at Gosford Place, The Mall,
Armagh
(Tel 028 37 522262)
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Additional information on existing cases which are open to social
services should be submitted without delay to the allocated Key/Social
Worker within the respective team or to the social work Team Leader.
6.0 Classification of Referrals by Social Workers
Where new information emerges relating to a different episode on a
case already open to social services, e.g. a case open because of
neglect and a disclosure of child sexual abuse is reported, this should be
recorded as a new referral under the UNOCINI format. The person
receiving the referral should clarify whether the nature of the concern
indicates actual or likely significant harm and whether urgent action is
needed to safeguard the child (paragraph 5.16 Regional Child Protection
Policy & Procedures).
In these circumstances a completed UNOCINI form is not required prior
to action by the receiving agency. However, where professionals make
verbal or telephone referrals to a Gateway Team in what appears to be a
clear child protection case, the referrer should try to complete a
UNOCINI at the time but at least within 24 hours specifying the nature
and extent of their concerns.
A number of referrals may be so vague that they do not fit neatly into
child in need or child protection categories and require professional
judgement. Where this type of referral is received the Duty Social
Worker should consult with a line manager.
7.0 Action to be taken by duty social worker on receipt of a
Referral
Upon receipt of a new referral the Social Worker should undertake a:
• Complete a check of manual and computerised records to
establish current involvement and/or a history of previous
involvement including details regarding previous child protection
registration.
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• Liaise with all relevant agencies, including their own, that may
have information about the child and family. 11 The Social Worker
should pass all information to their Line Manager as soon as
possible (paragraph 5.24 Regional Child Protection Policy &
Procedures) so that a decision can be made as to the classification
of the referral.
8.0 Allocation of Referrals in Child Protection Cases
The Social Work Manager:
• Should allocate the referral immediately to a suitably qualified and
experienced Social Worker to ensure the immediate protection of
the child including medical care if necessary.
• The allocation of referrals must be compliant with UNOCINI in
terms of adhering to statutory and procedural timescales for
example the completion of the Initial Assessment within 10 working
days, convening of Case Conferences and Looked After Children
Reviews.
• Should quality assure and sign off the UNOCINI at the various
stages of completion such as; Initial Assessment and with all
Pathway Assessments.
• Support, advise and supervise the Social Worker.
• Take account of all information to make decisions about further
action.
• Ensure the PSNI are notified immediately whenever a possible
criminal offence against a child/young person is suspected.
• Arrange a strategy discussion under the Joint Protocol Procedures
if appropriate.
• Discuss with the appropriate Senior Manager the need for a Child
Protection Case Conference.
• In conjunction with the Social Worker agree any decision to refer a
child to other services/agencies. In doing so there is a need for
the Social Work Manager to take account of the views of other
professionals/agencies when making such decisions.
• Seek a written statement from those health professionals involved
with the child/family as to the extent and nature of their
involvement and concerns.
11 Letter from Chief Social Services Officer ‘Information Sharing/Consent Issues – child care concern reported
to Children’s Services social work staff, 26 August 2008
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• Should a health professional become aware that a professional
assessment, opinion or diagnosis provided has been
misinterpreted they have a duty to contact Social Services/other
agencies, to clarify their view. All corrections should be made in
writing within 5 working days (paragraph 5.23 Regional Child
Protection Policy and Procedures).
• Ensure that the child is seen and spoken to within 24 hours of
receiving the referral.
9.0 Allocation of Referrals in Children in Need Cases
Children in need referrals can include requests for advice and
information, financial and material assistance, assistance with child
minding or respite care, additional support for the child/young person
and their family, therapeutic or counselling services, mentoring,
befriending or advocacy services, assessment of the child/young person
and or their family.
The Social Work Manager should:
• Categorise the case and allocate accordingly. Consideration will be
taken of the presenting concern with priority given to child protection
cases (see above).
10.0 Confirming Referrals
When the UNOCINI form is received the receiving agency should
confirm receipt of the referral within agreed timescales.
In cases of child protection the referral and action agreed including
categorisation of referral, should be confirmed in writing by the Social
Work Manager to the referrer within 5 working days of the receipt of the
referral (paragraph 5.21 Regional Child Protection Policy & Procedures).
11.0 Computer and Manual Records
The Social Work Manager must:
Ensure that the referral information is entered on the SOSCARE
computer data system on the day of referral. SOSCARE will
provide information on the numbers of referrals received, those
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allocated, the numbers of children assessed as needing a service
and the numbers receiving a service.
Ensure that the appropriate file record is created in respect of each
individual child within 24 hours (paragraph 5.29 Regional Child
Protection Policy & Procedures).
Ensure that the case file includes a record of the decision(s) and
actions agreed on the basis of all information obtained. Files
should also evidence any actions and decisions that were rejected
including reasons not to offer services. The file should be
countersigned by the manager in keeping with UNOCINI and
Regional Child Protection Policy & Procedures.
All information about the child and family should be recorded on
the child’s case file.
12.0 Unallocated Cases
In certain situations cases may be re classified as unallocated following
initial screening/ preliminary assessment. This will not include any
cases deemed to be of a child protection nature. If additional or new
information is received in respect of an unallocated case the Team
Leader will ensure this is considered and allocate immediately if deemed
to be of a child protection nature. A record of unallocated cases will be
maintained by the Social Work Manager and this will be monitored and
reported on each month by a senior manager to the Director of Social
Work. The monthly report will also provide information on those
assessed as needing a service which has not yet been provided
13.0 Emailing Referrals
Staff should also be aware of the referral policy in relation to the e-
mailing of UNOCINI forms to be initiated in the SH&SCT. This policy
can be located on the Trust Intranet site on the UNOCINI useful links
section
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Freedom of Information Act 2000.
APPENDIX 1
The Freedom of Information Act 2000 creates a statutory right of access
by the public to all records held by public bodies, however there are
some exceptions. Where issues arise staff should consult with their
relevant line manager.
Data Protection Act 1998.
All HPSS organisations have a statutory duty under the Data Protection
Act to protect the personal data which they hold, in relation to records
management. All HPSS organisations must ensure that they have a
system to:
• Maintain the accuracy of records held
• Protect the security of personal data
• Control access to personal data and
• Make arrangements for secure disposal once the record is no
longer required. However all HPSS organisations must ensure
that they comply with legislative requirements in terms of
safe/secure storage of records/files for specified timescales and
only dispose of records in keeping with legislation governing
disposal/destruction.
The Data Protection Act covers computerised records as well as
manual/paper records.
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APPENDIX 2
Family and Child Care
Thresholds of Intervention
Contents
1 Background ....................................................................................................... 20
2 Introduction........................................................................................................ 20
3 Developing Family and Child Care Thresholds of Intervention .......................... 21
4 Gateway Teams – Application of Thresholds of Intervention............................. 22
4.1 Information Exchange ................................................................................. 24
4.2 Advice and Guidance.................................................................................. 24
4.3 Referrals ..................................................................................................... 25
5 Care Pathways .................................................................................................. 26
5.1 Family Support............................................................................................ 27
5.2 Child Protection........................................................................................... 27
5.3 Looked after Children.................................................................................. 28
6 Summary ........................................................................................................... 29
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Background
The Department of Health Social Services and Public Safety, in conjunction with
other Departments of Government in Northern Ireland, is working, through the
Implementation of ‘Care Matters’ i to deliver the outcomes set out in the children and
young people’s strategy.
‘In developing our vision for children in care we should ensure that our aims and
objectives dovetail with those of the overarching OFMDFM Children’s Strategy
(2006). This Strategy identifies 6 outcomes and indicators to help benchmark
progress over the next 10 years. The outcomes are that children and young people
should be:
• Healthy;
• Enjoying, learning and achieving;
• Living in safety and with stability;
• Experience economic and environmental well-being;
• Contributing positively to community and society; and
• Living in a society, which respects their rights ii
A series of inspections into the child protection arrangements in Trusts as well as a
number of case management reviews identified, amongst other issues, the need for
consistent specification of both thresholds of needs and thresholds of intervention to
operate within Family and Child Care services in all Trusts.
Introduction
The UNOCINI project developed a thresholds of need model as part of the initial
development phase in 2005. Work continues to complete the thresholds across all
12 domains of the Assessment Framework to try to ensure that the dimensions of
the matrix are meaningful and owned by all stakeholders working in children’s social
care services.
The issues around thresholds of intervention are many and varied. The
complexity which has to be dealt with on a daily basis in teams, balancing priorities,
within priorities cannot be reduced to a series of simple one line statements. The 12
domains of UNOCINI are applied across four levels of need within the Threshold of
Needs model. Making decisions within a domain may represent a challenge, but
given the complexity of cases referred to the Family and Child Care service, and the
range of difficulties experienced by children and families, decisions have to address
an infinite number of combinations of variables. The research carried out within
trusts in the SHSSB, looked at 90 cases but was unable to establish a correlation
between clusters of factors at referral and the subsequent care pathway that the
case may follow.
