A Pathway of Care for Vulnerable Families (0-3)

2. This guidance

The Scottish Government asked NHS Quality Improvement Scotland ( NHSQIS) ⁵ to lead the development of a national multi-agency, multidisciplinary programme of work to support vulnerable children and families from conception to age 3 as part of the implementation of the Early Years Framework. ⁶

The guidance has been developed as part of that work. It is intended primarily for service managers across all agencies to use with their teams to support the specific aims of the Early Years Framework implementation.

The guidance draws on key Scottish Government publications launched between 2008 and 2011 to reinforce key messages around reducing inequalities, building capacity in individuals, families and communities and taking a holistic approach to meeting the needs of all children.

The overall aim is to ensure that vulnerable children (from conception to age 3) and families in all parts of Scotland receive support that is equitable, proportionate, effective and timely. Specific aims of the guidance are to:

• support a consistent approach to meeting the needs of pregnant women, children and families
• enhance local pathways for vulnerable children and families
• support implementation of the Getting it Right for Every Child ( GIRFEC) approach. ⁷

It is important to emphasise that the guidance seeks to build from existing best practice, in particular practice related to implementing the principles of GIRFEC, and to encourage professionals' critical reflection of existing practice. It reinforces key messages around service development and builds on A Guide to Implementing Getting it Right for Every Child: messages from pathfinders and learning partners, published in June 2010. ⁸

The guidance is presented in three main parts:

• the universal journey from conception to age 3, with specific guidance on supporting children, women and families at each stage of the journey;
• guidance on approaches within the antenatal period to enhance the universal pathway, using the GIRFEC National Practice Model to aid continuous assessment;
• guidance on approaches to enhancing the universal pathway in the immediate postnatal period up to age 3, again using the GIRFEC National Practice Model and sharing information around the well-being indicators to promote a consistent continuum of support.

It sets out a series of questions and issues that professionals from all agencies may want to consider as they explore potential concerns with children and families at different stages of the universal pathway.

The guidance is supported by two practical tools:

• a poster, The Universal Pathway - what everyone needs to know⁹
• The Healthcare Pathway, part of the Keeping Childbirth Natural and Dynamic ( KCND) pathways of maternity care. ¹⁰

2.1 Using the guidance

Professional leadership is central to ensuring not only that the guidance is used effectively to direct practice, but also to ensuring that children and families can gain access to the services and care they need.

The Scottish Government seeks to promote a shift from professional intervention for children and families only when a crisis happens to a position where prevention and early intervention are the norm. It aims to build capacity in communities and among children and families to help them tackle their problems. Strong professional leadership across health and social care services will be central to the achievement of both these aspirations. The Social Work Inspection Agency report for 2005 to 2009, ¹¹ for instance, indicated that:

• leadership is of critical importance in the performance of social work services
• the quality of leadership impacts on outcomes for people who use social work services
• leadership of social work has a direct impact on staff morale and confidence.

Managers and teams will therefore gain maximum benefit from the guidance when its implementation is supported by strong and effective leadership. It will also be most effective where there is an ethos of team working, where communication between team members is strong and where there is an understanding of, and respect for, the contribution of other practitioners and agencies.

Managers and their teams consequently need to give some consideration to the culture, systems and practice within their organisations before using the guidance.

2.2 Culture, systems and practice

Culture refers to the complex system of beliefs, values and behaviours displayed by a particular set of individuals, a group or organisation. Embedding the GIRFEC approach requires all agencies to work to a common aim and clear purpose. Roles and responsibilities should be clearly defined to enable the implementation or enhancement of local pathways of support for children and families with additional needs.

In relation to systems, embedding the GIRFEC approach requires agencies to ensure seamless, needs-led service provision to be developed and delivered within and between agencies.

And on practice, the GIRFEC approach calls for agencies to adopt a person and family-centred approach. Support and provision of care should be sensitive and responsive to needs and values, prioritising the health, safety and well-being of children and families.

Positive changes in culture, systems and practice are achieved through implementing the GIRFEC principles.

2.3 Questions and issues

When using the guidance to support the design and development of local pathways, agencies may wish to consider the following questions, each of which reflects elements of culture, systems and practice.

2.3.1. Are we thinking about the whole child and family, their safety and well-being?

• What models of assessment do you use within your designated area to identify individual needs of children and families?
• Are you aware of the assessment model your colleagues and partner agencies use?
• Do you have an individual plan of support for every child and family from conception to 3 years to identify their needs?
• Do you have an identified individual to facilitate the coordination of this plan?
• Do you use an agreed integrated assessment framework and planning model with your partner agencies?
• Are there models of assessment to determine parenting capacity for all families within your area and are they shared with your partner agencies?
• Do you work with families to anticipate their needs and support them to manage their needs where appropriate to do so?
• Do you think your agency always provides services with the needs of children and families at the centre?

