Scotland's Children - The Children (Scotland) Act 1995 Regulations and Guidance: Volume 1 Support and Protection for Children and Their Families

Introduction

1. The Act introduces a new legal framework for assessment, services and support to children with disabilities, children affected by disability and their families. Services for these children should be designed to minimise the adverse effects of disability and to enable them to lead lives which are as normal as possible. Specific provisions relating to children with or affected by disability do not stand alone. The general provisions in the Act apply equally to these children as others.

Section 23

2. This guidance covers all local authority functions under the Children (Scotland) Act 1995 as these relate to children with disabilities or affected by disability and refers, where appropriate, to other guidance for the implementation of the Act, and other legislation such as the Social Work (Scotland) Act 1968 as amended by the NHS and Community Care Act 1990, the Chronically Sick and Disabled Persons Act 1970, as amended, the Education (Scotland) Act 1980, as amended, the Disabled Persons (Services, Consultation and Representation) Act 1986 and the Carers (Recognition and Services) Act 1995. The guidance on provisions in the Act for local authorities' support, services and information to children in need and their families also applies to children with disability or affected by disability. Other guidance on child protection orders, children who are looked after by a local authority, and adoption will be relevant for children with or affected by disability in those circumstances.

3. Local authorities have a duty to safeguard and promote the welfare of children in need in their area and, so far as is consistent with that duty, promote the upbringing of children in need by their families by providing a range and level of services appropriate to the children's needs. The Act refers to a child in need as being in need of care and attention because

• he or she is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development unless there are provided for him or her, under or by virtue of this part of the Act, services by a local authority
• his or her health or development is likely significantly to be impaired, unless such services are so provided
• he or she is disabled
• he or she is affected adversely by the disability of any other person within his or her family.

Section 22

Section 93(4)

Section 23(2)

4. When a local authority provides services to children who are disabled, or affected by disability, and their families, those services should be designed to minimise the adverse effect of the child's disability, or that of the other person, and enhance the child's opportunity to lead as normal a life as possible. Services should be appropriate to their assessed needs. Transitional stages in children's development, such as entry to primary school, transfer to secondary school or school leaving age, are points at which the need for services and support may be particularly pressing.

Section 23(1)

5. The local authority has a duty to carry out an assessment of the child, or of any other person in his or her family, in order to ascertain the child's needs in so far as they are attributable to his or her disability or that of the other person, if asked to do so by the child's parent or guardian. It is good practice to consider any request for help made by a child directly, and assess his or her needs as required. When undertaking an assessment of a child's needs, under this section of the Act, local authorities should consider whether services available for children in need under section 22 should be provided to meet the child's wider needs, in addition to those attributable to his or her disability.

Section 23(3)

6. In carrying out an assessment to determine the needs of a disabled child, the Act requires the local authority to assess a carer's ability to provide, or to continue to provide care for the child, when asked to do so by the carer. This assessment will help the local authority decide whether there is a need to provide or arrange additional help and support for the carer in caring for a disabled family member; it is not to determine his or her fitness to do so. Any assessment of a disabled person should take into account their family circumstances.

Section 24

7. The "carer" is a person who provides or intends to provide a substantial amount of care on a regular basis for that child. The carer may be a parent or any other person, provided that he or she is not employed, or volunteering for a voluntary organisation, to care for the child. This could include a child or young person who is supporting a disabled sibling at home. Young people over the age of sixteen, who support a disabled adult family member, may be entitled to an assessment by the local authority under the Carers (Recognition and Services) Act 1995. Advice on how these assessments should be carried out is contained in guidance issued on the implementation of that Act (see Community Care Circular SWSG 11/96).

Section 24(1)(b)

Section 24(2)

Planning and Assessment

8. It is estimated that there are 33,000 children in Scotland with some form of disability. 14,285 children are recorded as having special educational needs. Children who are disabled are a diverse group and include a wide and varied range of disabilities, conditions and needs. Not all children with or affected by disability will need or want help from social work departments. Relatively few will make intensive or long-term use of social work services.

9. Local authorities will need help from local health and education services to identify the numbers of children in need who are disabled in their area. Local authorities should also take steps to identify the numbers and needs of children in their area who are affected by disability. Social work departments and their colleagues in health and education should work together to achieve a shared understanding of disability which facilitates early identification and joint working and assists each service to devise its contribution to local children's services plans.

10. The local authority itself is unlikely to provide all the services which may be needed by children with or affected by disability in an area. Local authorities should promote and make use of the voluntary and private sectors in providing services, taking into account local circumstances. Authorities will need to collaborate with neighbouring or larger authorities, voluntary and independent agencies in planning and funding specialist services, which cannot be provided locally. A local authority may negotiate arrangements for a service or assistance to be provided by another local authority if the location of the family, or the kind of service needed, make this desirable. Local authorities may wish to set up joint arrangements for specialist services to be provided across authority boundaries.

Assessment

11. Assessments of children in need will normally be carried out by the department of the local authority which carries responsibility for social work services and functions. In assessing children's needs local authorities should take into account families' views and preferences, and consider the contribution which other statutory and voluntary agencies, for example health and education, might make to the assessment or services provided. Social work departments should make arrangements with local education departments, Health Boards and NHS Trusts, and primary care teams, for sharing information, joint assessment and provision of health, education and social work services in individual cases, in the light of the requirements for collaboration under the Act. In many cases health professionals, such as health visitors, GPs, consultant neonatologists and paediatricians will identify a child's disability in the first instance. Whichever agency is the first to have contact with a disabled child, whether social work, education or health, that agency should begin to talk with the child's family about other local assessment processes and how to obtain access to the range of services from other agencies which they might find helpful. This will ensure that families have access to the full range of local services at an early stage. Support may be needed at later stages too. Even if help is not taken up immediately it may be welcomed later on.

Section 21

12. Some of the principles and practices in care management for vulnerable adults may be of use when thinking about how to meet the requirements of the Act to assess and co-ordinate packages of services to assist children in need who are disabled. Care management practices would need to be adapted carefully to take account of the often complex circumstances of vulnerable children and their families. The field social worker retains responsibilities for supporting the child and family which are incompatible with a purely purchasing role. Policy guidance was issued by the Department of Health and the Social Services Inspectorate for England and Wales, and practice guidance was issued jointly by SWSG and the Social Services Inspectorate for the implementation of care management and assessment arrangements under the NHS and Community Care Act 1990 (see Care Management and Assessment: Manager's and Practitioner's Guides, HMSO 1991). Social work departments should refer to this guidance to inform the development of local systems for assessment and providing services to children who are disabled.

