4.3 Early Help Assessment Framework in Knowsley

1. Introduction

Working Together to Safeguard Children Chapter 3, Section 1 sets out national guidance on early help. Early help means providing support as soon as a problem emerges at any point in a child's life that improves a family’s resilience and outcomes or reduces the chance of a problem getting worse. It is not an individual service, but a system of support delivered by local authorities and their partners working together and taking collective responsibility to provide the right provision in their area. Some early help is provided through ‘universal services’, such as education and health services. They are universal services because they are available to all families, regardless of their needs. Other early help services are coordinated by a local authority and/or their partners to address specific concerns within a family and can be described as targeted early help. Examples of these include parenting support, mental health support, youth services, youth offending teams and housing and employment services. Early help may be appropriate for children and families who have several needs, or whose circumstances might make them more vulnerable. It is a voluntary approach, requiring the family’s consent to receive support and services offered. These may be provided before and/or after statutory intervention.

The Early Help System Guide provides a toolkit to assist local strategic partnerships responsible for their early help system in their area. Effective provision relies upon local organisations and agencies working together to:

• Identify children and families who would benefit from early help;
• Undertake an assessment of the need for early help which considers the needs of all members of the family;
• Ensure good ongoing communication, for example, through regular meetings between practitioners who are working with the family;
• Co-ordinate and/or provide support as part of a plan to improve outcomes. This plan will be designed together with the child and family, and updated as and when the child and family needs change;
• Engage effectively with families and their family network, making use of family group decision-making, such as family group conferences, to help meet the needs of the child.

Early help means providing support as soon as a problem emerges at any point in a child's life, it can prevent further problems arising.

Any child may benefit from early help, but practitioners should, in particular, be alert to the potential need for early help for a child who:

• Is disabled and has specific additional needs;
• Has special educational needs (whether or not they have a statutory Education, Health and Care Plan);
• Is a young carer;
• Is bereaved;
• Is showing signs of being drawn in to anti-social or criminal behaviour, including being affected by gangs and county lines and  organised crime groups and/or serious violence, including knife crime
• Is frequently missing/goes missing from care or from home;
• Is persistently absent from education, including persistent absences for part of the school day;
• Is at risk of modern slavery, trafficking, sexual and/or criminal exploitation;
• Is at risk of being radicalised;
• Is viewing problematic and/or inappropriate online content (for example, linked to violence), or developing inappropriate relationships online;
• Is at risk of so called 'honour'-based abuse or Forced Marriage;
• At risk of Female Genital Mutilation (FGM);
• Is in a family circumstance presenting challenges for the child, such as drug and alcohol misuse, adult mental health issues and domestic abuse;
• Is misusing drugs or alcohol themselves;
• Is suffering from mental ill health;
• Has returned home to their family from care;
• Is a privately fostered child;
• Has a parent/carer in custody;
• Is missing education, or persistently absent from school, or not in receipt of fulltime education;
• Has experienced multiple suspensions and is at risk of, or has been permanently excluded.

A lead practitioner should co-ordinate the activity around the family, ensure the assessment and the family plan responds to all needs identified, and lead on ensuring the family co-produce the plan. The plan might include the family network. The time commitment to deliver this role will vary family by family depending on the complexity of their needs. Where appropriate, local authorities should engage families, including children, to have a say in who their lead practitioner is, and have a process in place to collate feedback on their relationship with them. The lead practitioner role could be held by a range of people. More details about which practitioners may act as a lead practitioner, their roles and responsibilities along with additional guidance, are provided in the Early Help System Guide.

The practitioners in Knowsley are supported through training and supervision to understand their role in identifying emerging problems, so that they:

• Know when to share information with other practitioners and what action to take to support early identification and assessment;
• Are able to identify and recognise all forms of abuse, neglect, and exploitation;
• Have an understanding of domestic and sexual abuse, including controlling and coercive behaviour as well as parental conflict that is frequent, intense, and unresolved;
• Are aware of new and emerging threats, including online harm, grooming, sexual exploitation, criminal exploitation, radicalisation, and the role of technology and social media in presenting harm;
• Are aware that a child and their family may be experiencing multiple needs at the same time.

The agencies in Knowsley have agreements in place which provide effective ways to identify emerging problems and potential unmet needs for individual children and families as well as clear guidance and procedures for all practitioners, including those in universal services and those providing services to adults with children. The provision of early help services should form part of a continuum of support to respond to the different levels of need of individual children and families.

