Short Term Breaks Referrals and Placements
RELATED LEGISLATION AND GUIDANCE
- Care Planning, Placement and Case Review (England) Regulations 2010;
- Children Act 1989 Guidance and Regulations - Volume 2: Care Planning, Placement and Case Review;
- Short Breaks: Statutory Guidance on How to Safeguard and Promote the Welfare of Disabled Children Using Short Breaks;
- Short break care: how local authorities should provide it.
AMENDMENTIn August 2017, a link was added to Friendship For All (The Children's Society) - If a child or young person is disabled and/or in the care system, they are more likely to miss out on friendship causing them to be socially isolated. Professionals delivering foster care and short breaks services are invited to implement simple changes to practice and strengthen carer training to increase friendship in the lives of children. Friendship For All provides freely downloadable, nationally piloted and evaluated resources.
1. The Legal Basis for Short Breaks
Children may be provided with short breaks under the following legislation:
- Under Section 17 Children Act 1989, in which case they are not looked after children, the 2010 Regulations do not apply and there is no requirement to appoint an Independent Reviewing Officer (IRO). A Child in Need Plan is required in accordance with the Assessment Framework. Reviews should be carried out at least every 6 months and more often if required; or
- Under Section 20 Children Act 1989, with short breaks of not more than 17 days each in the same setting (where the total number of placement days does not exceed 75 in any 12-month period). In these circumstances, the child is looked after, an IRO must be appointed, and a Short Break Care Plan drawn up. The 2010 Regulations are modified (Regulation 48), so that Looked After Reviews (see Section 5, Assessment of Needs below) and Section 7, Social Work Visits are less frequent and the short breaks are treated as a single placement; or
- Under Section 20 Children Act 1989, where the short breaks exceed a total of 17 days per placement/75 days per 12-month period and/or take place in more than one setting. In these circumstances, the child is looked after, an IRO must be appointed and a Care Plan drawn up. The 2010 Regulations apply in full, including the provisions on frequency of Looked After Reviews (see Section 5, Assessment of Needs below and Section 7, Social Work Visits).
Where a child is provided with a Short Break under Section 17 or Section 20(48) the requirements which usually apply to looked after children in respect of health assessments and reports, and notification of placements, do not apply.
The legal basis on which services are provided should be clear. The decision to provide a short break under Section 17 or under Section 20 should be informed by the assessment of the child's needs and should take account of parenting capacity and wider family and environmental factors, the wishes and feelings of the child and his/her parents and the nature of the service to be provided.
The key question to ask in deciding whether to provide the short break provision under Section 17 or Section 20 is how to promote and safeguard the welfare of the child most effectively.
2. Definition of a Short Term Break
A short term break is an arrangement where a young person who normally lives with his/her parents/primary carers, is provided with a break from their care for a short period.
These breaks are flexible arrangements to suit the young person, parent and carer and can include one or more overnight stay per month. Short break carers can provide extra day care e.g. in school holidays and in the family home.
Other than in response to an extreme immediate crisis a short break will be a planned placement subject to a thorough assessment of a child's and families' needs.
3. Assessing the Needs
Before making, and when reviewing, a decision about whether to provide accommodation under Section 17 or Section 20, there should be a careful assessment of the child and family's needs that addresses:
- Particular vulnerabilities of the child, including communication method;
- Parenting capacity of the parents within their family and environmental context;
- The length of time away from home and the frequency of such stays - the less time the child spends away from home, the more likely it is that Section 17 will be appropriate;
- Whether short breaks are to be provided in more than one place - where the child has substantial packages of short breaks in different settings, it is more likely that Section 20 will be appropriate;
- Potential impact on the child's place in the family and on primary attachments;
- Observation of the child - especially children who do not communicate verbally - during or immediately after the break by a person familiar with the mood and behaviour of the child e.g. parents or school staff;
- Views of the child and parents - some children and parents may be reassured by and in favour of the status of a looked after child, while others may resent the implications and associations of the 'looked after' status;
- Extent of contact between short break carers and family and between the child and family during breaks exceeding a 48 hour period;
- Distance from home; and
- The need for an Independent Reviewing Officer (IRO) to monitor the child's case and to chair reviews.
4. Levels of Assessment
4.1 Single Assessment
A single assessment will be sufficient in most situations where the trigger for the assessment is a request for a short break.
Assessment must be proportionate to the situation and the needs of the child and family and there are a range of shortbreak services available across Walsall that require no assessment and where evidence that a child is in receipt of medium or higher rate Disability Living Allowance is sufficient to access services.
4.2 Single Assessment
Where a child's needs and family circumstances are more complex, for example where overnight stays away from the family home may be indicated or requested on a regular basis, a Single Assessment will identify what types and level of services will be most appropriate to meet the identified needs.