13. When assessing children who are disabled social work departments should, in collaboration with other agencies and professionals, identify the needs of the child in relation to his or her health, development, disability, education, gender, racial origin, religious persuasion and cultural and linguistic background. Health includes physical and mental health. Development encompasses all aspects of development including social and emotional development. The needs of brothers and sisters should be considered and provided for within any package of support devised. Siblings may also require assessment in their own right as children affected by disability.

14. Local authorities should find ways of reducing duplication of visits by different professionals and the resulting stress upon families. Assessments of children in need who are disabled should be, wherever possible, combined with those under other legislation and information gathered by different local authority departments can be used for multiple purposes. Much of the information held by health, social work and education agencies is very personal. Local authorities should develop systems for sharing information between departments and health services which take account of the need to protect user's confidentiality. Families' and parents' consent should always be obtained before sharing information and exchange should be on the basis that the recipient has a clear "need to know". Health records held by parents and "personal passports" of information are successful examples of how information can be shared whilst ensuring that parents remain fully aware and involved. Established systems for formal assessment of special educational needs under the Education (Scotland) Act 1980, as amended, require collaboration between education, health and social work professionals and the involvement of parents and children and young people. These should contribute significantly to assessments of children with disabilities by social work departments and may be used as a foundation for further joint decision-making about families' wider needs for social support and services. Assessments of disabled children and their carers should normally take place concurrently.

15. Many children with disabilities may need continuing services throughout their lives. Assessment should take a long-term perspective. This will help families and professionals to make decisions about the kind of help needed, at different points in time, for example with education, independence training, respite or other services. The outcome of the assessment should be a full and accurate picture of the child and family which focuses on strengths and abilities as well as difficulties and needs.

16. When families seek their help, local authorities should provide families of disabled children with verbal and written information about their eligibility for certain assessments under the Act. When a local authority undertakes an assessment of the needs of a disabled child, they should also inform any carer who regularly provides a substantial amount of care for the child, of their entitlement to an assessment, if they want one, of their ability to continue providing care for the child. The local authority should routinely take into account the family's wider circumstances, including a parent's or carer's capacity to provide care, when considering what services should be provided to promote a child's welfare.

Sections 23 & 24

17. The local authority should inform the parents or carers and, where appropriate, the child, where he or she is of sufficient age and understanding, of the outcome of any assessment concerning the child or the child's carers, in writing as well as verbally. If the carer requests an assessment the local authority should have regard to the results of this assessment when deciding what services should be offered to promote and safeguard the child's welfare. Local authorities should avoid the use of professional jargon, and send written information and reports to families in good time, and, where possible, in advance of planning or review meetings.

Section 24

18. If the local authority decides to provide services to a child, they should make a plan with the family, which should form the basis of a written agreement outlining the nature of the service or services to be provided, for how long these may be required, the objectives of the plan and the roles, responsibilities and tasks of all those involved in the plan, including other agencies and family members. The plan will normally be co-ordinated by the social work department. Written plans provide families and social work departments with a benchmark against which both can assess the effectiveness of the services which the local authority provides to the child or family. The plan should include relevant information about services which the family receive from other agencies but, unless it refers to services which the local authority is arranging or commissioning jointly with another agency, it is primarily a tool to assist the local authority's work with the family. The plan and agreement should take account of the child's view and note any areas of disagreement between the social work department, the family or other agencies. It should specify how and by whom any problems or dissatisfaction will be dealt with if these arise. The agreed plan should be a concise document.

19. The social work department should, with the child and family, regularly review its plan to help the child and reassess the family's circumstances when necessary to ensure that services continue to meet the child and family's needs and are an effective use of the local authority's resources. Continuity of service should not normally be broken for reasons not related to the child's welfare. If reviews of the social work department's plan need to include other agencies and professionals, these should be co-ordinated with statutory reviews for other purposes, such as the case review of a child who is looked after by the local authority, or the education department's annual review of a child's educational progress, to avoid families having to attend a series of meetings called by agencies for different purposes. The conduct and content of any review should be appropriate to its purpose. Some will require detailed attention - others may be briefer.

Children affected by disability

20. Children affected adversely by disability in the family include siblings of disabled children, who may have a range of needs as a consequence of their brother or sister's disability and the additional demands upon their parents. Children may be adversely affected by the disability of their parents or other adults in their family. This group also includes children and young people who provide support and care for disabled family members. The needs of these children may be overlooked by professionals and they may experience disruption to their education and development if they carry inappropriate levels of responsibility for a parent or other family member. Care managers for disabled adults should be aware of and inform parents or adults of their right to request an assessment of their child's needs, in addition to assessment of their own needs for services under section 12A of the Social Work (Scotland) Act 1968. Social workers should assess the impact of adult disability on children in the family and should encourage parents to ask for an assessment of their child's needs when it appears that the family may need help. Whilst the level of responsibility for household and domestic tasks, care for siblings and other help for parents varies, children should not be expected to take on similar levels of caring responsibilities as adults or be responsible for intimate personal care and supervision of their parents.

Section 23

21. Disabled parents and their children may be anxious that acknowledgement of difficulties may lead to a break up of their family. There may be differences of view or conflicts of interest within a family. Both may need reassurance that social work departments offer a wide range of services and have a duty to support families in bringing up their children. Local authorities have duties to provide services for disabled adults under the Chronically Sick and Disabled Persons Act 1970. Providing adults with help that they need is likely to be an effective way of meeting the needs of their children. The first priority should be to provide sufficient help to the adult to enable him or her to exercise parental responsibilities and rights. If assessing the ability of a young person to provide care for a disabled family member, the local authority should also assess the child's needs. When undertaking assessment of children affected by disability, workers should

• listen to the child or young person and respect his or her views
• give time and privacy to children to help them talk about their situation and worries
• acknowledge parents' strengths and try to build rather than undermine their confidence and capacity for parenting
• consider to what extent responsibilities in the family are restricting the child's education, opportunities for social relationships and leisure activities
• consider the child's emotional and social development.