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Developing Family and Child Care Thresholds of Intervention
The threshold of needs model provides a backdrop to consider the Family and Child
Care thresholds of intervention. It would not be helpful to offer a simplistic solution to
these complex problems, as this would not assist managers and staff at the front line
in coming to better informed decisions. Conversely there is a need to reach a level
of understanding of the issues that will enable trusts to move progressively towards
offering consistent responses across the region and thereby remove some of the
uncertainties experienced by other stakeholders. One of the conclusions of the work
undertaken in SHSSB was that, ‘the levels of complexities demonstrated during the
review hindered a specific threshold criteria being developed.’
When considered with representatives from Trusts, the development of a score card
to classify work requirements was not viewed as a viable way forward. Attempts by
others to formulate a scorecard model have failed and it is recognised that the
quality of assessment is key to the definition of intervention thresholds and the
allocation of service priority.
In seeking to specify thresholds of intervention the following issues have to be
considered in relation to Family and Child Care service:
• Strengths of the family and/or extended family
• Risk of harm, both actual and potential
• Severity of individual unmet needs
• Potential for family circumstances and/or parental capacity to deteriorate
• Frequency of problems recurring
• Capacity to change and develop
• Resilience and protective factors, based on previous life experience and
development
• Insight and understanding
• Acknowledgement of problems and engagement in change
• Motivation and cooperation to work with social workers and other professionals
Level 1 of the threshold of needs model is defined as, children and families who use
universal services and may require occasional advice, support and/or information.
The needs of children at level 1 are not considered to be such that they should be
referred to Family and Child Care or anticipate a response from a trust.
Level 2 children within the model are specified as vulnerable children, who may be
at risk of social exclusion. In addition to universal services, these children and their
families may need access to community support services. Some of these services
may be subject to gate-keeping arrangements, which require an assessment to
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establish either eligibility or priority. The majority of children at level 2 are unlikely to
need a statutory social work intervention and one might question the validity and
appropriateness of using scarce social work resources to undertake an assessment
as part of gatekeeping, especially where an assessment has already been
undertaken by a professional in another service.
However, where vulnerable children are identified as having the potential to
deteriorate and escalate to a higher level of need, an assessment may be necessary
to identify the assistance and help required and thereby avoid escalation. In these
cases both assessment and preventative service or intervention are based on
consent and provided without recourse to compulsion. Additionally, children and
families with relatively lower levels of need, living in isolated rural communities,
where access to community services may be very limited may require a direct Family
and Child Care intervention to avoid deterioration in their circumstances and
potential escalation of needs.
Children at Level 3 have complex needs that may be chronic and enduring, and are
generally identified as Children in Need within the meaning of the Children (Northern
Ireland) Order 1995, including some of the children, who are in need of
safeguarding. It is recognised that almost always these children will require both
assessment and social work help to promote their welfare and well-being and/or
prevent family breakdown. These children and families usually have the option to
give their consent to the intervention of the Family and Child Care, service, which
cannot proceed to make an assessment or work with them without their agreement.
However, children in need safeguarding, who are at risk of significant harm will be
subject to child protection procedures, when the cooperation of the family, although
very desirable, is not a precondition to either assessment or intervention.
Level 4, within Family and Child Care service applies to children in the greatest need
– children in need of rehabilitation with critical and/or high risk needs; children in
need of safeguarding (inc LAC); children with complex and enduring needs. These
children are generally, although not always, likely to have had a significant history
with Family and Child Care and other agencies and are unlikely to present at
Gateway Teams for a first Initial Assessment . Clearly on the occasions when they
do present as referrals they are top priority. Some children may also have level 4
needs which can be the primary responsibility of another service e.g.:
• Children with education and learning needs at level 4 may be served entirely
by schools and other educational services, including residential schools,
• Children with mental health needs at level 4 may be the exclusive or primary
responsibility of the Child and Adolescent Mental Health Service.
Gateway Teams – Application of Thresholds of Intervention
The question of ‘what is a referral’ is the starting point to addressing the broader
issues relating to interventions. The challenge in arriving at a definition is that the
clarification is dependent upon the quality of the information made available at the
Gateway. The UNOCINI Review in January 2007 concluded that improving the
quality of referral information was critical to safe decision making. The quality of
referral information has been, and continues to be, stressed as a critical element in
improving the quality of assessment. Amongst the products of the UNOCINI Project
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is guidance on how to make a good referral, to assist the flows of good quality
information between stakeholders. However, it is important to note that when
professionals make a referral they determine that for themselves. The receiving
Family and Child Care gateway team establishes the appropriateness of the referral
and the need to open it as a case for assessment.
There appears to be three kinds of contact at the Gateway:
• Information Exchange – Bringing information to the attention of Family and
Child Care or another stakeholder, without any expectation of assessment or
intervention. These include the notifications from PSNI about domestic
abuse, or youth diversion matters. Notifications to Trusts from Housing
Executive concerning tenancy issues or rent arrears. (Other professionals
also receive information exchange type contacts: notifications from A&E
Departments to Community Nursing regarding attendance at A&E).
• Requests for advice and guidance - including obtaining access to and
information about universal and community services for children. Requests
may be for parenting, child rearing and child development advice, which once
given may be signposted on to community services, if there are no contra
indications in the records of the trust. They may also be necessitated
because of a lack of available information in other agencies and a lack of
clarity about, which services are provided by different agencies
• Referrals - requests for assessment and assistance, because of concern
about the safety, welfare and/or well-being of children. Referrals of children in
need should, whenever possible, be accompanied by a statement of consent
from the child/young person and the parents/carers. Where referrals are
expressing child protection concerns, the risk/concern about the child, who
may be suffering significant harm, will over-ride the consent requirement.
However, professionals should still strive to work in partnership with parents
and families whenever possible. The assessment of children in need,
including children in need of safeguarding is at the heart of the work of
gateway teams. It is expected that Gateway Teams will use the UNOCINI
Assessment Framework to assess, analyse and appraise the circumstances
of the child and family to ensure that safe and sound decisions can be made.
Additionally there are also a number of inappropriate referrals made to Family
and Child Care where the needs of the child are at level 2 or below and there
are no indications of a potential to deteriorate as the parenting capacity is at
level 1/2. Sometimes professionals, in other agencies, insist on passing on
these referrals although they may be advised that there are insufficient
grounds for statutory assessment or intervention. All such referrals should be
referred to the supervising manager.
These three types of contact are described in paragraphs 4.1 – 4.3 below and further
clarified with examples of each kind of contact.
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Information Exchange
As stated above there is no expectation that this information will become the basis of
either an assessment or lead to intervention. The incoming information should be
checked on SOSCARE and passed to the relevant team, if there is current activity or
bought to the attention of the supervising manager if the case is closed. After
scrutiny and appraisal by a supervising manager the information should be
logged, as an information item, and recorded in line with Regional policy.
Notifications received from PSNI, which detail the police attendance at an incident of
domestic abuse, in which the children were either not present or not involved will be
logged as an information item, and recorded in line with Regional policy, after
scrutiny by the supervising manager.
If three notifications are made within a twelve month period by agencies to Family
and Child Care, then this should lead to an escalation of the case and an UNOCINI
initial assessment should be initiated.
Example 1
PSNI were called to the home of the A family, at 23h00 on Friday night, after neighbours reported
a disturbance. The family consists of mother and father who were present in the home and two
teenage children, who were staying with friends and therefore absent from the home.
The disturbance was due to a dispute about the amount of money, which had been spent during
the evening at the local pub. There was no physical violence merely raised voices. PSNI had no
record of the family or the address prior to this complaint. Following the visit of the police officers
the situation returned to calm.
Family and Child Care had no prior knowledge of the family and following scrutiny by the
supervising manager the details were logged on SOSCARE and no further action was taken.
The potential for the E-System that will underpin UNOCINI to capture all contacts
and information exchange within the trust children services is to be explored, in line
with the Laming iii proposals, so that information exchanged between A&E and
Community nursing will become part of a more complete data base that combines
with notifications from other agencies.
Example 2
The B family presented at A&E on Saturday afternoon and explained that Z aged 3 had fallen
from a slide in the park onto a hard surface. At the time the mother and her partner X (who is not
the father of Z) had their attention on their younger child Y aged 4 months who needed to be
changed as she had colic.
The examination in A&E revealed superficial bruising to the right side of the body and bruising
and scratches to the face consistent with the explanation. The duty doctor had no concerns
about the child’s health or well being and she was at ease with both her mother and X.
The Community Nursing Manager examined the information and as the second child had just
been seen for her 4 month assessment and everything was reported as satisfactory with no
concerns about care or development, the information was logged as an information item, and
recorded in line with Regional policy.
Advice and Guidance
Whether presented via another agency or through a direct approach, responses to
specific requests are not requests for assessment or intervention. However, the
SOSCARE database and other information indices held by the trust should be
checked to establish that such a request is not merely a presenting issue, masking
more fundamental issues. Gateway Teams deal with many requests of this kind and
a simple process to log and record information, backed up by the scrutiny and
appraisal of the supervising manager, should be sufficient response, if there are
no contra-indications. These contacts include, for example, requests for advice on
accessing early years and after school provision and obtaining legal advice and
representation in contact disputes.
