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Framework for the Assessment of Children in Need

Framework for the Assessment of Children in Need

2.1 Assessing whether a child is in need and the nature of these needs requires a systematic approach which uses the same framework or conceptual map for gathering and analysing information about all children and their families, but discriminates effectively between different types and levels of need. The framework in this guidance is developed from the legislative foundations and principles in Chapter 1 and an extensive research and practice knowledge which is outlined in the practice guidance (Department of Health, 2000a). It requires a thorough understanding of:

• the developmental needs of children;
• the capacities of parents or caregivers to respond appropriately to those needs;
• the impact of wider family and environmental factors on parenting capacity and children.

2.2 These are described as three inter-related systems or domains, each of which has a number of critical dimensions (Figure 2). The interaction or the infiuence of these dimensions on each other requires careful exploration during assessment, with the ultimate aim being to understand how they affect the child or children in the family.

Figure 2 The Assessment Framework (the above diagram has been reproduced at Appendix A for ease of photocopying)

This analysis of the child's situation will inform planning and action to secure the best outcomes for the child. The Assessment Framework can be represented in the form of a triangle or pyramid, with the child's welfare at the centre. This emphasises that all assessment activity and subsequent planning and provision of services must focus on ensuring that the child's welfare is safeguarded and promoted.

Dimensions of a Child's Developmental Needs

2.3 Assessment of what is happening to a child requires that each aspect of a child's developmental progress is examined, in the context of the child's age and stage of development. This includes knowing whether a child has reached his or her expected developmental milestones. Account must be taken of any particular vulnerabilities, such as a learning disability or a physically impairing condition, and the impact they may be having on progress in any of the developmental dimensions. Consideration should also be given to the socially and environmentally disabling factors which have an impact on a child's development, such as limited access for those who are disabled and other forms of discrimination. Children who have been maltreated may suffer impairment to their development as a result of injuries sustained and/or the impact of the trauma caused by their abuse. There must be a clear understanding of what a particular child is capable of achieving successfully at each stage of development, in order to ensure that he or she has the opportunity to achieve his or her full potential.

2.4 The child's developmental dimensions are described below. These descriptions are intended to be illustrative rather than comprehensive of the different components of each dimension. s

2.5 The child development dimensions have been taken from the work of Roy Parker and colleagues which was commissioned by the Department of Health (1991) to find practical measures to assess the progress of children accommodated in children's homes and foster care, and to improve their outcomes. During the development stages of that work, the materials were tested with a large number of families in the community and it was found 'that the Assessment and Action Records can be used with parents and children in the community as a means of identifying difficulties and discussing how to address them' (Ward, 1995). These dimensions have therefore been demonstrated to be salient for all children.

2.6 When practitioners are undertaking an assessment of a child's developmental needs, they should:

• identify the developmental areas to be covered and recorded;
• plan how developmental progress is to be measured;
• ensure proper account is taken of a child's age and stage of development;
• analyse information as the basis for planning future action.

2.7 A number of questionnaires and scales have been assembled concurrently with the development of this guidance to assist social services staff, in particular, in specific areas when undertaking child and family assessments. Eight have been published in The Family Pack of Questionnaires and Scales (Department of Health, Cox and Bentovim, 2000) and a further two, the Home Inventory (Caldwell and Bradley, 1984) and the Assessment of Family Competence, Strengths and Difficulties developed by Bentovim and Bingley Miller (forthcoming) will be published later this year. In addition there are others which may be of use to assist the process of assessment.

 