Section 24

Section 23

22. Specialist services for children and young people who are affected by disability in the family may be useful sources of advice. These include projects for children supporting other disabled family members and children affected by their parents' HIV infection or AIDS. Helpful perspectives on work with young people supporting a disabled family member are contained in a report of four Social Services Inspectorate workshops. ¹

Partnership with Parents, Children and Families

23. Achieving partnerships with parents and children in the planning and delivery of services to children requires that

• they have sufficient information at an early stage, both verbally and in writing, to make informed choices
• they should be aware of the various consequences of decisions they may take
• they should be actively involved in assessments, decision-making meetings, case reviews and conferences
• they should be given help to express their views and wishes and to prepare written reports and statements for meetings where necessary
• professionals and other workers should listen to and take account of parents and children's views
• there should be clear and accessible means for families to challenge decisions taken by professionals and to make a complaint if necessary
• administrative arrangements should take account of the needs of children and their parents, for example, in deciding the location and timing of meetings to ensure their attendance, providing a welcoming and comfortable environment.

24. When a child has complex needs or communication difficulties additional arrangements may be needed to establish his or her views. It may not always be appropriate to have parents or other family members act as a means of communication between professionals and children and young people. There may be instances when the views of children and their parents do not coincide. The local authority should consider at an early stage whether an interpreter or similar facility is necessary to assist communication. Consulting children with disabilities requires expertise and staff may need special training. Local authorities should identify workers with the requisite skills so that a sound assessment of a child's special needs, requirements and abilities, and a clear account of their views, can be obtained. Such expertise may be found in specialist organisations if it is not available within social work or other departments. For example, local associations for people with a sensory impairment may have workers with specialist communication skills. Other agencies who provide services to the child and family and know the child may be able to help workers find out children's views.

25. Aids to communication, including information technology, the use of alternative and augmentative communication systems, interpreters and any other means of communication used by children and their families should be made available when they are needed, by the relevant local agency or service.

26. The child will need to understand how communication is going to take place, to trust both their social worker and any interpreter and feel the communication arrangements are adequate. If an interpreter does not know the child then he or she will need to meet the child and learn about his or her means of communication and level of comprehension before helping the worker find out the child's views. In seeking the views of children who are disabled, the need for mechanical aids to communication, an interpreter, or the need to clarify responses may make communi-cation slower. The child's own pace should determine the timing and content of interviews.

27. There is a fine balance between encouraging children and young people to be involved in decisions made about them, and burdening them with inappropriate levels of responsibility for decision-making or asking them to take decisions without sufficient knowledge or experience. All children need to be given information and plans should be explained, discussed and, if necessary, reassessed in the light of the child's views. The more mature the child, the more fully he or she will be able to enter into discussions about plans and proposals. Maturity is not solely dependent upon age. Younger children will also have contributions to make. Children's views should always be taken seriously. If a local authority makes a decision about a child that is at odds with his or her views or wishes, the child's social worker or equivalent, should take care to explain the reasons why this is necessary to the child.

28. Advocacy for children and families, within social work departments and with other statutory agencies, is one of the functions of the social worker. In addition a child or family may want an independent, knowledgeable person to help them represent their interests effectively in a variety of ways and settings. Some local authorities employ a designated Children's Rights Officer who undertakes this task for children in receipt of services from the local authority. Voluntary organisations may assist local authorities to develop advocacy and representation schemes in their area. Some parents may need a lot of help to participate effectively in planning services for their child or family, for example liaison with professionals and agencies, maintaining records of meetings and correspondence, filling in forms and seeking second opinions.

User's views, representations and complaints

29. Section 5B of the Social Work (Scotland ) Act 1968 as amended by the NHS and Community Care Act 1990 requires local authorities to establish local procedures for considering complaints about the discharge of any of their social work functions, including those for child care services. Complaints about the way the social work department is acting towards a child in need may be made by the child, his or her parents or anyone else with parental responsibility, any carer including foster carers or any person who has a legitimate interest in the child's welfare. Guidance on local authority procedures for complaining about social work services is contained in Circular SWSG 5/1996 in the Community Care series. If a family disagrees with decisions made by the education department about a child's special educational needs, they should ask the local authority to review the assessment and decisions. If the family remains concerned, they may appeal to the Secretary of State for a review of the assessment and any Record of Needs.

30. Social work departments should provide children and young people and their families with information that they can use about how to comment on their service. Social workers may need to help children with disabilities to lodge or pursue a complaint. Local procedures should be well publicised, simple to follow and easily accessible. Information should be made available in a variety of public places used by children who are disabled and their families, including GP surgeries, hospital outpatient departments and clinics, schools, libraries, nurseries, Benefits Agency Offices and Citizen's Advice Centres.

31. The complaints procedure must allow for any complaint to be resolved quickly and as close as possible to the point of service about which there is concern or dispute. Where a family makes a complaint about services that they feel are inappropriate for their child with special needs, the social work department may need expert advice on the needs in question and reassess its service or provision for these in the light of the outcome of the complaint.

Services for Children who are Living at Home

Social work services

32. Families with young disabled children should be able to use local services, including family centres, pre-school playgroups, mother and toddler groups, that are generally available to all children and families. Community based resources should include information and advice on disabilities, local services, entitlement to welfare benefits, counselling, general support with parenting, occupational, social, cultural and recreational activities. Resources and services should be appropriate for and accessible by local ethnic minority communities to use as they need. Local authority housing departments should ensure that suitable accommodation is available for families with disabled children including facilities to manage problems with, for example, mobility, incontinence or behavioural difficulties. Disabilities which carry special health care needs, such as epilepsy or HIV, should not be regarded as barriers to the use of local children's services in social work or education. ²

33. Local authorities should agree with local service providers, both internal and external, the standards of service which they and users can expect both generally and for individual packages of help and support. They will develop a range of services designed to meet local need in accordance with their own priorities and the resources available to them. Local agencies should promote a team working approach which allows flexible responses to children with disabilities and their families. Where specialist teams in health or education settings are the main source of support for local children who are disabled, social work should be represented in the work of such teams. Social work departments may consider the need to be represented in multi-disciplinary teams, particularly in hospitals or primary health care settings as a cost-effective way of organising flexible and responsive services.

Hospital social work

34. The health service is usually the first agency to identify childhood illness and disability, leading to longer-term needs. Parents and families describe the way in which their child's illness or disability is diagnosed and explained to them as being crucial in determining how they will adapt and come to terms with new and far reaching responsibilities. Social workers employed in hospitals are particularly well placed to offer information, advice and support for parents at this time and may also be able to identify the needs of children who are affected by the disability of a sibling or other family member. If a child has a prolonged stay in hospital the hospital social worker can provide emotional support for the child and family through counselling, and practical and financial help, for example arranging child care for a sibling or assisting the family to obtain travel expenses for hospital visits. He or she should prepare a plan to help the child's discharge home in liaison with community-based social workers, occupational therapists or specialist voluntary organisations.