4.3 Carer's Assessment
Parents of children who have a disability have the right to request an assessment of their own needs and should always be offered such an assessment by the social worker undertaking any other form of assessment. Such a request indicates the need for a Single Assessment and this should be considered by the worker undertaking a Carer's Assessment. Carer's Assessments should not be conducted in isolation and while there is a discrete focus on the needs of the carer the outcome of this assessment should be integrated within any broader assessment of the disabled child and their family. The needs of the parents can be recorded under the dimension of family functioning of the Assessment Framework.
5.1 Child in Need Plans
This is applicable where short breaks are provided under Section 17 Children Act 1989.
The Child in Need Plan should be in writing and set out clearly all the services that are to be provided to meet the child's needs. Many families with a disabled child receive a range of services to meet their child's needs. Wherever possible there should be a single plan which includes the full range of family support services on a multi-agency basis. The plan will show how the short break will meet the needs of the child and family identified in the assessment. It will:
- Have clear and realistic objectives and outcomes;
- Include the ascertainable wishes and feelings of the child and views of the family;
- Follow consideration of options, including but not limited to Direct Payments;
- State the nature and frequency of services, as far as is practicable. This should include health and social care in the same plan, especially if the short break is provided from different agencies;
- State the child's health, emotional and behavioural development, clearly outlining where these are different from chronological norms and expectations. Full details of the child's disability, clinical needs and any medication the child may require must also be included;
- Clearly state the child's specific communication needs, especially for children who communicate non-verbally, and include the child's likes and dislikes. Completion of the About Me tool will helpfully explore the child's likes and dislikes in relation to food, leisure activities and any trigger points;
- The outcome of all necessary risk assessments which could include, depending on the child's impairment, moving and handling, invasive procedures, and behaviour;
- Clearly state contact arrangements for emergencies;
- Clearly state commitments of professionals involved, including the named Lead Professional and the frequency of visits by those professionals involved;
- Refer to or summarise any other important documents about the child's development;
- Outline the timescale for and arrangements regarding the review of the plan.
The plan should include all the information necessary to ensure the welfare of the child in the short break. Much of this information will already be available from a variety of sources including the parent-held child record.
The plan should be made available as necessary in accessible formats and shared with the child, if appropriate, the parents in all circumstances and other professionals contributing to the plan.
The Team Manager must sign off the plan to signify that in the Manager's opinion the plan meets the assessed needs of the child and their family.
5.2 Short Break Care Plans
This is applicable where short breaks are provided under Section 20 Children Act 1989.
If following assessment, it is agreed with the family that their child should be Looked After under Section 20 of the 1989 Act, there will be additional requirements about planning and review.
The same information required for a Child in Need Plan will form the basis of the Short Break Care Plan.
The Short Break Care Plan must set out the arrangements to meet the child's needs with particular regard to:
- The child's health and emotional and behavioural development, clearly outlining where these are different from chronological norms and expectations and include information relating to the child's disability, clinical needs and medication regime;
- The child's specific communication needs, especially for those children who communicate non-verbally and include the child's likes and dislikes. Completion of the All About Me tool will helpfully explore the child's likes and dislikes in relation to food, leisure activities and any trigger points;
- Contact arrangements with parents/anyone with Parental Responsibility;
- Arrangements for contacting parents, in particular an emergency contact number;
- How the carers, as appropriate, promote the child's educational achievement;
- The name and address of the registered medical practitioner;
- The name, address and type of accommodation, of the registered person (provider);
- The child's personal history, religious persuasion, cultural and linguistic background and racial origin;
- The respective responsibilities of the local authority and parents/anyone with Parental Responsibility; any delegation of responsibility from parents to the local authority; the respective roles and responsibilities of the placement provider, social worker, Independent Reviewing Officer (IRO) and other staff employed or commissioned by the local authority to contribute to the plan for the child's care; the respective safeguarding responsibilities of the provider and the local authority;
- The expected duration of the arrangements and the steps to end them; arrangements for giving notice of intention to terminate the placement along with the local authority's responsibilities for convening a review of the child's Care and Pathway Plan where there is a risk of the placement being terminated;
- Frequency of visits;
- When the child is placed with a local authority-approved foster carer, confirmation of the foster carer's agreement;
- The provider's responsibilities for notifying the child's social worker of any significant change in the child's circumstances, behaviours or presentation.
As far as practicable, the child should be involved in agreeing the Plan and social workers must think creatively about the best way of enabling the child's involvement.
The plan should be signed by the parents, the local authority, those providing the care / the provider agency and, where appropriate, the child.
If following assessment it has been agreed that the child will be looked after under Section 20 the Short Break Care Plan should be linked to the Care Plan which should include all the key information about the child. These must not be separate plans with duplicate information.
Prior to any Short Break under Section 20 a pre-placement or introductory meeting should be arranged. If the child is accessing a Family Placement this will be arranged and chaired by Family Placement Services social worker and will include the parents, the child (where appropriate) and the Children & Young Person with Disabilities Team Worker. Where the child is attending a residential provision the Disability Team Social Worker will arrange the pre-planning meeting.