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Example 3
The local housing management office contacted the Gateway Team by telephone to ascertain if
there were mother and toddler groups available near a new housing development, which could
be accessed by W a single mother for her child V aged 1year 4months. V has recently been rehoused
following a disagreement with her own parents with whom she had been living. The
housing officer had no concerns about the welfare of V and was trying to help a young mother
settle into her new home in an unfamiliar area of town.
The Family and Child Care had no record of contact with either W or her extended family at
either of the addresses given.
Information was given about available mother and toddler groups in walking distance from W’s
new address. After consideration by the supervising manager the case was logged on as an
information item, and recorded in line with Regional policy
Example 4
U approached the Gateway Team to seek advice about access to his daughter T aged 7, which
is being denied by her mother following a disagreement when he took the child out for the
afternoon last Friday after school. The couple had lived together for almost eight years but split
up 5 months ago and this is the first disagreement about access.
Neither U, nor his partner, nor T had ever been bought to the attention of Family and Child Care
prior to this contact. U wanted advice about how to obtain a court order to ensure that he could
maintain contact with his daughter for whom he pays maintenance on a voluntary basis.
U was given information about the legal options and advised to seek legal advice from a solicitor
specialising in child care. After scrutinizing the notes the supervising manager, decided that the
details should be recorded on as an information item, and recorded in line with Regional policy
but no further action was taken.
Referrals
Referrals arrive within the totality of work including the many items of information
exchanged and the numerous requests for advice and assistance. Having good
quality information at the point of referral can be critical, identifying those referrals,
which should be opened as cases. These will then be progressed; seeking the
appropriate further information, under the direction of the supervising manager.
A referral is a request for both assessment and/or intervention, which should be
evidenced in the information provided by the referrer, ideally in a UNOCINI. The
timely collection of further information, with the consent of the family, is critical to
ensuring the safety, welfare and well-being of children.
Referrals made by children and young people either directly or through a third party
should always receive careful consideration and be allocated for assessment.
Sometimes referrals made by members of the community or voluntary groups have
insufficient information for sound decision making additional information should be
sought, with the appropriate consent of the family as soon as possible.
Referrals may be classified, from the referral information available, as follows:
Priority 1:- Needs of child are described and evidenced at Level 4 in one or more
domains and requiring urgent assessment and early intervention to safeguard the
child. Parental capacity is likely to be at level 3 or level 4 and environmental factors
may also be at a high level. It is likely that safeguarding procedures will apply and
the child should be seen and assessed within 24 hours.
Example 5
M an only child aged 8 has been causing concern to the school for some time, as he is not
learning or manageable in the classroom. He appeared at school after the weekend with severe
bruising to the face arms and legs. Mother is the sole carer and has a serious drug dependency
problem; she is known to have been abused both physically and sexually as a child.
M claims that his mother ‘lost it’ on Sunday evening, when he stole from her purse to buy sweets
as he was hungry.
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Supervising senior is consulted and agrees to urgent assessment and immediate contact with
PSNI and other agencies
Priority 2:- Needs of child are described and evidenced at level 3, including children
who may be in need of safeguarding and require assessment and intervention (if
parental capacity is also at level 3 or level 4). For those who are in need of
safeguarding, the initial assessment should be initiated within 24 hours and
completed within the 7 working days. For others, and if parental capacity is at level 1
or level 2, the case is likely to be less urgent but would still require an initial
assessment,
Example 6
T is an exuberant 11 year old boy, with 4 older siblings. He is well behind in his school work and
struggling to stay on good terms with any of his peers. He has become involved with a group of
older boys on the estate and is beginning to sniff glue.
His elder brothers have all had difficulties in the neighbourhood and alienated the community.
T’s parents appear to be unconcerned and have rejected advice from the local youth leader. They
appear to spend a lot of time away from the home leaving T in the care of his elder sister J who is
14 and has a moderate learning difficulty.
Priority 3: Needs of child are described and evidenced at Level 2, but the parental
capacity is at either level 3 or level 4 and environmental factors may also be high.
These referrals relate to children where there is likely to be a potential for the
circumstances to deteriorate leading to a reduction in parental capacity and/or an
escalation of children’s needs. If these referrals are defined as children in need the
consent of the child/young person and parent/carer will be required. If it is not
forthcoming the supervising manager should consider whether the need to safeguard
the child may over-ride issues of consent.
Example 7
GP has called in the HV to discuss P family. HV is supporting the parents of N aged 2 who has
severe cerebral palsy. P’s parents presented at surgery last night with their elder son R aged 7,
who has a moderate learning difficulty, and is becoming more and more difficult to manage. He
is now ‘challenging neighbours and throwing stones at their cat. His self care is poor and he is
often eneuretic.
The parents are both employed and have good support from both sets of grandparents. There
are no apparent practical problems and the parents would like help but are afraid of R being
‘taken away’.
Social worker proposes immediate allocation and exploratory visit with HV to obtain consent and
seek further information with a view to completing an initial assessment.
Inappropriate referrals: The needs of the child are described at level 2 or below
and parenting capacity is at level 1/2. Following explanation to the referrer and
Soscare check, after scrutiny by the supervising manager these referrals would be
NFA’d. Through local discussion of thresholds it is anticipated that the number of
inappropriate contacts from professionals should decline.
Care Pathways
Following the completion of the UNOCINI initial assessment, children and families
are likely to follow one of three Pathways dependent upon the needs, which have
been identified during the assessment process. All three Pathways have a
continuing requirement for assessment at predetermined points. However, when a
significant event occurs, which changes the circumstances of the child and family
this will require the assessment to be bought forward. The development of the
Safeguarding Board (NI) offers an opportunity to develop a more holistic approach to
meeting the needs of children and to addressing the needs of a wider range of
children than those, whose names appear on the child protection register.
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Overall the approach should be proportionate to the assessed strengths, needs, risk
and resilience and protective factors, and whilst offering the least intrusive service, it
should also ensure sufficient safeguarding of the children. At the same time the
approach adopted should not shy away from the difficult decisions: in some cases it
will be necessary to escalate service through child protection or accommodation.
The clarity which one seeks to achieve through assessment and reassessment
should not be distorted by the overtly co-operative parents, if the needs of the child
are not diminishing or if the child’s unmet needs are becoming greater.
The bulleted list shows the ways in which the Pathways can be used with the least
intrusive intervention at the top and the most intrusive at the bottom. It is proposed
that following the initial assessment the Pathway to be followed should be the least
intrusive possible dependent upon the issues set out in the previous paragraph.
• Family Support Plan
• Family Support Plan and Domain Specific Pathway Assessment
• Family Support Plan and Holistic Pathway Assessment
• Child Protection Register, CP Pathway Assessment and Protection Plan
• Accommodation, LAC Pathway Assessment and UNOCINI LAC Care Plan
Family Support
As a starting point all assessments should consider the feasibility and suitability of
developing a Family Support Plan to address the child’s needs within the family and
community on a voluntary basis. The focus on supporting the family and building on
their strengths is whenever possible the preferred mechanism to create long term,
sustainable improvement in the welfare and well-being of children. This approach is
likely to be most effective where the needs of the child do not exceed level 3 and the
capacity of the parents is relatively strong i.e. at level 2 or below and has been
assessed as having the potential for improvement. Clearly developing a Family
Support plan requires the co-operation and agreement of the children and family;
their continuing participation in the work required and the achievement of
requirements of the plan.
Example 8
An initial assessment revealed that three small boys M, N, and O aged 5, 7 and 8 were all being
left alone while their parents worked extra shifts at low paid jobs to clear large debts that had
built up during a period of unemployment. Parents have demonstrated strong commitment to
their children and are very worried and concerned that Family and Child Care will intervene and
remove the children. There are now arrangements in place for the children to be cared for by
their active paternal grandmother who lives near-by.
The assessment revealed that the middle boy N has developmental delay and is struggling to
keep up in school. He appears to have low self esteem and his self care has regressed. At
present he is over eating and his parents are finding it difficult to control both his eating and his
weight gain.
The parents have signed up to a Family Support Plan to promote a package of direct work with N
to be delivered by school nurse, counsellor and special needs teaching assistant.
The case will be closed by Family and Child Care and may be re-referred if further assessment
or intervention is necessary.
Child Protection
In a small number of cases, where there is a higher level of need and risk of
significant harm, either through a combination of needs at level 3 and/or level 4,
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together with assessed parental capacity at level 3 then it may be appropriate to
consider a child protection plan and the application of the child protection pathway.
There is a continuing need to look to the strengths of the family and extended family,
by for example, utilising the Family Group Conference Service. However, where
there is a pattern of high needs of the child(ren), limited capacity of parents and risk -
actual or potential - strict adherence to the ACPC policies and procedures will
be required. In some trusts there is already evidence that working on a cooperative
basis with children and families generally reduces or negates the escalation to the
Child Protection Pathway.
Although the development of the CP plan does not require the consent of children
and their parents/carers, the probability of a successful outcome for the children is
low if this engagement cannot be created through the active intervention of the
multidisciplinary core group.