DIMENSIONS OF CHILD'S DEVELOPMENTAL NEEDS Health Includes growth and development as well as physical and mental wellbeing. The impact of genetic factors and of any impairment should be considered. Involves receiving appropriate health care when ill, an adequate and nutritious diet, exercise, immunisations where appropriate and developmental checks, dental and optical care and, for older children, appropriate advice and information on issues that have an impact on health, including sex education and substance misuse. Education Covers all areas of a child's cognitive development which begins from birth. Includes opportunities: for play and interaction with other children; to have access to books; to acquire a range of skills and interests; to experience success and achievement. Involves an adult interested in educational activities, progress and achievements, who takes account of the child's starting point and any special educational needs. Emotional and Behavioural Development Concerns the appropriateness of response demonstrated in feelings and actions by a child, initially to parents and caregivers and, as the child grows older, to others beyond the family. Includes nature and quality of early attachments, characteristics of temperament, adaptation to change, response to stress and degree of appropriate self control. Identity Concerns the child's growing sense of self as a separate and valued person. Includes the child's view of self and abilities, self image and self esteem, and having a positive sense of individuality. Race, religion, age, gender, sexuality and disability may all contribute to this. Feelings of belonging and acceptance by family, peer group and wider society, including other cultural groups. Family and Social Relationships Development of empathy and the capacity to place self in someone else's shoes. Includes a stable and affectionate relationship with parents or caregivers, good relationships with siblings, increasing importance of age appropriate friendships with peers and other significant persons in the child's life and response of family to these relationships. Social Presentation Concerns child's growing understanding of the way in which appearance, behaviour, and any impairment are perceived by the outside world and the impression being created. Includes appropriateness of dress for age, gender, culture and religion; cleanliness and personal hygiene; and availability of advice from parents or caregivers about presentation in different settings. Self Care Skills Concerns the acquisition by a child of practical, emotional and communication competencies required for increasing independence. Includes early practical skills of dressing and feeding, opportunities to gain confidence and practical skills to undertake activities away from the family and independent living skills as older children. Includes encouragement to acquire social problem solving approaches. Special attention should be given to the impact of a child's impairment and other vulnerabilities, and on social circumstances affecting these in the development of self care skills.

2.8 Use of questionnaires and scales enables children and caregivers to express their views about their particular circumstances. They have been found also to identify areas of concern or difficulty which have not been identified previously through interviews or observations.

Dimensions of Parenting Capacity

2.9 Critically important to a child's health and development is the ability of parents or caregivers to ensure that the child's developmental needs are being appropriately and adequately responded to, and to adapt to his or her changing needs over time. The parenting tasks are described on page 21. Again, these descriptions are illustrative rather than comprehensive of all parenting tasks.

2.10 It is important that parenting capacity be considered in the context of the family's structure and functioning, and who contributes to the parental care of the child (see Family and Environmental Factors, paragraphs 2.13 to 2.25).

2.11 In family situations where there is cause for concern about what is happening to a child, it becomes even more important to gather information about how these tasks are being carried out by each parent or caregiver in terms of:

• their response to a child and his or her behaviour or circumstances;
• the manner in which they are responding to the child's needs and the areas where they are experiencing difficulties in meeting needs or failing to do so;
• the effect this child has on them;
• the quality of the parent - child relationship;
• their understanding of the child's needs and development;
• their comprehension of parenting tasks and the relevance of these to the child's developmental needs;
• the impact of any difficulties they may be experiencing themselves on their ability to carry out parental tasks and responsibilities (distinguishing realisation from aspiration);
• the impact of past experiences on their current parenting capacity;
• their ability to face and accept their difficulties;
• their ability to use support and accept help;
• their capacity for adaptation and change in their parenting response.

Observation of interactions is as critically important as the way they are described by the adults involved.

 

DIMENSIONS OF PARENTING CAPACITY Basic Care Providing for the child's physical needs, and appropriate medical and dental care. Includes provision of food, drink, warmth, shelter, clean and appropriate clothing and adequate personal hygiene. Ensuring Safety Ensuring the child is adequately protected from harm or danger. Includes protection from significant harm or danger, and from contact with unsafe adults/other children and from self-harm. Recognition of hazards and danger both in the home and elsewhere. Emotional Warmth Ensuring the child's emotional needs are met and giving the child a sense of being specially valued and a positive sense of own racial and cultural identity. Includes ensuring the child's requirements for secure, stable and affectionate relationships with significant adults, with appropriate sensitivity and responsiveness to the child's needs. Appropriate physical contact, comfort and cuddling sufficient to demonstrate warm regard, praise and encouragement. Stimulation Promoting child's learning and intellectual development through encouragement and cognitive stimulation and promoting social opportunities. Includes facilitating the child's cognitive development and potential through interaction, communication, talking and responding to the child's language and questions, encouraging and joining the child's play, and promoting educational opportunities. Enabling the child to experience success and ensuring school attendance or equivalent opportunity. Facilitating child to meet challenges of life. Guidance and Boundaries Enabling the child to regulate their own emotions and behaviour. The key parental tasks are demonstrating and modelling appropriate behaviour and control of emotions and interactions with others, and guidance which involves setting boundaries, so that the child is able to develop an internal model of moral values and conscience, and social behaviour appropriate for the society within which they will grow up. The aim is to enable the child to grow into an autonomous adult, holding their own values, and able to demonstrate appropriate behaviour with others rather than having to be dependent on rules outside themselves. This includes not over protecting children from exploratory and learning experiences. Includes social problem solving, anger management, consideration for others, and effective discipline and shaping of behaviour. Stability Providing a sufficiently stable family environment to enable a child to develop and maintain a secure attachment to the primary caregiver(s) in order to ensure optimal development. Includes: ensuring secure attachments are not disrupted, providing consistency of emotional warmth over time and responding in a similar manner to the same behaviour. Parental responses change and develop according to child's developmental progress. In addition, ensuring children keep in contact with important family members and significant others.