2.3.2 Are practitioners and agencies working together and is it clear who is doing what?

• Do your individual agencies have a common aim, clarity of purpose and defined roles and responsibilities?
• If yes, how do you share them with your partner agencies?
• If no, do you feel that it is important for you and your partner agencies to have a common aim, clarity of purpose and defined roles and responsibilities?
• If there are concerns in relation to a child's safety, is it clear who takes responsibility for coordinating support prior to child protection being confirmed?
• Are you clear about exactly what each practitioner's and agency's contribution would be in supporting children and families to achieve better outcomes?
• Where there are no additional needs identified, do you know the services within your own and partner agencies that may be used to support children and families?
• When children and families have multiple and complex additional needs that require support from a variety of practitioners and agencies, how do the services you provide integrate within and across agencies, including adult services, from a child and family perspective?
• Do you think it is easy for children and families within your area to understand how services are provided and how they join together?
• Does your agency have clearly defined processes for managing information sharing, confidentiality, consent and documentation?

2.3.3 What is essential for responding to need and improving outcomes?

Practitioners and agencies have traditionally used a range of service models to provide consistent and responsive care and to engage parents, children and families. In health, pathways have been used to improve access and put patients at the centre of services. In local authorities and voluntary agencies, referral guidelines and processes have been used as a means to access the most appropriate service for clients.

During the development phase for this guidance, practitioners and agencies indicated that national pathways would not be helpful, however, support for the implementation or enhancement of local pathways would be welcomed.

2.4 The design of an effective local pathway.

2.4.1 Child and family centred

The local pathway should:

• outline the journey children and families travel within universal or targeted service provision
• reflect the involvement of children and families in the process of accessing support
• demonstrate the decision-making process through a shared commitment to effective communication, common understanding of expectations and understanding of benefits, depending on the level of need that has been assessed and planned using the GIRFECNational Practice Model¹²
• identify the most appropriate named person/lead professional to coordinate support.

2.4.2 Outcome focused

The local pathway should:

• identify the outcome(s) to be achieved in the short and longer term
• define the indicators and steps for practitioners and agencies to take, in partnership with children and families, in the process of achieving outcomes. ¹³

2.4.3 Clarity for agencies working together

The local pathway should:

• demonstrate the use of a common language and appropriate utilisation of knowledge, skills, expertise and evidence to support practitioners and agencies in achieving better outcomes for children and families
• provide clarity in determining which agency/individual practitioner is best placed to support children and families who do not voluntarily access mainstream services.

2.4.4 Communication

The local pathway should:

• articulate systems and processes to support and protect children and safeguard their well-being in line with legislation ¹⁴ and professional codes of conduct.
• demonstrate integrated service provision and shared responsibility for early identification of concerns, sharing relevant information in a timely and accurate way and identifying gaps in information so that a full picture of the child and family can be established to accurately reflect additional need. ¹⁵

2.4.5 The named person and five key questions

The guidance builds on the GIRFECNational Practice Model by promoting access to services on a multidisciplinary and/or multi-agency basis for children and families, with support coordinated by the most appropriate named person/lead professional.¹⁶

Responsibility for assessing, promoting and monitoring the health of children aged 0-3 years traditionally falls within the remit of universal health services. Midwives assume the role of named person for the child from conception until transfer to public health nurses/health visitors, who then assume the role.

Once a concern has been brought to the attention of the named person, he or she is responsible to take action to provide help, or arrange for the right help to be provided, to promote the child's development and well-being. To respond proportionately, the named person will ask five key questions.

• What is getting in the way of this child or young person's well-being?
• Do I have all the information I need to help this child or young person?
• What can I do now to help this child or young person?
• What can my agency do to help this child or young person?
• What additional help, if any, may be needed from others?

These key questions should be asked by any professional when faced with a concern regarding a child's health or well-being.

2.4.6 Development of the Child's Plan ¹⁷

In a single agency plan, it may be enough to construct a plan from assessing concerns about a child's well-being, keeping in mind the whole of a child's world from the My World Triangle.

Where there is a multi-agency plan, it is likely that this will have involved the gathering of more complex information, using the My World Triangle and incorporating any specialist assessments from different professionals and agencies.