Home care services

35. Home care and related services for families with children who are disabled can provide help directly to the child or to some other member of the family if that would best promote the child's welfare. Domestic help, personal care, peripatetic support from education or health services, mobility training, the provision of aids and adaptations in the home, local transport and suitable housing, are all potentially vital resources which may reduce the impact of disability on a family and also prevent the need for a child to be cared for away from home. A home help to assist with household tasks may enable a parent to spend additional time with a disabled child or his or her sibling(s). Where necessary an occupational therapist should assess a child's living environment and identify changes necessary to enhance the child's quality of life. Aids and adaptations to a bedroom or bathroom, or the provision of additional equipment may remedy deficiencies in accommodation, or make the family environment safer for children who have a learning disability or behavioural problems related to their disability.

36. Meeting other parents with a child who is disabled can alleviate the isolation, stress and depression that many parents experience. Local groups for parents or carers, including young people supporting a disabled family member, can be a useful source of support. Some parents may need support and encouragement from professionals to become involved. For example a visit by a social worker before a first group meeting may reduce worries a parent may have about attending. Others may choose not to participate because they do not want their support to be organised around their child's disability. The worker advising the family should discuss the options available and a family should not be referred to another agency without their knowledge and consent. Volunteer befriending schemes which provide support for parents of young children, usually from other experienced parents, have proved popular with families who have welcomed help and support in coping with the normal stresses of child-rearing. With additional specialist advice these services may also assist parents of children who are disabled.

Day care

37. Local authorities shall provide appropriate day care for children in need in their area who are aged five years or under and have not yet started school. They may provide day care for young children who are not in need as defined in the Act. Local authorities also have a duty to provide appropriate care after school and during holiday periods for children in need who are of school age. They may also provide such care for children who are not in need. The development of most young children with disabilities or special educational needs may be enhanced if they can attend day care and educational services for all children. In making arrangements for including children with disabilities in day care or pre-school settings, providers practitioners and inspection and registration staff should ensure that the physical environment, staff/child ratios, skills and training of staff are appropriate to meet the practical, emotional and developmental needs of these children. Children attending a day nursery or nursery class need to communicate with staff, receive appropriate attention, stimulation and education, to move around freely where possible and interact with other children positively.

Section 27

38. SWSG have issued guidance on standards, quality and regulation of day care services. ³ Local authorities should consider the needs of children with disabilities in planning and registration of local day care provision, including the childminding provision in the area. Local authorities' statutory triennial reviews of local day care and related provision under the Children Act 1989 should include information about services for children with disabilities, access, and parental involvement, and have regard to representations made to them by those concerned with such services, including families and referrers, as well as local providers.

The role of the voluntary sector

39. There are many local and national voluntary organisations in Scotland and the rest of the UK concerned with disability. Most have local groups and many work together with other voluntary organisations. Voluntary agencies are often valuable sources of information for families. They may provide emotional support and advocacy for families and offer practical services, such as loans or financial help to buy equipment, play schemes, holidays, residential, education or respite services.

40. Many voluntary organisations have developed new skills and expertise in working with children with rarer disabilities or complex needs, such as those with multiple disabilities or challenging behaviour, or from minority groups. Specialist skills and knowledge will be helpful in assessing need both generally and in individual cases. As local authorities enter into contractual arrangements with voluntary organisations for provision of local services, they should secure

• early involvement of voluntary agencies in planning services
• explicit service agreements
• agreed assessment, recording and review procedures
• training opportunities for voluntary sector staff.

Education

41. When providing support and services to families with children who are disabled local authorities should make every effort to ensure that children can attend a local mainstream school or local special school if this can meet their identified needs and is in their best interests. The success of an integrated placement in education will depend on positive attitudes and expectations and on a clear understanding of the child's needs and how these can best be met. Where children with disabilities have particular health needs and require medication or treatment in school, whether occasionally or regularly, special arrangements may need to be put in place to ensure medicines are administered safely and appropriately. Arrangements for the safe administration of medicines in schools should be developed in conjunction with local providers of school health services. Similar arrangements should be put in place to avoid children with disabilities being excluded from other local authority and independent sector provision. The Scottish Office Department of Health and Education and Industry Department intend to issue a statement of good practice in this area entitled "Medicines in Schools", following a report by the National Pharmaceutical Advisory Committee.

42. Education authorities have a duty under section 1 of the Education (Scotland) Act 1980 to secure the adequate and efficient provision of school education for children in their area, including those with special educational needs.

43. Children and young persons have special educational needs if they have a learning difficulty which calls for provision for special educational needs to be made for them (section 1(5)(d) of the Education (Scotland) Act 1980). A learning difficulty is said to be present if children or young persons

• have significantly greater difficulty in learning than the majority of those of their age
• suffer from a disability which either prevents or hinders them from making use of educational facilities of a kind generally provided for those of their age in schools managed by their education authority
• are under the age of five years and, if provision for special educational needs were not made for them, are, or would be likely, when over that age, to have a learning difficulty as defined above.

44. Special educational needs may arise from learning difficulties related to neurological or physical disability, or barriers to learning caused by sensory impairment, social, emotional or behavioural problems, or mental illness.

45. Education authorities carry out assessments of special educational needs in order to determine whether a formal Record of Needs should be opened. Although as many as 20% of children may at some time have educational needs requiring some form of additional provision, only about 2% will require a Record of Needs. A Record of Needs identifies a child's learning difficulties so that long-term educational strategies can be developed especially for him or her. ⁴

46. The education authority will generally initiate an assessment

• as a result of a school-based assessment
• following a recommendation by the education authority psychological service
• through referral from another source, such as medical or social work personnel
• at the request of parents
• at the request of a young person.

47. SOEID Circular 4/96 emphasises the need for early identification of children and young people with learning difficulties, the need to involve parents, children and young people fully in the assessment and recording process, and the need for all agencies involved to work together effectively. It notes that young persons are given specific rights under the 1980 Act to request an assessment, to have informa-tion, to have their views taken into account and to challenge decisions made about them by the education authority. Where a young person is not able to exercise these rights, his or her parents may exercise them on his or her behalf. Delays in assessment and opening a Record of Needs put a child or young person at a disadvantage and therefore the Circular recommends that authorities complete assessments and make a decision about whether a Record of Needs is required within six months of their notification that assessment may be necessary.