2.12 The parenting tasks undertaken by fathers or father figures should be addressed alongside those of mothers or mother figures. In some families, a single parent may be performing most or all of the parenting tasks. In others, there may be a number of important caregivers in a child's life, each playing a different part which may have positive or negative consequences. A wide range of adults, for example grandparents, step relations, child minders or baby sitters, may have a significant role in caring for a child. A distinction has to be clearly made between the contribution of each parent or caregiver to a child's wellbeing and development. Where a child has suffered significant harm, it is particularly important to distinguish between the capabilities of the abusing parent and the potentially protective parent. This information can also contribute to an understanding of the impact the parents' relationship with each other may have on their respective capacities to respond appropriately to their child's needs. The quality of the inter-parental relationship, which has an impact on the child's wellbeing will be considered more explicitly in the following section on family and environmental factors.

Family and Environmental Factors

2.13 The care and upbringing of children does not take place in a vacuum. All family members are infiuenced both positively and negatively by the wider family, the neighbourhood and social networks in which they live. The history of the child's family and of individual family members may have a significant impact on the child and parents. Some family members, for example, may have grown up in a completely different environment to the child, others may have had to leave their country of origin because of war or other adverse conditions, and others may have experienced abuse and neglect as children.

2.14 The narration and impact of family histories and experiences can play an important part in understanding what is happening currently to a family. An adult's capacity to parent may be crucially related to his or her childhood experiences of family life and past adult experiences prior to the current difficulties. The family may be in transition, for example refugee families.

2.15 An understanding of how the family usually functions, and how it functions when under stress can be very helpful in identifying what factors may assist parents in carrying out their parenting roles. Of particular importance is the quality and nature of the relationship between a child's parents and how this affects the child. For example, sustained confiict between parents is detrimental to children's welfare. The quality of relationships between siblings may also be of major significance to a child's welfare. Account must be taken of the diversity of family styles and structures, particularly who counts as family and who is important to the child.

2.16 The impact of multiple caregivers will need careful exploration, with an understanding of the context in which the care is being provided. As Cleaver (Department of Health and Cleaver, 2000) writes in the notes of guidance for use with the assessment records:

Children can be protected from the adverse consequences of parenting problems when someone else meets the child's developmental needs.

She adds that it is important to record when there is evidence that no one is responding appropriately to the child. In some circumstances children who have a number of caregivers may be more vulnerable to being maltreated. Special attention should be given to the needs of disabled children who experience multiple caregivers as part of their regular routine, and to their need for reasonable continuity of caregivers.

 

FAMILY AND ENVIRONMENTAL FACTORS Family History and Functioning Family history includes both genetic and psycho-social factors. Family functioning is infiuenced by who is living in the household and how they are related to the child; significant changes in family/household composition; history of childhood experiences of parents; chronology of significant life events and their meaning to family members; nature of family functioning, including sibling relationships and its impact on the child; parental strengths and difficulties, including those of an absent parent; the relationship between separated parents. Wider Family Who are considered to be members of the wider family by the child and the parents? Includes related and non-related persons and absent wider family. What is their role and importance to the child and parents and in precisely what way? Housing Does the accommodation have basic amenities and facilities appropriate to the age and development of the child and other resident members? Is the housing accessible and suitable to the needs of disabled family members? Includes the interior and exterior of the accommodation and immediate surroundings. Basic amenities include water, heating, sanitation, cooking facilities, sleeping arrangements and cleanliness, hygiene and safety and their impact on the child's upbringing. Employment Who is working in the household, their pattern of work and any changes? What impact does this have on the child? How is work or absence of work viewed by family members? How does it affect their relationship with the child? Includes children's experience of work and its impact on them. Income Income available over a sustained period of time. Is the family in receipt of all its benefit entitlements? Sufficiency of income to meet the family's needs. The way resources available to the family are used. Are there financial difficulties which affect the child? Family's Social Integration Exploration of the wider context of the local neighbourhood and community and its impact on the child and parents. Includes the degree of the family's integration or isolation, their peer groups, friendship and social networks and the importance attached to them. Community Resources Describes all facilities and services in a neighbourhood, including universal services of primary health care, day care and schools, places of worship, transport, shops and leisure activities. Includes availability, accessibility and standard of resources and impact on the family, including disabled members.