The Knowsley Model of Children in Need Threshold (see below) includes information as follows:

• The process for early help assessments and the type and level of early help and targeted early help services to be provided;
• The criteria, including the level of need, for when a child should be referred to Knowsley children's social care for assessment and for statutory services under:
  • Section 17 of the Children Act 1989 (children in need, including how this applies for disabled children);
  • Section 47 of the Children Act 1989 (reasonable cause to suspect a child is suffering or likely to suffer significant harm);
  • Section 31 of the Children Act 1989 (care and supervision orders);
  • Section 20 of the Children Act 1989 (duty to accommodate a child); and
• Clear procedures and processes for cases relating to:
  • The abuse, neglect and exploitation of children;
  • Children managed within the youth secure estate;
  • Disabled children.

2. Early Help Assessment Framework in Knowsley

The agencies in Knowsley have agreements in place such as the Knowsley Model of Children in Need Threshold (see below) and the Knowsley Engaging Families Toolkit, which provide effective ways to identify emerging problems and potential unmet needs for individual children and families as well as clear guidance and procedures for all professionals, including those in universal services and those providing services to adults with children. The provision of early help services should form part of a continuum of support to respond to the different levels of need of individual children and families.

The Early Help Assessment Framework (EHAF) is a key part of delivering frontline services that are integrated and focused around the needs of children and young people, supporting them to achieve their full potential. The EHAF is a standardised approach to conducting an assessment of a child's additional needs and deciding how those needs should be met. The process will promote more effective, earlier identification of additional needs, particularly in universal services. It is intended to provide a simple process for an holistic assessment of a child's needs and strengths, taking into account the role of parents, carers and environmental factors on their development. Practitioners will then be better placed to agree, with the child and family, about what support is appropriate. The EHAF will also help to improve integrated working by promoting co-ordinated service provision.

Within Knowsley, four levels of need have been identified and defined:

Examples of each level are shown below:

Children, young people and their families can require support at any of the above levels and may move up and down levels dependent on their needs.

Level 1 - Universal

Children at Level 1 should be able to reach their full potential across the 5 outcomes. If a Practitioner identifies a need at this level it is likely that a referral/appointment would be made internally or to another single agency that would address this need, but practitioners may find it useful in helping identify specific needs at this level to use an EHAF. 

Examples of low level support would include offering advice and support, sign posting and referral on to other universal agencies.

Level 2 – Need for Support

At this level issues can be resolved by accessing appropriate support from available services (see Case Study 2a). If the full needs of the child are not clear an Assessment (see Appendix 1: Knowsley Early Help Assessment for Children, Young People and Families) could be completed at this level to assist in accurately identifying support required (see Case Study 2b below).

At this level, Practitioners should be able to provide assistance, advice and information. It should also be possible to offer specialist support and involve other agencies as appropriate. However if the support provided does not meet the needs of the child/young person and further intervention from other agencies is required, then the family support /EHAF model should be followed.

If the Practitioner decides that an EHAF is required then they should take the following steps:

Step 1 – In order to find out who else may be working with a child, young person or family, the Practitioner should do a background information search on the Early Help Module (expected Summer 2016).  As an interim measure, the Practitioner may contact the Early Help Team who will conduct a search on EHM. (Tel no 0151 443 4092/4707). 

This search will highlight:

1. Whether an EHAF already exists and/or whether issues and concerns have been raised previously;
2. Which services are currently or have been involved with the family.

Step 2 – Depending on the outcome of the search, the Practitioner has three options:

1. If the background information search identifies that the child has a Lead Practitioner or an EHA a in place, the Practitioner should contact the relevant Practitioner leading on the case to share their own concerns (see Case Study 2c); or
2. If the background information search identifies that the child or young person is already well known to services and is receiving uncoordinated support, the Practitioner should call a multi-agency Team Around the Family (TAF) meeting (see Appendix 2: Early Help – Team around the Family Meetings Template) with all those involved, including the family. The Practitioner is responsible for organising and chairing the meeting and also inviting the appropriate service providers. The meeting will serve to co-ordinate the response from all services and enable the relevant Practitioners to work closely with the family to share information and plan interventions, creating a Multi-agency Support Plan (See Case Study 2d and 2e).  Practitioners with limited experience of TAF processes can call on the assistance of the Early Help Team (0151 443 4092) who will advise on the process and offer hands-on support where practical;
3. If the background information search identifies that the child or young person is NOT well known to services, apart from universal services, and there is no existing or recent assessment information available, the Practitioner should initiate an Early Help  Assessment (in document form pending access to EHM). (See Case Study 2b). If the Practitioner is confident with the assessment and knows which services could offer support to the family, the Practitioner can move straight to completing the EHAF and call a TAF meeting to create a Multi-agency Support Plan. This meeting should decide on the level of support required in relation to the Threshold Document and identify a different Lead Professional if this is appropriate;
4. If reviews of service interventions at TAF meetings show that progress is being made and the child's/young person's needs are being met, they may move down to less intensive support from Universal Services for example.  If more time is needed to meet the family's needs then Early Help should continue to be provided by the Lead Professional and partners until it is agreed that needs have been met as far as possible, support is no longer required due to progress, or an escalation of support is required (including to Children's Social Care).
   