48. An assessment of special educational needs will include educational, medical and psychological advice; information from parents and any others who know the child well and can make a positive contribution; advice from the social work department or the Health Board and any other relevant advice or information. Social work and education departments should develop joint procedures to make sure that assessments for different purposes are well co-ordinated, do not duplicate effort and place families under greater stress. Education departments should notify social work departments of impending assessments of special educational needs involving children with disabilities so that the social work department may consider whether a conjoint assessment of needs under the 1995 Act should be undertaken. Similarly the education department should inform the social work department when a Record of Needs is opened. The local authority should advise families of the local arrangements for sharing information between departments when this would assist assessment or improve their capacity to provide services.

49. The 1980 Education Act requires education authorities to consider and report upon what educational provision would benefit a child with a Record of Needs after he or she ceases to be of school age. Education departments should carry out this assessment of the child's future educational needs within the two years before the child leaves school. They must complete the assessment at least nine months before the child is eligible to leave school. The assessment should take into account the views and wishes of the child and his or her parents. Section 13 of the Disabled Persons (Services, Consultation and Representations) Act 1986 requires the education department to obtain an opinion from the appropriate authority, normally the social work department, as to whether or not the child is a disabled person, before carrying out a future needs assessment. Where the social work department gives an opinion that the child is a disabled person they must then assess, and prepare a report on, the needs of the child for any statutory services under any of the relevant welfare enactments. The child's needs for social care or services should be assessed concurrently with the future needs assessment, unless the child, or his or her parents, request that such an assessment should not take place.

50. Education departments should review the progress of a child or young person with a Record of Needs at least annually. Where a social work department is providing support to a child or family, the social worker or care manager should receive copies of relevant reports and should be invited to attend any review meetings provided that the parents and child or young person agree. Similarly the social worker or care manager should be involved in any review of the Record of Needs. These arrangements ensure that both education and social work staff are well informed about the child's progress and any difficulties that he or she may be experiencing at home or in school which may affect him or her in the other setting.

51. The Children (Scotland) Act 1995, the Education (Scotland) Act 1980 and the Disabled Persons (Services, Consultation and Representation) Act 1986 together create a new framework within which social work and education departments can co-ordinate assessment and services for children with special educational needs, including children with disabilities. Some children may also be the subject of supervision requirements from children's hearings on the grounds of non school attendance or other grounds. Local authorities should make arrangements for departments to review jointly the provision made for those children whom the local authority looks after.

Health

52. In order to fulfil their responsibilities in relation to children with disabilities local authorities need to work closely with local child health services in the community and in hospitals. Local authorities have to consider a child's health and development in providing services to children in need and they should be aware of good practice in health services' assessment and surveillance of child health. These include

• the oversight of the health and physical growth of children
• monitoring the developmental progress of all children
• providing advice and support from diagnosis onwards to parents or those caring for the child, and referral of the child to appropriate services
• providing an effective immunisation programme against infectious diseases
• encouraging parents to participate in health, education and training for parenthood programmes.

53. Children with disabilities should have access to the same services for health surveillance and health promotion as are available generally. Social work staff including day care staff, foster carers and childminders should be aware of local arrangements for early support from child health services and understand the importance of ensuring that children with disabilities use these services.

54. Child health services should be able to offer information, advice and help to other agencies to assist with the integration of children with disabilities into local services and schools. Primary care teams and other specialists in child health care have an important role in local assessment arrangements for children with complex needs, including mental health problems. When children present emotional or behavioural problems, local authorities should consider the need to seek advice or assessment from a clinical psychologist and/or a psychiatrist. Social workers should have information about local child mental health services and how to refer to them.

55. Some children will have extensive needs for medical, paramedical and nursing care and the health service has a continuing role in providing care for these children whether in the short or longer-term. The need for such provision should be identified after multi-disciplinary assessment and should form part of a comprehensive programme of support and care for the child. Where possible children should be supported in community-based placements with input from the NHS to assist this aim. Where NHS provision is required, the aim should be to provide care in small, homely, locally based units suitable for children to live in. If, through illness, a child needs to spend lengthy periods in hospital or at home, the local authority should make provision for their educational needs. Hospital social workers are well placed to contribute to the continuing assessment of health and social care needs of the very small number of children and young people in hospital and to give practical advice and support to families and health care teams.

56. Some children have major health care needs or life threatening conditions. In many such cases health services provide personal support for children and their carers. Families may also need access to local independent advocacy and support services. The wishes and feelings of the child should guide the intervention of professionals. Children and families should be able to talk to medical advisers about the management of their condition and future prognosis. Sensitive support, such as counselling, home nursing and respite services, may enable families to look after their child at home throughout an illness, including its final stages. A children's hospice may combine respite, support in the family's home and residential care to suit the child and family's needs. The management of very sick children requires a holistic approach which involves health, social work, education and specialist voluntary sector workers in planning how best to meet all their needs, in addition to the requirements stemming from illness.

Looking after a Child who is Disabled

Respite services

57. There are many kinds of respite arrangements to help children with disabilities - provision within the child's home, daytime care, occasional overnight stays and regular periods of care with an approved family or foster carer, or in a residential home and shared care arrangements with foster or other family carers. Children who are placed for respite in a residential or family setting for more than twenty-four hours in any one period, that is, where the child remains away from his or her home overnight, are looked after by the local authority and the Arrangements to Look After Children (Scotland) Regulations 1996 apply to these children. The Regulations allow a planned respite care arrangement involving a series of placements at the same place to be treated as a single placement for the purposes of the Regulations and associated requirements for planning and review. For family placements all such multiple arrangements should normally take place with the same carer and for residential placements, these should take place at the same establishment. The Regulations require that a child beginning a series of regular placements for respite should undergo a first medical examination. This examination will provide helpful information and protection for carers and parents but this would not need to be repeated for subsequent placements. The Regulations do not apply to multiple respite placements lasting less than twenty-four hours.

Regulation 17

58. Respite services may give family carers a break, extend the range and quality of the child's experience and give him or her opportunities to develop increasing autonomy and independence. A flexibly managed community-based respite service is likely to be cost-effective when compared with the cost of family stress and breakdown. Families may not always welcome separation from their child, especially if the child is terminally ill. A respite scheme could provide care for the child with accommodation for the whole family. A report on respite care commissioned by the Social Work Services Inspectorate in 1993 found that there are good examples of family-based and residential respite care in Scotland, but services were generally patchy and those for children tended to focus on children with learning disabilities. Services for children with physical disabilities were often in health care settings alongside adults, older people and the terminally ill. Social Work Services Group issued guidance on how respite care services should be developed (Circular SWSG 10/96 of 28 March 1996). This is primarily concerned with adults but many of the principles apply to children.