2.17 In families where a parent is not living in the same household as the child, it is important to identify what role that parent has in the child's life and the significance to the child of the relationship with that parent. It cannot be assumed that parents who live apart are estranged. This arrangement may be by mutual agreement.

2.18 A wide range of environmental factors can either help or hinder the family's functioning. Here it is important to think broadly and creatively about the family and environmental factors described on the previous page.

2.19 Careful account should be taken of how these factors are infiuencing both a child's progress and the parents' responses. This can be illustrated by the following examples of the inter-relationship between such factors and a child's development:

• Family history
  A child may have a genetic condition or pre-disposition, such as sickle cell disorder or Huntington's Chorea, which may affect current or future physical or mental health and the need for services.
  
  
• Family Functioning
  Despite a recent separation, the parents co-operate regarding decisions about key events in a 10 year old boy's life such that he continues to attend the same school, maintains a strong group of friends, and is fully supported in his education by both parents. This enables him to do well in school.
  
  
• Wider family
  A child may have developed a close, affectionate attachment to a friend's parent who, over a number of years, compensates for chronic parental problems in the family home, giving that child a sense of belonging and selfesteem. This may become a resource to be mobilised at the time of family breakdown.
  
  
• Housing
  Accommodation which is damp, infested and overcrowded may be contributing to a low birth weight baby's failure to thrive and chronic ear, nose and chest problems, requiring urgent action.
  
  
• Employment
  The expectation that a 13 year old girl will assist regularly in the family business may result in her sudden failure to keep up with school work and difficult behaviour in class.
  
  
• Income
  Accommodation low income over many years and parents' inability to manage on this income may mean a young adolescent being bullied at school simply because he is wearing clothes which do not have the correct designer logo.
  
  
• Family's social integration
  Constant racial harassment and bullying in a neighbourhood may result in a teenager from a minority ethnic family being isolated and excluded from positive and affirming friendship group experiences at a formative stage of developing his identity.
  
  
• Access to community resources
  Knowledge of resources available in the community which are accessible and accommodate disabled children may enable an isolated single mother to organise out of school care and activities for her 6 year old disabled child, thus enabling her to remain in work.

2.20 The complex interplay of factors across all three domains should be carefully understood and analysed. Parents may be experiencing their own problems which may have an impact through their behaviour on their capacity to respond to their child's needs. This could cover a variety of situations. It could include parents who are unable to read or write and are therefore unable to respond to notes sent home from school. On the other hand, it could include a child being traumatised by witnessing her mother being regularly assaulted by her father.

2.21 The publication Children's Needs - Parenting Capacity by Cleaver et al (1999) focuses on the impact of particular parental problems (mental illness, domestic violence, drug and alcohol misuse) on a child's development while Crossing Bridges (Falkov (ed) 1998) addresses parental mental illnesses in more detail. Such problems may adversely affect a parent's ability to respond to the needs of his or her child. While some children grow up apparently unscathed, others exhibit emotional and behavioural disorders as a result of these childhood experiences. This knowledge can assist professionals to be clear about the impact of a parent's difficulties on a child. In some situations, where the parents' problems are severe, such as major psychiatric illness or substance misuse, there may need to be joint or concurrent assessments; to examine the parent's problems, the impact of those problems on the child, and the effect of the child on the parent. Such assessments should be carried out within a clear focus on the needs of the child.

2.22 There is increasing knowledge about the characteristics of adults who maltreat children. Research has shown a strong association between domestic violence and child abuse. It has shown also, that not all parents who have suffered childhood abuse or deprivation go on to maltreat their children, but a significant proportion of parents who harm their children have been abused themselves (Department of Health, 1995d).

2.23 The interactions between different factors are often not straightforward which is why it is important that:

• information is gathered and recorded systematically with care and precision;
• information is checked and discussed with parents and, where appropriate, with the child;
• differences in views about information and its importance are clearly recorded;
• the strengths and difficulties within families are assessed and understood;
• the vulnerabilities and protective factors in the child's world are examined;
• the impact of what is happening on the child is clearly identified.