Example 9
The designated teacher at Willow Primary School telephoned an urgent referral to the Gateway
Team about Q aged 7. She arrived for school looking cold and said she was hungry. When
questioned further by the designated teacher she alleged that her mother’s boyfriend had hit her
with a cane because she would not eat the food her mother cooked. She went on to claim that
he regularly hit her with his hand or with anything that was close by.
The S family have been known intermittently to Family and Child Care for many years. Mrs S
has a history of mental illness and when she does not take her medication her capacity to
provide parenting to her two children Q and R aged 7 and 10 declines rapidly. Her husband left
the family, over six years ago, shortly after the birth of Q. Mrs S has had a number of liaisons
with other men but has not formed a stable relationship.
Both Q and R have learning difficulties but are well supported in school. They have had periods
in care which they found very unsettling and are attached to their mother, who is usually warm
and affectionate.
Following discussion with the supervising manager, the social worker visited Mrs S at home to
obtain her agreement to medical examination. Mrs S consented when the position was
explained to her but her boyfriend objected and threatened Mrs S. Although the children did not
know the boyfriend’s surname, when pressed Mrs S explained who he was and that he had a
criminal record for assault.
The response of the Gateway Team was to secure the welfare of the children and ensure that
there was clarity about their injuries etc. This was all achieved in cooperation with PSNI and the
other agencies involved, school, EWO and GP. It was agreed that a CP conference would be
convened and that subject to Mrs S ejecting the boyfriend, although he was unlikely to be bailed,
and restarting her medication the children would remain in her care with regular support from
Family and Child Care.
These conditions and elements of service would form the basis of the CP plan which would be
considered at the Initial CP Conference. If either the boyfriend returned or Mrs S mental health
did not improve then action would be initiated to accommodate the children.
Looked after Children
For a small cohort of children there are few chances of improvement if they remain
within their family and community. Neither the family support pathway nor the child
protection pathway is appropriate because their needs are so great at levels 3/4 and
the capacity of their parents/carers to address their needs is at an equally high level.
For these children, having exhausted the potential of the other pathways to offer the
reduction in risk and improved outcomes to their welfare and well-being, the
provision of accommodation may be the only option. Generally it is expected that
work will have been undertaken to promote the family functioning and utilise the
strengths of the family and extended family, to ensure that every opportunity is taken
to meet the child’s needs before recourse to accommodation.
Example 10
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After an initial assessment completed in five days due to the seriousness of the neglect
experienced by F and G, a little boy aged 3 and his sister aged 4 plus. The case was progressed
to case conference and the children were included in the CP register.
The family had been known to Family and Child Care from time to time. The mother of the
children had a drink problem and although she received both counselling and in-patient
treatment, she was still frequently incoherent due to alcohol. Her physical health is poor and she
appears emaciated.
Her relationships with her estranged partner, extended family and
neighbours are hostile. She has no external support.
Both children were very dirty and infested, their body weight was well below the 25 th centile and
medical examination revealed extensive nappy rash on F, who was not toilet-trained. Neither
child appeared to know how to eat with a spoon or fork and used their fingers for any food put in
front of them.
During the assessment the children were found unattended and unfed during an early evening
visit. Their clothes were so dirty it was impossible to see the colours.
After discussion with their mother on her return the children were accommodated. Discussions
are going forward about their return, but their mother is preoccupied with the impact that the
decision may have on her income support and her available cash for the purchase of alcohol.
The children appear very happy, very quickly in the foster home
The third dimension of the assessment framework relates to the environment in
which the family live. This has not featured in the descriptors above and while it is
accepted that Family and Child Care is neither an accommodation provider nor an
income maintenance agency, the connection between poverty and deprivation is well
documented and universally accepted. The opportunity for intervention within these
aspects of the family’s life, should not be under estimated. Improving the housing
conditions, in which a family live or ensuring that where they are dependent upon the
benefit system that they are receiving their entitlement may tip the balance in
improving parental capacity to meet children’s needs.
Summary
Family and Child Care thresholds of intervention are often difficult and complex
issues to unravel and reconcile. The approach that has been adopted, which
appears to offer the best chance of consistent application, is to provide guidance for
staff and front line managers backed up by examples. This guidance can then be
used as part of the induction, development and regular review of staff and managers
in the Family and Child Care and the development and performance management
arrangements for the service.
The development of the managerial capacity at senior social worker and service
manager levels will also be critical to success, in ensuring quality assessment and
accurate application of thresholds of intervention. These two groups of managers
share the responsibility for quality assurance and performance management.
Further investment in these key groups of staff may be required to embed and
sustain the improvement in assessment and the management of thresholds of
intervention.
There will always be limitations on the application of thresholds across the
organisational boundaries of trusts, given the different history, culture, demography
and geography of the trusts. Regular monitoring of the application of thresholds
connected with the application of the workload management scheme may lead to
increasing levels of consistency over time. In order to apply a threshold of
intervention, adequate information to form a judgement is required at referral and
after the completion of either UNOCINI initial or pathway assessment.
Equality
This guidance has been screened for equality implications as
required by Section 75 and Schedule 9 of the Northern Ireland Act
1998, and it was found that there were no negative impacts on
any grouping.
Human Rights
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APPENDIX 3
Thresholds of Need Model
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Contents
1 Introduction........................................................................................................ 33
2 Four Levels of Need Model................................................................................ 34
3 Definitions of Levels of Need ............................................................................. 35
4 Using the Model to Support Practice ................................................................. 35
5 Using the Model to Identify Appropriate Services .............................................. 35
6 General Statements Regarding Appropriate Service Response to the Four
Levels of Need ......................................................................................................... 36
7 Limitations of the Model..................................................................................... 37
8 Appendix One: Needs Tables............................................................................ 38
9 Appendix Two: Services Tables......................................................................... 45
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Introduction
The UNOCINI assessment framework has been developed to:
• improve the quality of assessment within stakeholder agencies
• assist in communicating the needs of children across agencies
• avoid the escalation of children’s needs through early identification of need
and effective intervention
UNOCINI has three areas each divided into four domains and all stages of
assessment require professionals to revisit the domains and case plan services to
address issues in the three areas.
In order to be able to describe the different levels of children’s needs, a multi-agency
group of professionals from across Northern Ireland has worked together to develop
this model. It is based upon the domains and dimensions of the UNOCINI Northern
Ireland Assessment Framework. These are:
The child’s needs, parent’s capacity to
meet these needs and family and
environmental factors which impact
upon the child or young person. The
way in which these factors interact
with, and influence each other, must
also be carefully analysed in order to
gain a complete picture of a child’s
unmet needs and how to identify the
best response to them.
Basic Care and Ensuring Safety
Emotional Warmth
Guidance, Boundaries and
Stimulation
Stability
Child’s Needs
Parents’ or Carers’ Capacity to Meet
the Child’s Needs
Health and Development
Education and Learning
Identity, Self-Esteem and Self-Care
Family and Social Relationships
Family and Environmental Factors
Family History, Functioning and
Well-Being
Extended Family and Social &
Community Resources
Housing
Employment and
Income
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Final Version
Updated 24/06/09
Four Levels of Need Model
This model proposes four levels of need: the model is based upon the work of Pauline
Hardiker and also upon the work within the Northern Ireland Family Support Model iv . The
diagram below provides a useful way of conceptualising these levels of need:
Level 1: Base population
Children 0-18 living in Northern Ireland, including children and families
who may require occasional advice, support and/or information
Level 2: Children with additional needs
Vulnerable children who may be at risk of social exclusion
Level 3: Children in need
Children with complex needs that may be
chronic and enduring
Level 4: Children with
Complex and/or Acute
Needs
Children in need of rehabilitation;
children with critical and/or high
risk needs; children in need of
safeguarding (inc LAC); children
with complex and enduring needs
Children will obviously move between these levels of vulnerability according to their
particular circumstances and so it is essential that the service response can be flexible and
able to address these changing needs. The model is not intended, nor should it be used
to exclude children and families from help in an arbitrary manner. The aim of early
identification, referral and service provision (i.e. through use of UNOCINI) is to ensure that
children are prevented from moving towards the higher levels of need and wherever
possible concerns reduced so that their levels of need reduce. The division between the
levels should not be conceived of as ‘hard and fast’. Children in need of safeguarding may
present with different combinations of needs at level 3 and/or level4. There will need to be
some flexibility around the boundaries to ensure that children are properly assessed,
making use of inter-disciplinary consultation and ensuring that appropriate services
arranged.
34

Definitions of Levels of Need
Level One: Base Population
The majority of children and families in NI whose needs are being met. They utilise
universal services and community resources as required.
Level Two: Children with Additional Needs
Vulnerable children and their families, who require additional support to promote social
inclusion, to reduce levels of vulnerability within the family and/or to minimise risk-taking
behaviours.
Level Three: Children in Need
Children with complex needs that may be chronic and enduring and whose health
(physical & emotional) and development may be significantly impaired without the
provision of services v . This may include some children who are in need of safeguarding.
Children with a disability are also children in need.