   

Level 3 – Child Welfare Concern

N.B BEST practice dictates that consent should be sought for the sharing of information.   Practitioners can share information without parental consent if they feel this is in the best interest of the child.

At this level, Section 17(1) of the Children Act (1989) states that it is the general duty of each local authority:

• To safeguard and promote the welfare of the children within their area who are in need; and
• So far as is consistent with that duty, to promote the upbringing of such children by their families by providing a range and level of services appropriate to those children's needs.

A child is taken to be in need if:

1. They are 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 them of services by a Local Authority;
2. Their health and development is likely to be significantly impaired or further impaired without the provision for them of such services; or
3. They are disabled.

Therefore, at this level it is likely that the child/young person will already be known to services due to the complexity of their presenting needs. This should be identified through an Early Help Assessment.

Many concerns about children/young people can be reduced at this stage by appropriately matching need to services.  Practitioners working with a child or young person with presenting needs at Level 3 should therefore follow their internal procedures. For example, contacting the Lead Safeguarding Person in their organisation with a view to seeking further advice and guidance.

If an Early Help Assessment (see Appendix 1: Knowsley Early Help Assessment for Children, Young People and Families) identifies the potential needs for services from the Children & Families' Division, the completed EHA must be shared with the Children & Families' Division at the point of contact, and consent sought from the child's parent/person with parental responsibilities.

At this point the Children & Families' Division/Local Children & Families' Social Work Team would consider the child's identified needs and whether or not it is appropriate to undertake a Single Assessment.

In addition, children may be at risk of or experiencing physical, sexual, or emotional abuse and exploitation in contexts outside their families.

Extra-familial contexts include a range of environments outside the family home in which harm can occur. These can include peer groups, school, and community/public spaces, including known places in the community where there are concerns about risks to children (for example, parks, housing estates, shopping centres, takeaway restaurants, or transport hubs), as well as online, including social media or gaming platforms.

Working Together to Safeguard Children recognises that, whilst there is no legal definition for the term extra-familial harm, it is widely used to describe different forms of harm that occur outside the home. Children can be vulnerable to multiple forms of extra-familial harm from both adults and/or other children. Examples of extra-familial harm may include (but are not limited to): criminal exploitation (such as county lines and financial exploitation), serious violence, modern slavery and trafficking, online harm, sexual exploitation, child-on-child (nonfamilial) sexual abuse and other forms of harmful sexual behaviour displayed by children towards their peers, abuse, and/or coercive control, children may experience in their own intimate relationships (sometimes called teenage relationship abuse), and the influences of extremism which could lead to radicalisation.

Level 4 – Need for protection

A child in need of protection will be assessed under Section 47 of the Children Act 1989 which states:

Where a Local Authority:

1. Is informed that a child who lives, or is found, in their area:
   1. is the subject of an emergency protection order; or
   2. is in police protection; or
2. Has reasonable cause to suspect that a child who lives or is found in their area, is suffering or is likely to suffer, Significant Harm, the authority shall make, or cause to be made such inquiries as they consider necessary to enable them to decide whether they should take an action to safeguard or promote the child's welfare.

Therefore, many children and young people at this level will have their needs met through existing Safeguarding procedures for multi-disciplinary working. (See Multi Agency Safeguarding Hub (MASH) Procedure). If safeguarding procedures are in place, but some of the child's needs are not being met, Practitioners should identify the statutory Lead Practitioner and the concerns should be re-directed appropriately. (See Case Study 4a and 4b). It is not appropriate for children and young people at this level to be discussed at a Service Allocation Meeting.

In the unlikely event that a child is assessed to be at Level 4 but is not currently receiving a service, (e.g. those with acute illness, mental health needs, complex disability), the procedures outlined at Level 2 and Level 3 should be followed to identify needs and take appropriate action. However, if a child/young person is identified as being at risk of significant/immediate harm, Practitioners should not follow the procedures set out for Levels 2 & 3. They should immediately make a direct referral to the local area Children & Families Social Work Team and follow up with an EHA within 48 hours if appropriate.

Once the child/young person is making progress and is moving towards achieving their full potential across the 5 Outcomes, they may move down to an appropriate level. At lower levels, the child's/young person's needs will be monitored closely through both specialist support and Multi-agency Meetings.