Chapter 4 elaborates on the processes of analysis, judgement and decision making which follow on from the information gathering and collation stages.

2.24 Ward (1995, p.85) in her community study of almost 400 children and their families concludes:

It is likely to be the interaction between a number of factors rather than any specific characteristic that leads to parenting difficulties. Thus most families are able to overcome adversities and provide their children with a sufficiently nurturing environment, although they may fall down in one or two areas. Only a very small proportion are unable to provide a sufficiently consistent standard of care across all seven (child development) dimensions, but it is they who form the group whose children are most likely to be admitted to care or accommodation.

2.25 The framework for assessment is, therefore, a conceptual map which can be used to understand what is happening to all children in whatever circumstances they may be growing up. For most children referred or whose families seek help, the issues of concern will be relatively straightforward, parents will be clear about requiring assistance and the impact on the child will not be difficult to identify. For a smaller number of children, the causes for concern will be serious and complex and the relationship between their needs, their parents' responses and the circumstances in which they are living, less straightforward. In these situations, further, more detailed and, in some cases, specialist assessment will be required. These issues are considered in the next chapter on the process of assessment.

Inclusive Practice

2.26 The Assessment Framework is predicated on the principle that children are children first, whatever may distinguish some children from others. This poses a challenge for staff - how to develop inclusive practice which recognises that all children share the same developmental needs to reach their optimal potential but that the rate or pattern of progress of individual children may vary because of factors associated with health and impairment. At the same time, due weight needs to be given to other important infiuences on children's development. Prominent amongst these are genetic factors, the quality of attachment to primary caregivers and the quality of everyday life experiences.

2.27 When assessing a child's needs and circumstances, care has to be taken to ensure that issues which fundamentally shape children's identity and wellbeing, their progress and outcomes are fully understood and incorporated into the framework for assessment. Dutt and Phillips (Department of Health, 2000a) write:

Issues of race and culture cannot be added to a list for separate consideration during an assessment, they are integral to the assessment process. From referral through to core assessment, intervention and planning, race and culture have to be taken account of using an holistic framework for assessment.

2.28 In assessing the needs of children, practitioners have to take account of diversity in children, understand its origins and pay careful attention to its impact on a child's development and the interaction with parental responses and wider family and environmental factors.

2.29 Use of the framework requires that children and families' differences must be approached with knowledge and sensitivity in a non-judgemental way. Ignorance can result in stereotyping and in inappropriate or even damaging assumptions being made, resulting in a lack of accuracy and balance in analysing children's needs. To achieve sensitive and inclusive practice, staff should avoid:

• using one set of cultural assumptions and stereotypes to understand the child and family's circumstances;
• insensitivity to racial and cultural variations within groups and between individuals;
• making unreasoned assumptions without evidence;
• failing to take account of experiences of any discrimination in an individual's response to public services;
• failing to take account of the barriers which prevent the social integration of families with disabled members;
• attaching meaning to information without confirming the interpretation with the child and family members.

2.30 The use of the framework, derived from children's developmental needs and which also takes account of the context in which they are growing up, takes on more significance in relation to children for whom discrimination is likely to be part of their life experience. Such children and their families may suffer subsequent disadvantage and a failure of access to appropriate services. It is for this reason that chapters have been included in the practice guidance which consider in more detail issues of race and culture and of disability in assessing the needs of children in the context of their family and their environment.

Disability Discrimination Act 1995

2.31 Under Part III of the Disability Discrimination Act 1995 (rights of access to goods, facilities and services) service providers, including social services departments and health but not as yet education, must not discriminate against disabled people (including children) by refusing to provide any service which is provided to members of the public, by providing a lower standard of service or offering a service on less favourable terms. These requirements came into force on 2 December 1996.

2.32 Since October 1999, service providers have had to take reasonable steps to:

• change any policy, practice or procedure which makes it impossible or unreasonably difficult for disabled people to make use of services;
• provide an auxiliary aid or service if it would enable (or make easier for) disabled people to make use of services; and
• provide a reasonable alternative method of making services available to disabled people where a physical feature makes it impossible or unreasonably difficult for disabled people to make use of them.

2.33 From 2004 service providers will have to take reasonable steps to remove, alter or provide reasonable means of avoiding physical features that make it impossible or unreasonably difficult for disabled people to use the services.

Prepared 29 March 2000