Level Four: Children with Complex and/or Acute Needs
Children who are suffering, or likely to suffer, significant harm without the provision of
services. This includes children who are looked after; those at risk of being looked after
and those who are in need of rehabilitation from a care or custodial setting; children with
critical and/or high risk needs; children in need of safeguarding and children with complex
and enduring needs.
Using the Model to Support Practice
It is intended that this model be used to enable practitioners and their agencies to
communicate their concerns about children using a common format, language and
understanding of the levels of need, concern or risk for all children across Northern
Ireland. It is also intended as a tool to enable practitioners to complete a needs ‘map’,
using the tables in Appendix One, to assess children and articulate the needs and
strengths of the child and the family and the risks and protection issues that may exist.
Using the Model to Identify Appropriate Services
Having identified an overview of a child and family’s needs, practitioners will be able to
apply the general statements below to enhance their understanding of the type of services
most likely to be suitable to meet the needs of the child and their family. (For example, a
child with level 4 needs will be in receipt of all universal services (alongside all other
children in the base population – i.e. level 1); they may also benefit community based
services at level 2, and they may also require provision such as accommodation as a
looked after child at level 4.)
This understanding can be further enhanced by using the tables available in Appendix
Two, which identify the services that agencies provide to children across the four levels of
need on a Regional basis. The tables are separated to identify services from the following
agencies/types of provision:
a. Health
b. Social Services
c. Child and Adolescent Mental Health (CAMHS)
d. Education
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e. PSNI
f. Justice (including Probation, Youth Justice, Prison Services, and NIACRO) – Not yet provided.
g. Housing – Not yet provided.
Community and voluntary sector services have been included within the most appropriate
agency tables: these services are provided by a great number of agencies, teams and
groups, many of which are provided in certain localities only. The detailed breakdown of
services from the community and voluntary sector should become included within
individual Trusts’ directories of resources.
The directories of services (being developed by the five individual Trusts within their local
areas) can then be used to further support practitioners in identifying the services that may
be available to children and families within their locality.
General Statements Regarding Appropriate Service Response to the
Four Levels of Need
Level One: Base Population
Children and families typically self-refer and access universal and community resources as
part of everyday day life. For example, seeing their G.P. for minor ailments; attending
school; joining a club; attending a community meeting or play group. Additionally, many
agencies undertake preventative and awareness raising work at this level. For example,
health promotion sessions and crime prevention road-shows.
Level Two: Children with Additional Needs
In recognition of their vulnerability or potential for social exclusion, some children and
families will be offered enhanced assistance from universal services or through community
voluntary organisations. For example breast feeding support, Surestart Playgroup,
counselling or parenting support group.
Level Three: Children in Need
Children in need and their families will, usually following an assessment, be provided with
community based services to safeguard their welfare and well-being, organised through a
single agency or on a multi agency basis. For example professionals including health
visitors, education staff including teachers, and social workers will cooperate to provide
inputs such as specialist assessment, regular support and intervention from experienced
professionals, sponsored playgroup or child minding placement, behaviour management,
educational needs statementing, family centre intervention.
Level Four: Children with Complex and/or Acute Needs
Children experiencing the most acute and/or complex difficulties will be provided with
coordinated support and intervention that is likely to be on a multi-agency basis. For
example, Protection Plans for children, which incorporate inputs from social workers,
education welfare officers, health visitors and mental health workers. Those children who
have issues that that cannot be resolved within their family will be accommodated in
health, education, justice or social care placements to facilitate their rehabilitation
whenever possible. For example children with serious medical conditions may be in
hospital, some children may be in special residential schools, children who have
committed serious crimes will be in youth justice placements and other children may be in
foster care or social care establishments, including secure placements.
36/52

Limitations of the Model
The model cannot be an exhaustive list of all likely or possible needs, concerns, risk
factors or services. It is indicative and should not be rigidly applied. The presence of
single or multiple combinations of factors, the age and resilience of the child and protective
factors will all need to be taken into account.
The model is not intended to replace professional consultation, or inter-disciplinary
collaboration and relies upon good quality assessment of the child’s circumstances
by the agency representatives concerned: this degree of professionalism is of
paramount importance in identifying the appropriate response.
37/52

Appendix One: Needs Tables
Child’s Needs
Level One:
Health & Development
• Physically well
• Adequate diet / hygiene / clothing
• Health appointments are kept / developmental checks /
immunisations up to date
• Regular dental and optical care
• Developmental milestones met, or being attended to
appropriately (including speech and language)
• Feelings and actions demonstrate appropriate
responses
• Good quality early attachments
• Able to adapt to change
• Able to express and demonstrate empathy.
Education & Learning
• Acquired a range of skills/interests (including sports,
hobbies etc)
• Experiencing success/achievement (including sports,
hobbies etc)
• Access to books/toys, play
• Attends school/group regularly and any absences are
explained
• Usually punctual or lateness acknowledged and
explained
• Behaves well in classroom or other learning situation
• Is actively engaged in learning
• Learning is on track, appropriate to age and ability
• Has good access to enhanced opportunities to learn in
school, home and community
Identity, Self-Esteem & Self-Care
• Positive sense of self and abilities
• Demonstrates feelings of belonging and acceptance
• A sense of self and an ability to express needs
• Appropriate dress for different settings
• Good level of personal hygiene
• Growing level of competencies in practical and
emotional skills, such as feeding, dressing and
independent living skills
Family and Social Relationships
• Stable and affectionate relationships with caregivers
• Good relationships with siblings
• Positive relationships with peers
Level Two:
Health & Development
• Emotional and behavioural difficulties but not
significantly impairing health or development
• Susceptible to minor health problems
• Minor concerns re diet / cleanliness / hygiene / clothing
• Defaulting on health appointments / immunisations /
checks
• Not registered with GP/Dentist
• A&E attendance giving cause for concern
• Slow in reaching developmental milestones
• Signs of disruptive or challenging behaviour
• Early signs of anti-social behaviour
• Difficulties with peer group relationships and with adults
• Can find managing change difficult
• Starting to show difficulties expressing empathy
• Low level substance misuse
Education & Learning
• Truants with peers, or being disruptive in class
• Reduced access to toys and books
• Occasional unexplained absences from school or other
group
• Poor punctuality
• Poor behaviour in classroom/other learning
environment
• Sudden or sustained drop in preparedness to learn and
engage e.g. no kit or homework and not participating in
sport and hobbies
• Not realising educational potential and /or reaching
level appropriate to age and ability
• Unable to access or participate in enhanced learning
opportunities e.g. groups, trips, etc
Identity, Self-Esteem & Self-Care
• Some insecurities around identity expressed e.g. low
self-esteem
• May experience bullying discrimination or harassment
due to ethnicity sexual orientation, disability or religion
• Previously happy child becomes sad, withdrawn, quiet,
argumentative, aggressive
• Can be over friendly or overly fearful with strangers
• Can be provocative in appearance and behaviour
• Not always adequate self care e.g. poor hygiene
• Some delay in developing age appropriate self-care
skills
Family and Social Relationships
• Some support from family friends
• Has some difficulties sustaining relationships
• Child has caring responsibilities which has some impact
on education or development
• Being a victim of, or having witnessed a traumatic event
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Child’s Needs
Level Three:
Health & Development
• Moderate mental / emotional health or behavioural
difficulties (including self-harm)
• Behaviour impacting on health and development
• Concerns re diet, hygiene, clothing, overweight /
underweight
• Missing routine and non-routine health appointments
• A&E attendance causing concern
• Concerns re enuresis / encopresis
• Developmental milestones delayed and not being attended
to
• Finds it difficult to cope with anger, frustration and upset
• Disruptive challenging / offending / anti social behaviour at
school or in neighbourhood and at home, involvement of
agencies, police, Behaviour Support Service, Youth Justice
Services
• Persistent difficulties in relationships with peer group and
adults
• Finds change particularly difficult to manage
• Unable to demonstrate age appropriate empathy
• Child young person with permanent & substantial
disabilities requires support/care package
• Some evidence of inappropriate sexual activities
• Substance misuse potentially damaging to health and
development
Education & Learning
• Poor school attendance i.e. less than 80%, including child
refusing to attend school
• Regularly late 2-3 times per week
• Serious behaviour problems in classroom, leading to
suspension
• Disaffected from learning and other school activities
• Failing to reach potential in exams, test appropriate for age
and ability and/or has no record of achievement
• Not engaged in enhanced learning opportunities eg trips
and other groups
• Statement of special needs requested or in progress
• Not achieving key stage benchmarks / identified learning
needs
• No interest / skills displayed (including sports, hobbies etc)
• Toys and books absent from environment
Identity, Self-Esteem & Self-Care
• Demonstrates significantly low self-esteem in a range of
situations
• Subject to discrimination e.g. racial, sexual or due to
disabilities
• Child has few (if any) positive relationships and can be
hostile to others
• Is provocative in behaviour / appearance
• Hygiene problems
• Child previously able to care for self regresses
• Poor self care for age including hygiene
Level Four:
Health & Development
• Has severe mental or emotional health problems or
behavioural difficulties which affect development
• Severe and / or multiple disabilities or serious health
problems affecting development
• Self harming or suicide attempts linked to periods of
depression
• Appears undernourished / obese / dirty / infested / very
poor standard of clothing
• Child has suffered or may have suffered physical, sexual
emotional abuse or neglect
• Multiple A&E attendances causing concern / suspected
non-accidental injury
• Developmental milestones unlikely to be met / failure to
thrive
• Regularly in anti social/criminal activities, which places self
or others at significant risk
• Offending behaviours likely to lead to custody / remand or
other court appearance
• Puts self or others in danger e.g. regularly going missing,
violence towards others, relationships dysfunctional
• Demonstrates disregard for others’ feelings
• Disabled child or young person with permanent &
substantial disabilities requires support package to meet
needs significantly in excess of that normally
• Early teenage pregnancy where there are concerns about
young person’s ability to parent
• Inappropriate sexual activities
• Substance misuse or self harming damaging health and
development
Education & Learning
• Children may be in alternative provision and school
placement has broken down
• Does not attend school on a regular basis(Prosecution likely
or in process)
• Is usually late when attending
• Behaviour is unmanageable and likely to be expelled or has
been expelled
• Not learning in classroom or other situations
• No pattern to learning
• Not engaged in extra curricular development activities
• Not engaged in education, training or employment
appropriate to age
• Pre-school child who is unable to engage or participate in
play activity
Identity, Self-Esteem & Self-Care
• Experiences persistent discrimination, placing the child at
risk or is adversely affecting the child’s health and
development
• Is socially isolated and lacks appropriate role models,
placing the child at risk
• Regularly seen in inappropriate / inadequate clothing
• Hygiene problems causing isolation affecting child’s selfesteem
and development
• Child repeatedly presenting as being hungry
• Neglects to use self care skills due to alternative priorities
e.g. substance misuse
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Family and Social Relationships
• Lack of positive role models / deteriorating parental
relationship
• Misses school or leisure activities
• Peers also involved in challenging behaviour
• Involved in conflicts with peers / siblings
• Regularly needed to care for another family member
impacted on education / developments
• Young person living independently and not coping
Family and Social Relationships
• Concerns about a child who is or was previously looked
after
• Family breakdown related in some way to child’s
behavioural difficulties
• Peers / siblings engaged in criminal / high risk activities
• Child has caring responsibilities that impact significantly
on child’s education / health / development
• Young person living independently, but homeless
• Parent or sibling suicide
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Parents’ or Carers’ Capacity to Meet the Child’s Needs
Level One:
Basic Care & Ensuring Safety
• Provide for child’s physical needs, e.g. food, drink,
appropriate clothing, medical and dental care
• Protect from danger or significant harm, in the home and
elsewhere
Emotional Warmth
• Shows love, praise and encouragement
Guidance, Boundaries & Stimulation
• Provide guidance so that child can develop an
appropriate internal model of values and conscience.
