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Contents

1. Aim
2. Summary
3. Context
4. Principles
5. Practice Standards
6. Referrals and Children's Social Care Teams to Mental Health Services
7. Referrals from Community Mental Health Teams to Children's Social Care
8. Young Carers
9. The Referral to Referral and Assessment Team - Children's Social Care
10. The Initial Assessment
11. Criteria for a Full (Mental Health)/Core Assessment (Children's Social Care)
12. The Full Core Assessment
13. Review
14. Policy Review

1. Aim

• To assess the needs of adults with mental health problems and their children appropriately
• To deliver a safe and effective service

Note : The term 'mental health problem' refers to a Parent with Significant, acute and or enduring mental illness

2. Summary

Child orientated teams (i.e. Children's Social Care) undertaking assessments should, if they have reason to believe that a child's Carer has mental health problems, find out if this is indeed the case.  Permission to make the necessary checks will need to be obtained unless the concerns are such that enquiries are being made under child protection procedures.

Adult orientated teams (i.e. Adult Mental Health Services) should always identify if there are children living with, and/or dependant on their child

This requires the use of systematic assessments for both areas of service provision

If there is any concern that a child's needs are not being fully met, then consideration should be given to a joint assessment.

3. Context

This protocol is informed by:

Children Act 1989 Framework for the Assessment of Children in Need and their families (DOH 2000) Policies and procedures of:
	South London & Maudsley NHS Trust including Child & Adolescent Mental Health Services Children's Social Care Lewisham Safeguarding Children Board
Attention is also drawn to the agreed protocols surrounding Substance Misuse

4. Principles

• Children's needs are paramount
• Children's needs are best met when Parents are supported
• Parents with mental illness have the right to be supported in fulfilling their Parental roles and responsibilities
• Children have the right to be protected from harm and to receive services when their health or development is at risk
• A multi-agency approach to assessment and service provision is in the best interests of Parents and children
• Risk is reduced when information is shared effectively across agencies
• Risk to children is reduced through effective multi agency and multidisciplinary working
• Services should be needs led
• Resources may influence the service that can be provided to meet identified need
• While many Parents with mental health and or substance problems safeguard their children well, children's life chances may be limited as a result of those factors, and health professionals need to consider this possibility for all patients with children

5. Practice Standards

• Mentally ill Parents' needs should be defined as including those occasioned by Parenting, as well as by the adults' own personal needs, e.g.  personal care of the child; preparation of meals and drinks; attending to the child's health needs, Parental involvement in indoor and outdoor play; support in education.
• Parenting needs should also be seen as tasks that do not directly involve the Parent, but support their Parenting choices, e.g. providing childcare while a Parent rests.
• When a referral to Children's Social Care is made to consider an assessment of a child's needs, Parents and children (where appropriate) need to be informed of the referral and their consent obtained to contact other agencies.  If a referral is made where there is likely or actual risk of harm to a child, consent is not required.
• Parents and children (where appropriate) should receive copies of assessments in formats accessible to each individual.
• Assessments and care plans should always be inter-agency in their approach.
• Care plans must ensure a clear focus on the welfare of the child.
• Adults and children (where appropriate) should always be advised as to how to make representations or complaints about any part of the assessment and care planning process and be supported should they wish to do so.

6. Referrals and Children's Social Care Teams to Mental Health Services

• Childcare teams should routinely record whether a Parent has a mental health problem at the Initial Assessment; the source of the information should also be made explicit.
• A decision should be made about whether the child is potentially a child in need within the terms of Lewisham's Threshold Criteria, within 24 hours of a referral.
• If a child is not identified as being 'in need', and a Parent has a mental health disorder, consideration should first be given to referring any concerns to the patient's GP.  Where the problem is significant or acute and the person is previously known to Adult Mental Health Services, then referral to a Lewisham Community Mental Health Team (CMHT) would be appropriate, using the referral information guide, referring by telephone and following up with a written referral.
• If a child is potentially 'in need' because of the likely negative impact of the Parent/Carers mental ill health, as well as a Parent experiencing a mental health disorder, a referral should be made to CMHT, and arrangements made for a joint initial assessment.  This should be led by CMHT Staff, who should take responsibility for contacting the family.  In situations where the child's needs are multiple and complex with the Parents mental ill health being only one factor, it should be negotiated between the services who should take the lead.

7. Referrals from Community Mental Health Teams to Children's Social Care

• CMHTs should routinely record whether there is a child in the family and whether there are any other caring responsibilities i.e. an elderly Parent, child minding responsibilities etc.
• At the first visit, if the CMHT worker considers that the child/ren is/are considered to be in need, or if there are any concerns, they should be referred to the Children's Social Care on the appropriate referral form or Common Assessment Framework form.  Questions about whether a child is in need should be made within the terms of Lewisham's threshold criteria.
• If the CMHT worker does not consider the child to be potentially 'in need' they should record their reasons for concluding this as part of their assessment, CMHTs should carry on with their usual assessment and care planning process.  This should always include frequent and active consideration of whether the child's needs are being met.
• If the children are potentially at risk of significant harm a referral should be made to the Referral and Assessment Team in Children's Social Care and arrangements made for a joint initial assessment.  Any referral should always be followed up in writing using the Children's Social Care referral form or CAF.  Where a child has emotional difficulties, consideration should also be given to referring to Child and Adolescent Mental Health Services (CAMHS) in Lewisham.
• If as a result of referral to Children's Social Care the assessment does not result in the child being identified as being in need and therefore not in receipt of further services/input from Children's Social Care Division, the CMHT referrer must be advised of this outcome.  A re referral must be made if the situation for the child changes or deteriorates and the CMHT worker continues to be concerned or becomes more concerned.