59. Respite care should be provided as part of a planned package of services to support the family or, where the child is being looked after by the local authority, the child's usual placement. Families with children affected by disability may need speedy access to respite carers whom they know when a parent experiences an acute relapse or needs to go into hospital suddenly.

60. Local authorities should seek to achieve

• an accessible service, where the placement can maintain good links with home and school
• a standard of provision which ensures that the child's developmental needs are met in addition to those deriving from disability
• a mix of flexibility and planned availability - a service in which parents and children can exercise choice about when to use respite
• partnership between the local authority, service providers and the family
• respite care for children with complex needs or challenging behaviour
• respite care which provides younger children and adolescents with relevant care and activities
• care which takes account of the child's family background, racial and cultural origins, religious and linguistic or other communication needs
• care which is part of a framework of professional support which addresses the wider needs of the child and family.

61. In order to safeguard and promote the welfare of children while they are placed for respite away from their own homes, a series of short planned placements which include overnight stays may be treated as a single placement, provided

• all the placements occur within a period which does not exceed one year
• no single placement is of more than four weeks duration and,
• the total duration of the placement does not exceed 120 days. Regulation 17

The requirements of the Regulations apply to such placements except that they need not be repeated for each placement in the series. The placements must be subject to a care plan and the plan must be reviewed. The child should receive a medical before the series of placements commences, but does not need to receive one annually, or at other intervals, unless the child's needs indicate this would be beneficial. A review of the care plan should take place within three months of the series of placements commencing, and then every six months thereafter.

paragraph 61 amended 13/12/2004

Regulation 17

62. The local authority is required to review regularly the cases of children whom they look after. A series of short-term placements which are treated as a single placement should be reviewed by the local authority within three months from the date on which the first placement was made and thereafter at periods of within six months of the date of the previous review. Reviews of respite placements should be fit for the purpose and cover those issues outlined in Annex 3 of Volume 2 chapter 1 of the guidance on Children Looked After by Local Authorities. The local authority is less likely to review those matters which are ordinarily the concern of the child's parents, such as health or education, unless these have a direct bearing on the child's welfare in the respite placement or affect the suitability of the placement. In their application to short-term placements the Regulations provide for flexibility so long as the service remains appropriate to children's needs and safeguards their interests and welfare.

Section 31

Regulation 17(3)

Family care

63. There has been considerable growth in fostering for children with special needs, including multiple disabilities. Some social work departments have developed, with help from voluntary agencies, specialist fostering schemes able to provide multiply and profoundly disabled children and young people with high quality and skilled family care. Many foster carers bring considerable skills and practical experience to caring for children with disabilities, and are a valuable source of expertise for social work departments.

64. Accommodation for a child with a disability should be suitable for his or her needs and arrangements may need to be made to ensure the child's health and safety within the household. Some foster homes may need adaptations to enable a placement to proceed. A telephone may need to be adapted to enable children with hearing impairments to talk to their family and have access to confidential helplines. Children with disabilities should have privacy in bedrooms and bathrooms and should not be prevented access to the main areas of the home such as the living room or kitchen because, for example, a door is insufficiently wide for a wheelchair or too heavy for a child to push open, or the physical environment is not safe for children with special needs. If children require medication or treatment occasionally or regularly, foster carers may need special training and support to administer medicines safely and appropriately. Advice offered to school staff about the administration of medicines in schools may be of assistance here to local authorities in developing local practice in foster care.

65. There may be a risk that children would be excluded from certain areas or rooms if foster carers do not feel confident about managing a child with a particular type of disability. To prevent this the placing social worker should consider with foster carers any potential difficulties with their accommodation or their need for additional support in looking after a child who is disabled, prior to placement, and regularly throughout the placement. Support for the foster child and foster family may be available from a local GP through "temporary registration". There may also be a need to ensure continuity of specialist health care where this is being provided. The local authority should give foster carers, like any other carers, information about the full range of local services for children and make sure that they are put in touch with other parents and professional and voluntary agencies which can offer help and support. Many authorities and voluntary organisations will have experience of developing specialist fostering schemes for children with disabilities upon which other local authorities might usefully draw.

66. Continuity in education should be given high priority in making a placement. Foster carers should be willing to participate in the social, academic and community activities of the school which a child placed in their family attends. This might entail attending school activities such as open evenings and education department reviews, liaising with the child's class teacher(s), making sure that the child has access to and is able to use facilities for study, encouraging and helping the child to bring friends to the foster home or attend leisure activities or play schemes, and to have an active and fulfilling social life.

67. The social work department has a responsibility to ensure that the welfare of children in private fostering placements is safeguarded and promoted as for other children in need or looked after by the local authority. ⁵

Residential care

68. Assessment of needs, led by either the education or social work department, may indicate a specialist residential placement is required to promote a child's development. Any placement should be made on the basis of this being in the best interests of the child. The Regulations and guidance on children who are looked after by a local authority deal with the care of children who live in residential homes and outlines the assessment, planning and review processes needed to make sure that residential placements successfully meet the needs of children and their families. As with children placed in foster families, children with disabilities placed in residential homes will have special needs over and above those of children without disabilities. They should have the same quality of accommodation and rights to privacy as non-disabled peers and a child should not be placed in a setting where he or she cannot use the recreation, living or garden areas because he or she cannot gain access to them. Homes which accommodate children with a disability should have the equipment, facilities and adaptations needed to include them in all aspects of home life. For example, a child with a visual impairment might need access to a computer at the home to do homework; the management of incontinence will require suitable bathroom accommodation which offers space, privacy, sufficient hot water and proximity to other living areas. Children in residential homes also need to feel safe and protected by staff. In some circumstances adults may need to prevent children from acting in ways that are harmful to themselves or others. Residential schools should negotiate local arrangements for access to school health services or ensure equivalent arrangements with local primary care services.

69. Residential homes should ensure that physical safety precautions are in place, particularly in older or adapted buildings which have not been designed to accommodate children with disabilities. British Standards Institute publications give guidance on access issues for disabled people. Arrangements for fire drills and evacuations should be well publicised and clear, and their effectiveness reviewed regularly. Children with physical or learning disabilities or sensory impairments should be aware of and able to respond to fire alarms. The fixtures and fittings in residential units should comply with fire safety standards.