• Facilitates cognitive development through interaction
and play
• Enable child to experience success, or cope with
disappointment
• Consistent parenting providing appropriate guidance
and boundaries
• Supports the child in developing appropriate peer and
other relationships
• Ensures that legal obligations in respect of child’s
education are meet
• Demonstrates support for child’s education
• Ethnic minority – ‘to be supplied’
Stability
• Ensure that secure attachments are maintained
• Provide consistency of emotional warmth over time
Level Two:
Basic Care & Ensuring Safety
• Poor maternal health / not accessing post/ antenatal
care
• Inability to recognise health care needs for self or child
• Parent requires ongoing advice on parenting issues
• Parental engagement with services is poor
• Professionals are beginning to have some concerns
around child’s physical needs being met
• Mental or physical health needs, or learning disability,
substance misuse or other health problems but they do
not appear to significantly affect the care of the child
• Some exposure to dangerous situations in the home or
community
• Parental stresses starting to affect ability to ensure
child’s safety
• Condoned absence from school
• Misplaced anxiety regarding child health
Emotional warmth
• Poor parent/child relationships
• Inconsistent responses to child by parent(s)
• Child able to develop other positive relationships
Guidance, Boundaries & Stimulation
• Child behaves in anti-social way in the neighbourhood
e.g. petty crime
• Inconsistent parenting – difficulties setting boundaries
• Limited parental guidance in relation to appropriate
emotional responses
• Child spends considerable time alone e.g. watching
television.
• Child is not often exposed to new experience or
activities
• Parent has literacy/numeracy/communication difficulties
that impact on their ability to fully engage in their child’s
educational development
• Ethnic minority differences ‘to be supplied’
• Fails to engage with school or attend school events
Stability
• Key relationships with family members not always kept
up
• May have different carers
• Starting to demonstrate difficulties with attachments
• Irregular pattern of emotional interactions
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Parents’ or Carers’ Capacity to Meet the Child’s Needs
Level Three:
Basic Care & Ensuring Safety
• Inadequate care not meeting physical needs
• Inability to put child’s need before own needs
• Inability to recognise health needs for self or child such
that child’s health and development is likely to be
significantly impaired
• Difficult to engage parents with services
• Professionals have serious concerns
• Parent is struggling to provide adequate care
• Mental or physical health needs, substance misuse or
frequent health problems leading to the majority of
parenting responsibilities not being undertaken and
child’s health and development is likely to be
significantly impaired
• Child perceived to be a problem by parents
• Parental stresses affecting ability to ensure child’s safety
• Child may be subject to neglect e.g. exposed to
dangerous situations in the home or community;
experiencing unsafe situations
• Child regularly left alone or unsupervised
• Child previously looked after by Trust
Emotional Warmth
• Child / parent relationship at risk of breakdown
• Receives erratic or inconsistent care
• Has no other positive relationships
• Parental instability affects capacity to nurture
Guidance, Boundaries & Stimulation
• Parent does not offer a good role model e.g. by
behaving in an anti-social way
• Erratic or inadequate guidance provided
• No parental guidance in relation to appropriate
emotional responses
• Not receiving positive stimulation; lack of new
experience or activities
Stability
• Child has multiple carers
• Child has been looked after by Trust
• Parent has withdrawn from emotional interaction
Level Four:
Basic Care & Ensuring Safety
• Failure to access adequate health care resulting in
serious risk to child’s health (includes unborn child)
• Concerns about parenting of child
• Severe mental or physical health needs, substance
misuse or other health problems such that vital
parenting roles cannot be undertaken and child at risk of
significant harm
• Persistent serious domestic violence such that child is at
risk of significant harm
• Parents involved in crime which is affecting parents
capacity to provide care or is significantly impacted on
child’s development
• Parents unable to keep child safe
• Young child left alone or unsupervised
• Concerns about a child in a family where parents were
unable to care for previous child and child has been
removed
• Concerns about parenting of a child who is / or has been
looked after or is at risk of becoming looked after
• Child refusing to return home
• Allegation or reasonable suspicion of serious injury /
abuse or neglect
• Currently or previously on Child Protection Register
Emotional Warmth
• Parents inconsistent, highly critical or apathetic towards
child / concerns of emotional abuse. ‘low warmth high
criticism’
Guidance, Boundaries & Stimulation
• Frequently behaves in an anti-social way in the
neighbourhood leading to risk of criminal conviction or
subject to an Anti-Social Behaviour Order
• No effective boundaries set by parents leading to child
being beyond parental control
• Parental disinterest in child’s emotional development
• Parental disinterest in child’s educational development
• No constructive leisure time or guided play which
significantly impacted on child’s development
Stability
• Child is beyond parental control
• Child has no parent or carer / abandoned child or
unaccompanied minor
• Parent / carer has rejected child from home or is
threatening to reject child from home
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Family and Environmental Factors
Level One:
Family History, Functioning & Well-Being
• Good relationships within family, including when parents
are separated
• Few significant changes in family composition
• Good access and use of universal services
• Family live in an area unaffected by civil unrest
Extended Family and Social & Community Resources
• Sense of larger familial network and good friendships
outside of the family unit
• Family is integrated into the community
• Good universal services in neighbourhood
Housing
• Accommodation has appropriate facilities
• Security of tenure and absence of harassment
Employment & Income
• Parents able to manage the working or unemployment
arrangements and do not perceive them as unduly
stressful
• Reasonable income over time, with resources used
appropriately to meet individual needs
Level Two:
Family History, Functioning & Well-Being
• Parents have some conflicts or difficulties and minor
incidents of domestic abuse (which have not involved
children) have been reported
• Child has experienced loss of significant adult through
separation or bereavement
• Child has caring responsibilities
• Parent or sibling has received custodial sentence Sibling
with disability or significant health problem
• Refugee family able to access community resources
• Asylum seeking family able to access community
resources
• Impact of multiple births/number of pre-school children
• Family live in an area affected by civil unrest but are not
directly involved
Extended Family and Social & Community Resources
• Limited support from friends and family
• Some social exclusion experiences
• Family may be new to the area
• Family experiencing harassment or discrimination or are
victims of crime
• Adequate universal resources but family may have
access issues
Housing
• Adequate / poor housing without some basic amenities
• Uncertain tenure / rent arrears
• Frequent change of address
Employment & Income
• Parents have limited formal education affecting ability to
find employment
• Periods of unemployment of the wage earning parents
• Low income from work or welfare benefits
• Some early concerns regarding debt
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Family and Environmental Factors
Level Three:
Family History, Functioning & Well-Being
• Incidents of domestic abuse between parents have been
witness by children and/or caused them distress
• Acrimonious divorce / separation
• Child is principle carer for parent, sibling or other family
member
• Parent or sibling is in custody
• Family have serious physical and mental health
problems
• Refugee family without access to community services
• Asylum seeking family refused the right to remain
• Family under strain due to impact of civil unrest
Extended Family and Social & Community Resources
• Family has poor relationships with extended family or
little communication
• Family is socially isolated and limited support from
extended family
• Parents socially excluded
• Parents experience stress without support network
• Poor quality universal resources and access problems to
these and targeted services
Housing
• Poor state of repair, inadequate temporary or
overcrowded housing
• Eviction in process / awaiting temporary housing
Employment & Income
• Parents find it difficult to obtain employment due to poor
basic skills
• Parents experience stress due to unemployment or
overworking
• Sustained low income
• Serious debts / poverty impact on ability to have basic
needs met
Level Four:
Family History, Functioning & Well-Being
• Significant parental discord and domestic abuse that is
witnessed by children, who appear to be affected by
domestic violence.