8. Young Carers

When a young is undertaking any caring role within the family consideration must be given to the needs of the child in their role as Carer as well as whether or not the adult is receiving necessary services.  Referrals to Children's Social Care services in relation to young Carers should therefore automatically be referred to CMHTs and a joint assessment carried out, led by CMHTs.

9. The Referral to Referral and Assessment Team - Children's Social Care

For all new referrals, i.e. those children who do not currently have a Social Worker allocated to them or have their case open on duty to one of the service areas.  The Referral and Assessment Team - Children's Social Care will determine whether an Initial Assessment will be initiated within 24 hours of receiving the referral.  The referral form will include questions as to whether the consent of the service user has been sought and that they are aware of the referral.

If the CMHT worker already knows that the child's case is open to a service or a worker within Children's Social Care division, the referral should be made directly to that worker or in his or her absence, the duty officer covering the service.  If it is not known whether the child's case is currently open, a referral should be made to the Referral and Assessment Teams, where checks will be undertaken and information given to the referrer about who they should contact if the case is already open.

There should be agreement between appropriate mangers in the respective services as to who/which service will take responsibility for leading on the case.  These conclusions, together with their rationale, should be included in the case notes in both services.

When it concerns Child Protection, however, Children's Social Care will automatically take the lead.

10. The Initial Assessment

The initial assessment should be completed within 7 working days of referral to Children's Social Care, who will take responsibility for co-ordinating the process.  The childcare Social Worker is expected to see the child and complete the DoH assessment framework documentation. The CMHT worker should complete their assessment forms.  The agency assessments should be shared and the following additional points agreed and included in both.

The initial assessment should:

• Identify the core needs of the mentally ill Parent
• Explore the degree of permanency of the Parent's mental illness
• Identify the child's developmental needs, and the Parents' capacity to meet those needs within the context of their environment
• Take account of known variations in the need for assistance, such as additional support during school holidays, at weekends, etc.
• Agree a joint action plan with the Parent(s) and child (if appropriate) which identifies the care package to be provided, responsibility for provision and timetable for review.  Clear links between child care procedures and mental health procedures (i.e. Care Programme Approach) should be apparent
• This plan should include contingencies such as fluctuating medical conditions, hospitalisation of Parent or child, and partners absence, so that should any of these eventualities occur a reassessment is not required, and prior authorisation of services has been obtained
• Decide whether a full/core assessment is required.

11. Criteria for a Full (Mental Health)/Core Assessment (Children's Social Care)

A full/core assessment should be carried out when:

• The needs of the Parent are complex
• There is a risk of significant harm to a child in the family
• The adult's impairment or illness is stable, but the child's/children's needs are complex
• The absence of a full/core assessment is likely to lead to a re-referral
• Three or more initial assessments have been carried out within the last 12 months
• The Carer meets the threshold for a Care Programme Approach assessment and likelihood of service provision.

12. The Full Core Assessment

This assessment is an in-depth assessment of need, which should be carefully planned and involve all relevant agencies.  It should be completed within 42 working days of the original referral.

At the start of a full/core assessment, a Core Group meeting should take place between a member of Staff from each service, the family and relevant professionals from other agencies who might be asked to contribute to the assessment process.  At this meeting a recommendation should be made as to the most appropriate service to take the lead and a written agreement completed with the family.

A full assessment under the Care Programme Approach should be led by CMHTs when:

• The Parent has a significant, acute and enduring need complex, and requires a package of care to support them in their Parenting role

A core assessment should be carried out in line with the assessment framework for children in need, and will be led by Children's Social Care when:

• There is a risk of significant harm to a child in the family
• The adult's impairment or illness is stable, but the child's/children's needs are complex

At the end of a full/core assessment, a care plan should be jointly agreed between Children's Social Care and the CMHT.  This should be recorded within Children's social Care and on the CPA care plan.  The appropriate Managers from both services should approve this care plan and agree the recommendations for the allocation of resources to support a care package before presentation to the budget holders in the respective services.  The agreed funding split, together with the signed agreement of the budget holders must be included on both sets of records.

FUNDING ARRANGEMENTS FOR SHARED PACKAGES NEEDS TO BE DEVELOPED IN A SEPARATE DOCUMENT

13. Review

Time-scales for review will be identified at the point that a joint action plan or joint care plan is agreed.

The review process should take account of the fact that the needs of people with mental health problems constantly change in both foreseen and unforeseen ways.  A timescale should therefore be set in response to:

• The particular circumstances surrounding the adult service user's needs (through clinical and funding reviews)
• The changing needs of the child, and
• The complexity and size of the package being provided.

There should always be the flexibility for a case to be re-reviewed at any time or re-opened speedily if they have been closed

Should the priority for review differ between the two services then a shorter timescale will be adopted.

14. Policy Review

This protocol will be reviewed 9 months from implementation, and yearly thereafter.

Also see Flowchart for Assessment of Mentally Ill Parents and Children in Need

End