70. Residential establishments, other than those controlled or managed by local authorities, which provide personal care or support for children and vulnerable adults, as their sole function or as a substantial part of their functions, may be required for the purposes of the 1995 Act or the 1968 Act, to register with the local authority. This includes residential establishments which are grant-aided or independent schools. Residential schools for children with disabilities which provide such care and support and are registered, will be regularly inspected and their managers and staff will have access to advice and guidance from the local authority. Enhanced arrangements for inspection are of particular importance for children with disabilities because they are potentially more vulnerable due to communication difficulties, the greater number of adults involved in often very intimate care and the distance from their homes at which some children may be placed. Local authorities should refer to the guidance relating to arrangements for registration and inspection of these homes in Volume 2, chapter 5 of this guidance. HM Inspectors of Schools also examine whether there are adequate arrangements in place to safeguard and promote the welfare of resident pupils as part of their inspections of residential schools.

Section 61
Social Work (Scotland)
Act 1968
(as amended by Section 34)

Section 35

71. Children with disabilities may be placed in specialist establishments at long distances from their homes and communities. Local authorities should set clear aims and objectives for any residential school placement and determine how the child's links with his or her family and community of origin will be maintained. The local authority should keep in regular contact with the residential school and the child's parents, and local authority social work and education departments should maintain good communication and co-ordination throughout the placement. This will assist any arrangements for the child's future or further education at the end of the placement. When a child is provided with accommodation for the purposes of attending school, the education authority, board of management or managers of the school have a duty to safeguard and promote the welfare of the child throughout the period he or she is accommodated in the school.

Section 35

72. If a child in residential accommodation provided by a Health Board, NHS Trust, private hospital or nursing home has had, or is likely to have, no contact with a parent or other person with parental responsibilities for a continuous period of three months or more, the local authority must be notified by the person responsible for providing the accommodation. Contact is the personal contact that reasonable parents could be expected to have with their child whilst the child is away from home. This should normally include visits and telephone calls. The local authority must then determine whether the child's welfare is being adequately safeguarded and promoted, and whether they should exercise any of their functions under Part II of the Children (Scotland) Act 1995. The local authority might consider providing the child with accommodation or any other services, or seek a parental responsibilities order (refer to guidance in Volume 3 of the Children (Scotland) Act 1995 series). A person authorised by the local authority has powers to enter and inspect public and private health services premises and records for the purposes of ensuring that responsibilities under this and other sections of the Children (Scotland) Act 1995 and relevant sections of the Social Work (Scotland) Act 1968 as amended are satisfactorily met. The local authority social work department or equivalent should make sure that local health and hospital services are aware of the name, address and contact telephone number of the appropriate person in the local authority to whom such circumstances should be notified.

Section 36

Protecting Children who are Disabled

73. Children who are disabled have the same needs, the same rights and should enjoy the same protection as any other child. Many factors may make them vulnerable to abuse and exploitation including isolation, communication difficulties, limited mobility, sensory impairments and social stigma. Child Protection Committees should make sure that local child protection procedures take account of the special circumstances and needs of children with or affected by disability. Children with disabilities living away from home may be particularly vulnerable and local authorities should have policies and measures to prevent abuse of children who are looked after in residential or foster care. Specialist social workers for children with or affected by disability should be aware of local child protection procedures and be equipped to undertake child protection work where necessary.

74. Child protection work is complex and potentially contentious. Children with disabilities who may have poor access to information and communication difficulties may not know how, or who, to talk to about problems. Social workers supporting children who are disabled need to take account of their special requirements. Staff should be alert to the risk of emotional abuse or neglect which can be difficult to detect where there are language barriers or other health problems. Police and social workers, and other relevant agencies should share information about referrals at an early stage and plan together the best way to proceed. Joint training for social workers and the police should include consideration of the special needs of children with disabilities in joint investigations. If the social worker undertaking child protection inquiries does not have the requisite skills to communicate with a child, they need ready access to specialist workers to enable effective communication and find out whether a disabled child has been harmed or abused. With support and the advice of a known and trusted individual, the majority of children with disabilities can communicate their feelings, views and needs.

75. Child protection workers should assess each child's needs and the extent of his or her abilities, taking into account the particular disability, when deciding how to conduct initial inquiries. Child protection workers should also assess the ability of the parent or parents to communicate with and understand the specific needs of their child. Many parents will be the people most able to communicate with their child, but some will have more difficulty. Some parents may not have developed skills to communicate fully with their children, for example, not all will have sign language skills to enable them to communicate fluently with a child who is deaf. The social work department should not ask any person implicated in abuse of a child, or partners, close colleagues and friends to assist communication with the child.

76. There are a number of practical points to be noted when undertaking child protection work with children who use alternative communication

• the social worker and any interpreter will need to spend time together to plan and agree their respective roles in work with the child and the issues to be raised in any session
• the social worker and interpreter should explain their respective roles to the child and family. If the interpreter does not know the child then he or she will require time with the child, prior to work beginning, in order to assess the child's means of communication and level of comprehension
• interviewers must establish the extent of the child's vocabulary. For example, does the child have the necessary vocabulary to describe or identify body parts?
• there may be implications for the method of recording interviews with children who communicate in different ways. Video recording needs to be very high quality to pick up any detail of facial expressions and gestures, which may be of particular significance
• workers should be sensitive to body language and non-verbal cues. Workers should address the child and not the interpreter.

77. There are many factors which workers conducting child protection inquiries and interviewing children who are disabled, may need to consider. ⁶ For example, a deaf child who lip reads may not follow and understand all that is said. During any interview the speaker should make sure that the child has understood what is being communicated. If the child is communicating with more than one person, care should be taken to ensure that he or she can see the faces of everyone in the room. Good lighting is essential. A child who is deaf and communicates through the use of sign may be able to refer to and describe visible objects but may have more difficulty with abstract concepts, for example, yesterday, tomorrow, hot, soft, trust, disappointed. Social workers and police officers involved in investigative interviews should consider the terms they use with the child carefully and take time to ensure that the child understands what is being said.