4. EHAF Procedure within Knowsley

The EHAF exists to support children, young people and their families. It will help to ensure that children and young people receive the right support at an early stage, as a preventative measure. As the EHA  is a shared assessment, overseen by  single practitioner but including the contributions of others, it will also prevent families having to repeat the same story to different practitioners. 

Having identified that a child has additional need(s), practitioners must decide whether this need can be met via a referral to a single external agency or whether the needs are more complex, requiring referral to two or more teams. If the presenting needs can be met by a single agency then existing referral procedures can be used and there is no need for an EHA. However if the presenting needs require support from two or more teams then the EHA must be completed and the following process followed:

• Use the EHM when available, to check if an EHA already exists and support is in place;
• If an EHAF already exists, the practitioner should contact the Lead Practitioner to discuss the issues. If the practitioner has access to EHM and they could request permission to contribute the EHM episode and become part of the TAF process making contributions to ongoing review and assessments;
• If an EHAF does not exist then an EHA should be completed with the child and/or family. At this time informed consent must be obtained to share the information with other teams/agencies;
• If not created on EHM, the completed EHA must be logged centrally with the Early Help Assessment Manager who will record on EHM that an EHA and support are in place; 
• The Lead Practitioners must co-ordinate the actions of the multi-agency teams plan and ensure that it is reviewed in a timely manner (suggested maximum of 6-8 weeks);
• At this review, it may be decided that the child's needs have been met and the EHA and can be closed. At this point the EHA must be closed on the EHM system;
• Consent should be regularly reviewed as the family also has the right to withdraw consent at any stage. If this was to happen the Practitioner should follow their own internal procedures but recorded on EHM;
• If during discussion with the child/young person/family it has been identified that an EHA cannot go ahead due to lack of engagement with the family and the Practitioner is of the view that the child/young person may be at risk of Significant Harm. The Practitioner should speak with their local named Safeguarding Person.

See Early Help Assessment Framework Process Chart.

5. Consent

It is important that professionals are aware the Data Protection Act 2018 and the UK GDPR place duties on organisations and individuals to process personal information fairly and lawfully and to keep the information they hold safe and secure. The Data Protection Act 2018 contains 'safeguarding of children and individuals at risk' as a processing condition that allows practitioners to share information. This includes allowing practitioners to share information without consent, if it is not possible to gain consent, it cannot be reasonably expected that a practitioner gains consent, or if to gain consent would place a child at risk.

Note: The Data Protection Act 2018 and UK GDPR do not prevent, or limit, the sharing of information for the purposes of keeping children safe. Fears about sharing information must not be allowed to stand in the way of the need to promote the welfare and protect the safety of children. See Information Sharing Procedure.

Consent is the key to successful information sharing and central to the EHAF process as without the family's consent the EHA process cannot proceed.  As such, it is essential that children, young people and their family understand the EHAF process and how their information will be shared between agencies.

Throughout the process, Practitioners should discuss the issue of consent with the family and explain why it may be necessary for agencies to share information. The Practitioner should be clear about what information is likely to be collected, how it will be used, who it will be shared with and why. Children, young people and their families may agree only to partial consent, specifying what information may be shared and with whom. The individual's wishes should be respected, unless a child is at risk of harm.

There are some circumstances in which it would be appropriate to share information without consent, such as:

• The disclosure prevents the child/young person from committing a criminal offence or places the Practitioner at risk of collusion;
• The child/young person is at risk of significant harm or harming someone else;
• The information is required as part of a legal proceeding;
• Information is requested by the police as part of a criminal investigation;
• In any other circumstance where public interest overrides the need to keep information confidential.

When decisions are made to share information without consent, the reasons for doing so should be recorded and the family should be made aware (if this does not place the child at increased risk of harm).

Working with young people and consent

Although the EHAF process focuses on the need to share information and the importance of including the whole family in assessment, Knowsley recognises that young people may not always want to involve their families in decision making. As such, procedures have been established to allow young people to consent to the EHAF process alone if they are of sufficient maturity and development (see below).

When working with a young person it is important to encourage them to discuss issues with their parents/carers, however this may not always be appropriate. At this point, depending on the young person's needs, it should be explained that only limited support may be offered to meet their needs as many services work with the whole family. However, the young person should be reassured that the appropriate services will work with him/her and respect their wishes if they are deemed to be 'Fraser Competent.'

A young person (12 years and over), who has the capacity to understand and make their own decisions, may give (or refuse) consent to sharing information. In these circumstances the young person is deemed to be 'Fraser Competent'.