• Violence from siblings / parents
• Imminent family breakdown and risk of child becoming
looked after
• Schedule One offender is living in the family Wider
Family
• Family have serious physical and mental health
problems that pose a significant risk to the child’s wellbeing
and development
• Refugee family socially isolated and scapegoated by
community
• Asylum seeking family denied right to remain and
awaiting deportation without access to funds or other
support
• Family breaking up or a member is absent due to civil
unrest
Extended Family and Social & Community Resources
• Destructive / unhelpful involvement from extended family
• No effective support from extended family
• Family chronically socially excluded
• Poor quality services with long term difficulties with
accessing target populations
Housing
• Physical accommodation places child in danger
• Homeless and is not eligible for temporary housing from
official bodies
Employment & Income
• Family unable to gain unemployment due to significant
lack of basic skills or long term difficulties e.g. substance
misuse which affects their ability to provide basic care
and parenting
• Chronic unemployment that has severely affected
parents own identities and has seriously impacted on
their ability to parent (see parenting domain)
• Family / young person not entitled to benefits with no
means of support
• Extreme poverty / debt impacting on ability to care for
child and have basic needs met; food, warmth,
essentials, clothing
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Appendix Two: Services Tables
Threshold of Need
Services Available to Children across the Four Levels of Need: Health
Needs: Level 1 – Base Population Level 2 – Children with
Additional Needs
Assessments: Family Health Needs
Assessment
Level 3 – Children in Need
Specialist Assessments
Level 4 – Children with
Complex and/or Acute Needs
Services:
Health For All Children:
Health Promotion - feeding and
nutrition, reducing sudden
infant death, baby care,
behaviour management,
safety/accident prevention, oral
health, parenting skills,
immunisation, information on
local support services, how to
promote child development,
smoking cessation, routine
enquiry of mothers about
whether they are experiencing
domestic abuse, and routine
assessment of maternal mental
health.
Health Protection -
immunisation programmes,
neonatal blood screening,
neonatal hearing screening, TB
risk assessment, ongoing
surveillance of the general
health and development of the
child, awareness session for
teaching staff regarding
anaphylaxis/ diabetes/epilepsy,
UNOCINI Preliminary
Assessment
Community based support to
children and families with
additional needs; some children
may be receiving assistance
and/or treatment from specialist
clinics. This may also include
services to families and groups
who are socially vulnerable.
For example, A&E attendance
and short-term hospital stays,
supporting children recently
discharged form hospital
following an acute or chronic
illness, speech therapy,
assessment and/or treatment
from health consultants,
services to teenage mothers,
postnatal depression
treatments, behaviour advice,
TB liaison, A&E liaison, review
of visual/hearing/growth health
needs, reviews for specific
medical conditions, individual
work with children/young
people regarding lifestyle/risktaking/
diet, and support to
parents re the same, enuretic
Advice, support and planned
intervention to children and
their families with more
complex needs, in community,
hospital and clinic settings.
For example, support with
enteral feeding, behaviour
management clinics, support to
young carers, support to
disabled and /or looked after
children/young people and their
families and to those with
chronic health problems, child
protection visits to
children/young people on the
child protection register and
their families, health needs
group for looked after children,
care plans for children with
complex health needs,
supporting children with
ADHD/Autistic Spectrum
Disorders/ severe learning
disabilities and their families,
speech and language input for
children with complex needs,
acute hospital stay, and
Support to children with more
complex health needs and their
families, for example to those
with life-limiting, and severe
long-term/chronic conditions.
For example, in-patient and
hospice care, secure treatment
for young people with high level
risk-taking behaviours (e.g.
suicidal behaviour, significant
self-harming behaviours), care
packages (possibly defining
multi-agency input) to meet
complex health needs in
children and young people.
45

and weight and height
monitoring
Building Relationships with
Families
services within school health,
supporting families where
parenting capacity has been
compromised by additional
health needs in parents, and
referral to other agencies.
supporting families where
parenting capacity has been
significantly compromised by
substantial health needs in
parents.
Professionals:
The above services are
provided by a range of
professionals, including:
G.P.s
Health Visitors
School Nurses
Hospital and Community
Midwives
Health Promotion Officers
Newborn Hearing
Screeners
Community and voluntary
sector workers
In addition to those
professionals providing services
at Level 1, the following
professionals may become
involved at Level 2:
Hospital staff
Allied Health professionals
Community and Hospital
Paediatricians
Mental Health and/or
addictions workers
Surestart
Voluntary sector workers
working with children with
additional needs
In addition to those
professionals providing services
at Level 1 and 2, the following
professionals may become
involved at Level 3:
Child Development Clinic
staff
Professionals providing
dietetic services to
children and young people
with eating disorders
Health Visitor to looked
after children
Psychiatry / Tier 3
CAMHS
Crisis Intervention Team
staff (for parents with
mental health issues)
Forensic Medical Officer
(in cases of
suspected/alleged child
abuse)
Voluntary workers
(services likely to be
directly contracted or
commissioned by Social
Services – e.g. Barnados,
Extern, NHC, NSPCC,
Women’s Aid)
In addition to those
professionals providing services
at Level 1, 2 and 3, the
following professionals may
become involved at Level 4:
Professionals working
within secure
accommodation provision
Professionals working
within in-patient psychiatric
services
46

Thresholds of Need
Services Available to Children across the Four Levels of Need: Social Services
Needs: Level 1 – Base Population Level 2 – Children with
Additional Needs
Assessments:
Early Years Assessments
UNOCINI Preliminary
Assessment
Level 3 – Children in Need
UNOCINI Initial Assessment
UNOCINI Pathway Assessment
Children in Need + CiN Case
Plans
Level 4 – Children with
Complex and/or Acute Needs
UNOCINI Pathway Assessment
Looked After Children + Care
Plans
UNOCINI Pathway Assessment
Child Protection + Protection
Plans
Residence and Contact reports
to court
Assessment of needs and
Pathway Plans for looked after
young people and care leavers
aged 16 - 19
Services:
Children within the base
population access resources ad
services through universal,
community and voluntary sector
resources. Although Social
Services do not directly support
children and families at this
level, they do commission
others.
For example: child minding,
day care, play groups, after
schools clubs, parenting
programmes, interpreting
services, Court Welfare
services, contact centres, and a
range of voluntary and
community groups offering
universal family support
services, e.g. Parents Advice
The majority of children with
additional needs will access
services through enhanced
universal services and
community and voluntary sector
resources (which may be
funded wholly or in part by
Social Services as part of their
preventative strategy).
A minority of children with
additional needs, following
assessment, may receive either
direct or commissioned social
service provision to prevent
deterioration of their
circumstances and/or
escalation of their needs.
For example: Sponsored
childminding schemes,
Specialist Assessments
(e.g. Domestic Violence,
Graded Care Profile of Neglect)
Children in need, including
some children in need of
safeguarding and children with
a disability, following
assessment may receive
planned services. The focus of
these services is to promote the
welfare and well-being of the
child within their own family and
community.
For example: supported
housing for young homeless,
therapeutic intervention for
children who exhibit sexually
harmful behaviours
The small number of children
who have complex and/or acute
needs will receive the highest
levels of care and intervention.
Some of the children within this
group may be subject to Care
Orders. Children at this level
often receive services
coordinated and commissioned
from multiple agencies. It is
unlikely that the range of care
and intervention required by
this group of children could be
met by any single agency.
For example: services to care
leavers, advocacy services for
looked after children, housing
schemes for care leavers,
services to looked after children
47

Professionals:
and Women’s’ Aid.
The above services are
provided by a range of
professionals, including:
Early Years workers
Travellers support workers
Community development
workers
Court Welfare Officer
Women’s centre workers
Homestart workers
Community and voluntary
sector workers
community holidays and
Summer schemes, mediation
services, support to families of
children with autism and/or
learning disabilities, parents’
support and parenting groups,
services for young people at
risk of offending drug and
alcohol advice, counselling and
advice, assessment and family
support to children whose
circumstance may deteriorate
without input.