78. Some children may be able to make only limited use of visual material and diagrams. They may appear to have a facility with words which may not be matched by their ability to understand verbal communication. Discussion should be broken down into small steps and interviewers must make sure that they and the child have understood each other before moving on to the next stage. In order to establish exactly what may have happened to a child who is unable to describe this in typical ways, the methods used to communicate with the child who is disabled may need to be adapted to reflect the child's needs and requirements. Where there are language and reading problems, comprehension can sometimes be greatly assisted by using pictures, drawings, diagrams and other graphic means. Agencies will need to consider whether these may be needed as evidence in any later criminal prosecution and therefore should be retained by the police. Workers using different tools and methods of communication in investigative interviews should be trained and skilled in the use of these techniques to ensure that these are used appropriately.

79. Workers should make sure that effective communication continues beyond an initial investigative interview. Children with communication difficulties will need help to convey their views and wishes to, for example, child protection conferences, and, where necessary, children's hearings and courts.

80. Some children who are disabled will need particular types of skilled care and would possibly suffer harm if a parent or carer were unable or unwilling to undertake such care. Definitions of "health" and "development" may be more difficult to agree upon when a child has multiple disabilities or complex behaviour patterns. Some children may need care tailored to their specific and individual needs. In making judgements about the nature and degree of risk, social workers should use the expertise and skills of specialist professionals. They may be able to help in understanding the significance of particular physical injuries or symptoms and establishing whether the child is suffering, or likely to suffer significant harm within the context of the child's special needs.

81. When a child who is disabled needs to be separated from his or her usual carers because he or she is not safe, the process of separation and admission may be particularly traumatic, especially if it is hard to communicate the reasons for this. The child should be placed in an environment which will be able to address the child's emotional distress as well as his or her practical needs. There may be a particular need for interpreting or additional aids to communication to reduce the risk of a child's isolation. The local authority has a duty to promote and maintain the child's links and contacts with his or her parents, family and other supportive and familiar adults where this is consistent with the child's welfare. If a child's family is not able to look after him or her in the long-term, the local authority should ensure that planning for the child's care takes account of their needs for security and permanence, and that arrangements for consent to medical treatment are satisfactory, particularly where the local authority or the child's carers do not have parental responsibilities in respect of the child.

Section 17

82. Children with disabilities, like other children, also have legal rights to consent to treatment or withhold consent to medical examination if they are judged, by medical practitioners, to have sufficient understanding to do so. Special efforts should be made to explain the purpose and potential outcomes of any medical examination or assessment. Children may be reluctant to have an examination if it involves unknown people in a strange place or unfamiliar or intimate procedures. They should have the opportunity to talk over what is being asked of them, with a trusted adult able to communicate effectively using the child's own preferred mode of communication or language.

Section 90

83. Child protection plans should outline the roles and relationships of child protection workers and specialist workers skilled in understanding and responding to the particular requirements of children who are disabled. Planning should actively involve the child's parents and other family members and other agencies, such as health and education, who are providing services to support the child and his or her family. Where abuse has been established children will need access to counselling and other forms of help to deal with the after-effects of trauma. In those cases where abuse is not substantiated families will need acknowledgement of this and perhaps some support to accept any help that they may later need from the local authority.

The Transition from Child to Adult Services

84. Families' needs for information and services will change as their son or daughter approaches adulthood and they begin to make plans for his or her longer-term future. Most young people become independent gradually, experiment with different kinds of accommodation, experience successes and make mistakes and often rely on their families for practical and emotional help until well after they reach eighteen years. Children with disabilities are more likely to need continuing support and services from local authorities, and often considerable help from their families, to assist entry into employment, training or further education, to live independently or remain with their family, and to achieve their full potential as adult members of their community. Children who have been adversely affected by another's disability may also require support and assistance to achieve independence or further their education if this has been disrupted by family illness or additional responsibilities at home.

85. Greater understanding and improvements in services have made it possible for disabled people to lead active, fulfilling independent lives in local communities. Where a child has a Record of Needs, the requirement to prepare a "future needs assessment", under section 13 of the Disabled Persons (Services, Consultation and Representation) Act 1986, can prompt the beginning of a planning process which takes account of the full range of the young person's needs. To help a young person make the transition from childhood to adulthood smoothly, social work departments should work with local schools, colleges, housing departments and families, and begin planning well before decisions have to be made. Local authorities should take into account the needs of people who are disabled in the development and adaptation of local housing provision and allocation policies and procedures. The housing and social work departments should work together to identify the extent and type of local housing need. They should consult local service users in doing so.

86. Before a child who is looked after by the local authority reaches eighteen years, up to and including the date of his or her eighteenth birthday, the circumstances and needs of the young person and his or her family should be assessed, taking into account their views and wishes for the young person's future, under section 12A of the Social Work (Scotland) Act 1968. Similar assessment should be offered to other young people who may need or are using services. The assessment should identify the young person's needs in relation to the following areas

• accommodation, including necessary aids and adaptations
• day care and respite services
• continuing education
• training or employment
• health care needs
• entitlement to welfare benefits
• social networks, recreation and leisure.

87. This assessment may form the basis for the provision of a planned package of adult services. Families should receive information about social work services available for adults and services available from other relevant local authority departments. They need to know about any differences in services available for young people who have reached the age of eighteen years.

88. As parents get older they may be physically less able to cope with their disabled child's care needs. The young person may wish to leave home, with or without the agreement of his or her parents. The young person may need access to an independent source of advice and support. Young people with disabilities should have access to independent living schemes, vocational training, suitable adapted housing and community support to enable them to achieve independence consistent with their abilities and wishes. The social work department should inform parents of their entitlement to an assessment of their needs under the Carers (Services and Recognition) Act 1995, when their son or daughter is over eighteen years of age. In circumstances where there is disagreement between the young person and their parents, or the young person and the local authority, about what is in his or her best interests, an independent advocate may help to represent the views and wishes of the young person and ensure that these are given sufficient weight in decision-making.

89. The knowledge, skills and experience accrued by a young person and those involved in helping him or her during contact with children's services, will need to be consolidated and built upon in order for the transition to adulthood to be successful and productive. Although different agencies' statutory responsibilities for children may vary by age, authorities should ensure some continuity for children and families during this transitional period. A worker, or key worker, should be identified from whichever service has most direct involvement to whom the young person and his or her family can turn for information and advice. This worker may be best placed to co-ordinate the package of services to assist the young person. At this stage in their lives many young people have worries about their personal and sexual development, and experience loneliness and isolation. Young people with disabilities should have access to skilled counselling about disability, sexuality and relationships, to take up if they wish, and receive information about available help and advice. Local authorities should aim to work closely with young people and their families to help them maximise their potential throughout their childhood and into adult life.