• A child has sufficient understanding if they can:
• Understand the question being asked of them;
• Have a reasonable understanding of: what information might be shared; reasons for sharing the information;
• Implications of sharing/not sharing the information;
• Appreciate and consider alternative courses of action;
• Weigh up one aspect of the situation against another;
• Express a clear personal view on the matter;
• Keep a reasonable consistency in their views.

Any child below the age of 16 years can give consent when they reach the necessary maturity and intelligence to understand fully the intervention proposed and the consequences of their decision. However the Practitioner must consider the fact that intelligence and the ability to understand will vary greatly for every child, so the decision of 'Fraser Competency' must be carefully considered. If a child is deemed 'Fraser Competent' after receiving all appropriate information regarding the intervention, then the consent (or refusal to consent) is valid.

Young people should also have a say in who will act as their Lead Practitioner. Provided they have the skills and knowledge, any Practitioner may be requested to act as a Lead Practitioner, meaning that those who specifically work with young people, such as a Youth Worker or a Connexions Personal Adviser, could take on this role. The young person should feel comfortable with the Practitioner and able to express their opinions, knowing that the Practitioner will work in partnership with them to ensure their needs are met.

6. The Team Around the Family Meeting (TAF)

The Practitioner who completes the EHAF with a family should call a Multi-agency meeting. These meetings are a way in which to co-ordinate the delivery of services to a family. Attended by the family and representatives from each service working with that family, these meetings will ensure that children/young people are receiving the support they need and that the family is involved in the decision making process.

(See Appendix 2: Early Help – Team around the Family Meetings Template).

The Practitioner who has completed the EHA is responsible for:

• Convening the meeting;
• Inviting the child/young person/family and Practitioners working with the family to attend;
• Ensuring that the family have consented, fully understand the process and are able to contribute to the proceedings;
• Sharing information;
• Agreeing actions for the Multi-agency Support Plan.

It should be a requirement of this meeting that a Lead Practitioner is appointed and agreed upon in consultation with the multi-agency team and the family. This does not need to be the person who has completed the EHA but the Lead Professional will assume responsibility for the EHA and subsequent planning and review. (See Section 7, Lead Practitioner).

To ensure that services are delivered in a timely, co-ordinated manner, the Practitioners involved in EHA support  should complete meetings and reviews within the following recommended time frames:

• TAF meetings should be held within 15 working days of completing an EHA. It may be appropriate to convene a TAF to inform the completion of the EHA however;
• Multi-agency support plans need to be reviewed approximately every 6-8 weeks (maximum suggested time lapse of 3 months).

7. Lead Practitioner

The Practitioner who completes the EHA is responsible for convening the initial TAF Meeting. It is at this meeting that a Lead Practitioner will be appointed. This decision is made in agreement with the multi-agency team and the child/young person/family, based on the ability of the Practitioner to coordinate services that meet the needs of the family.

The responsibilities of the Lead Practitioner include:

• Acting as a single point of contact for the child/young person/family;
• Acting as an advocate for the family, ensuring that their needs are being met and that they are kept informed of progress, so that they may contribute to proceedings;
• Ensuring that children, young people and families get appropriate interventions and that these are well planned, reviewed and effective.

When a Lead Practitioner has been assigned they are responsible for:

• Keeping an overview of what is to happen;
• Monitoring progress on behalf of the group;
• Keeping track of plans and timescales, ensuring regular reviews, calling and chairing further meetings;
• Making sure all Practitioners involved know what they need to do.
• Making sure the family are aware of information sharing;
• Being the first contact for any new Practitioner;
• Being the first contact for the family or young person.

Although the Lead Practitioner will be the main point of contact for the family, each service represented on the Multi-agency Support Plan will have shared responsibility for the outcomes and service delivery within their own agency. The Lead Practitioner is NOT responsible or accountable for the quality of services delivered by other agencies. 

8. Conclusion

The EHA model provides a framework to develop effective multi-agency working. All Practitioners, regardless of their role, should be working to the same procedure.

By providing a common language around levels of need and clear guidance on the EHA process, Practitioners should be able to clearly identify a child's/young person's needs and be able to offer the relevant services to support them. Monitoring this service provision will provide Knowsley with an up to date needs analysis, allowing gaps in service provision to be identified. As such, these processes can be utilised to inform future commissioning decisions.

Following this model will help to ensure that services within Knowsley not only meet the requirements of the Children Act 2004 but also co-operate to improve the outcomes for children and young people within the Borough.

9. Glossary of Terms

Appendices

Appendix 1: Knowsley Early Help Assessment for Children, Young People and Families

Appendix 2: Early Help – Team around the Family Meetings Template