In addition to those
professionals providing services
at Level 1, the following
professionals may become
involved at Level 2:
Social Workers in Gateway
Teams working with children
who have higher level 2
needs
Social Workers providing
family support services to
children with higher level 2
needs
Social Workers working in
early years services
Family support workers
Surestart workers
Play and development
workers
Juvenile Justice workers
Family centre workers
Voluntary sector workers
working with children with
additional needs
In addition to those
professionals providing services
at Levels 1 and 2, the following
professionals may become
involved at Level 3:
Social Workers providing
family support services
Social Workers working in
Gateway Team
Social Workers working with
children who have a
disability
Social workers working with
children in need of protection
(high level 3 needs)
Residential social workers
providing outreach services
Voluntary workers (services
likely to be directly
contracted or commissioned
by Social Services – e.g.
Barnados, Extern, NHC,
NSPCC, Women’s Aid)
(e.g. accommodation, social
work support, intervention with
families of looked after
children), applications to court
for secure orders and secure
accommodation
In addition to those
professionals providing services
at Levels 1, 2 and 3, the
following professionals may
become involved at Level 4:
Foster Carers
Residential Workers
Social Workers working with
looked after children
Social workers working with
children in need of protection
Psychologist (Attached to
residential services)
Voice of Young People in
Care (VOYPIC)
Personal Advisors for looked
after children and care
leavers
48

Needs:
Assessments:
Level 1 – Base
Population
Routine FHNA, school
medical screening,
GP diagnosis
Thresholds of Need
Services Available to Children across the Four Levels of Need: CAMHS
Level 2 – Children with Level 3 – Children in Need Level 4 – Children with Complex and/or
Additional Needs
Acute Needs
Preliminary Assessment Specialist Assessment Specialist Assessment
Services (inc.
referral route):
Professionals:
Tier One: children’s emotional health and
well0-being needs are met by
professionals currently engaged with the
child. There is no specialist CAMHS
service at this level.
For example, recommendations
regarding lifestyle choices; positive
parenting advice
General practitioners
Community paediatricians
Health Visitors
Social Workers
Teachers
Staff in community and voluntary
organisations providing direct provision
to children.
Tier Two: assessment, treatment and
intervention. Some families will selfrefer
to tier 2 services, other are
referred through by Tier 1 staff as a
consequence of its complexity,
levels of risk and persistence.
CAMHS services are provided through
Family Centres and direct work in
people’s homes.
For example, professional consultation
and assessment; group work to
groups identified as requiring
CAMHS services; family therapy;
advice about building sense of self,
identity and self-esteem; individual
psychotherapy; parent management
training; NLP (Neuro-Linguistic
Processing);
behaviour therapy; cognitive
therapy;
In addition to those professionals
providing services at Level 1, the
following professionals may become
involved at Level 2:
Child care social workers
Education psychologist
Youth Justice Workers
Community Psychiatric Nurses
Specialist mental
heath services (for example, Family
Centres) provided or commissioned
Tier Three: assessment,
management and treatment of
children and adolescents whose
mental health needs cannot be
managed at Tier 2 because of the
complexity, risk, persistence and
interference with social functioning
and normal development.
In addition to those services
provided at Tier Two, the
following may be provided: selfregulation
therapy; eye
movement desensitisation
Reprocessing (EMDR)
In addition to those professionals
providing services at Level 1 and 2,
the following professionals may
become involved at Level 3:
Clinical Psychologists
Child Psychiatric Nurse Specialists
Social Work staff with specific
child and adolescent mental health
expertise
Tier Four: In-patient
assessment,
treatment and
intervention for
adolescents who are
referred from Tier 3
services due to their
mental health
problems being
extremely complex,
high-risk and
persistent.
provision of
specialist
intervention on a
regional basis which
would not be costeffective
in every
locality
In addition to those
professionals
providing services at
Level 1, 2 and 3, the
following
professionals may
become involved at
Level 4:
Clinical
Psychologists
Child Psychiatrists
49

y the Trust for children with the more
complex needs
Thresholds of Need
Services Available to Children across the Four Levels of Need: Education
Needs Level 1 – Base Population Level 2- Children with
additional Needs
Level 3- Children in Need
Community
Paediatricians
Level 4-Children with
Complex and/or Acute Needs
Assessments: Key Stage Assessments
Termly / Yearly School
tests and reports
Public Exams
Discipline Record
SENCO – Stage 1or2
Code of Practice for SEN
UNOCINI Preliminary
record
SENCO – Stage 3,4 or 5 of
Code of Practice for SEN
Statement of Special
Education Needs
Services:
School or pre-school group
manages all aspects of child’s
education and learning needs
School manages all aspects of
child’s education and learning
needs with advice from
Education Support Services
work with the school to support
the child through the provision
of specialist services
Education Support Services,
schools and other services work
together as a multi-disciplinary/
agency response to address the
child’s needs
Professionals:
Teachers
Designated Teacher for Child
Protection
Pastoral Care Staff
SENCO
In addition to those
professionals providing services
at Level 1, the following
professionals may become
involved at Level 2:
In addition to those
professionals providing services
at Level 1 and 2, the following
professionals may become
involved at Level 3:
In addition to those
professionals providing services
at Level 1, 2 and 3, the following
professionals may become
involved at Level 4:
Education Support Services as
necessary
CPSSS
Education Welfare Service
Educational Psychologist
Behaviour Support Team
Special Educational Needs
professionals
Withdrawal Units
Counselling Support
SAM Programme
Looked After Children
Education Support Team
Parent Support Programmes
Young Offenders Support
50

Thresholds of Need
Services Available to Children across the Four Levels of Need: PSNI
Needs Level 1 – Base Population Level 2- Children with
additional Needs
Level 3- Children in Need
Level 4-Children with
Complex and/or Acute Needs
Assessments: PSNI needs assessment UNOCINI information
notification/Preliminary
Assessment
Services (inc referral
route):
Protection and well being of all
children. This will be achieved
through prevention and
education examples of which
are outlined below:
Education
CASE – Provision of good
citizenship programme, healthy
lifestyles and crime prevention.
APU – Information on staying
safe on our roads, Road traffic
legislation, alcohol misuse on
our roads.
DRUGS – Provision of
prevention of drugs and
substance misuse programme.
Engaging with children and
young people who are
displaying signs of risk taking
behaviour. To also engage with
those C&YP who are victims
and witnesses to crime.
Example of which is outlined
below:
Risk Taking Behaviour:
ASB – Preventative measures
including voluntary contracts
with police, specialised officers
providing guidance and support,
referral to external agencies
(support services), education
packages (CASE), Youth
Diversion Scheme.
UNOCINI Assessment/Joint
Protocol Assessment
Responding to children and
young people suspected of
involvement in criminal activity
and engagement with
vulnerable Children and young
people. Example of which is
outlined below:
Sexual Activity:
Child abuse investigation,
deployment of MASRAM
services, engagement of
support services, referral to
external agency, multi-agency
meetings.
UNOCINI Assessment Joint
Protocol Assessment
Responding and engaging with
all those children and young
people involved in critical and or
high risk situations that requires
immediate police intervention.
Incidents referred to in Level 3
that include additional
aggravated factors, which will
escalate the risk to Level 4 and
will receive enhanced police
response proportionate to the
needs identified.
Professionals:
Below are a range of disciplines
within policing that can provide
a range of services to meet
children’s needs:
Beat officers
Road policing officers
Domestic abuse officer
Youth Diversion officer
Community & schools officer
Minority liaison officer
In addition to those disciplines
outlined in Level 1 the following
may become involved in Level
2:
Public Protection officers
Family liaison officers
Investigate officers
In addition to those disciplines
outlined in Level 1 and 2 the
following disciplines may
become involved:
Child abuse investigators
MASRAM officers
As outlined in Level 3.
51

DRAFT
i
Care Matters in Northern Ireland – A Bridge to a Better Future (March 2007)
ii
Our Children and Young People - Our Pledge (2006)
(A TEN YEAR STRATEGY FOR CHILDREN AND YOUNG PEOPLE IN NORTHERN IRELAND 2006 – 2016)
iii
Every Child Matters
iv For example Southern Area Children’s Services Plan 2005-2008 pages41-42
Southern Health and Social Services Board
For example Children’s Services Plan 2005-2008 pages 16-16
Western Health and Social Services Board
v Children in Need:
A child shall be taken to be 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 an authority under this Part;
(b) his health or development is likely to be significantly impaired, or further
impaired without the provision for him of such services; or
(c) he is disabled,
and ‘family’, in relation to such a child, includes any person who has parental
responsibility for the child and any other person with whom he has been
living. Article 17
The Children (Northern Ireland) Order 1995
Equality
This guidance has been screened for equality implications as
required by Section 75 and Schedule 9 of the Northern Ireland Act
1998, and it was found that there were no negative impacts on
any grouping.
Human Rights
This guidance has been considered under the terms of the Human
Rights Act 1998 and was deemed compatible with the European
Convention Rights contained within the Act.
52