The child's health, communication, behavioural and medical needs will be discussed and persons identified to provide the carers with all training necessary to enable them to administer the child's. Other issues discussed include transport arrangements and programmes that need to be replicated by the carer e.g. behaviour management.
Introductions should commence as soon as practicable. Should the child be unable to attend for any reason the child's parents will notify the short break carer with as much notice as possible and all parties will then rearrange an alternative introduction date. Should any difficulties arise during the schedule the child's social worker and Family Placement Services social worker/residential key worker will be notified so that discussion can take place to resolve issues or as a last resort, end the introduction plan.
Should any difficulties arise during the schedule the child's social worker and Family Placement Services social worker will be notified so that discussion can take place to resolve issues or as a last resort, end the introduction plan.
Should it be considered that either the child or parent is not ready to begin the placement, or the carer is not fully confident/competent in caring for the child this will be discussed and further day care introductions may be arranged before reviewing the situation again.
There is no a requirement for a separate Placement Plan for short breaks.
6.1 Reviews - All Cases
No significant change to a Child in Need Plan or a Short Break Care Plan should be made unless it has first been considered at a review.
In all cases, whether the child is provided with accommodation under Section 17 or under Section 20, the review should consider whether this continues to be the most appropriate legislative basis for the service provided.
A record should be kept, recording the views of those involved in the review, decisions taken and the identity of the persons responsible for implementing them, with timescales.
Reviews are part of the care planning process for children. They provide an opportunity to reconsider any existing Care Plan, monitor changes in circumstances and make transitional arrangements. They also help to ensure that the aims of the plan are being achieved. It is also through this process that the Care Plan may be changed.
Each child receiving a short break should be given the opportunity to express their wishes and feelings in a communication method that is most suitable to the child. In addition the child may attend their review meeting if they wish and are of an age/or stage of development to understand the issues raised.
6.2 Children in Receipt of Short Breaks under Section 17
A short break review for a child who is not looked after should:
- Safeguard and promote the welfare of the child;
- Ensure the service(s) provided meet the needs identified in the Child in Need Plan;
- Focus on the specified required outcomes for the child and family;
- Be a multi-agency review whenever possible and facilitate written submissions if physical attendance is not possible. Different elements of a child's care package should not require different reviews;
- Include the ascertainable wishes and feelings of the child as well as those of the family;
- Take place at least at least every 6 months. The changing needs of the child and/or their family may indicate that a review should take place earlier, more frequently and before this statutory minimum.
A review will usually include a face to face meeting but in some cases, this may not be necessary. It should be possible to include a review of short breaks provided to a child and their family with a review of some other aspect of services to the child's e.g. health or education.
The review should take place in the form of a meeting if requested by the family.
In all circumstances a face to face meeting should take place at least once every 12 months.
6.3 Children in Receipt of Short Breaks under Section 20
The first review must take place within the first 3months from the start of the placement. Second and subsequent reviews must take place at intervals of not more than 6months.
Reviews may be convened earlier e.g. at the request of the child, the family or where there is concern that a child's circumstances have changed resulting in the need to consider a change to the existing package of care to ensure that the child or family's needs continue to be met.
6.4 Children in receipt of a Short Break under Section 20
The 2010 Regulations in relation to Looked After Reviews apply in full, and reviews will take place as follows:
- The first review must take place within 20 working days of the first placement;
- The second review must take place not more than 3 months after the first;
- Subsequent reviews must take place at intervals of not more than 6 months;
- Reviews may be convened earlier e.g. at the request of the child, the family or where there is concern that a child's circumstances have changed resulting in the need to consider a change to the existing package of care to ensure that the child or family's needs continue to be met.
7. Social Worker Visits
Visits should usually be undertaken by a qualified social worker and always by a person with the skills and experience to communicate effectively with the child and fulfil the functions of the visit.
A record must be kept of all visits, including the names of members of staff spoken with and details of what the child was engaged in during the period of visit.
There is no statutory requirement for visits. However, the allocated worker must be able to satisfy themselves that the child's welfare is being safeguarded and that the service being provided is meeting the needs of the child and their family.
A minimum of at least one visit between each review is best practice.
Section 20 (48)
Visits should take place at regular intervals and be recorded in the Short Break Care Plan before the start of the first placement. The frequency of the visits should be agreed with the Independent Reviewing Officer and the child's parent's/person with parental responsibility.
In all circumstances the first visit to the child in placement must take place within 3 months of the first placement day and subsequent visits to the child in placement at intervals of no more than 6 months for as long as the short breaks continue.
On all visits the social worker must see the child, the room they are using and communicate with the child as appropriate and in keeping with their emotional and behavioural development.
Visits must take place within one week of the start of the child's placement and thereafter at intervals of no more than 6 weekly.
On all visits the social worker must see the child, the room they are using and communicate with the child as appropriate and in keeping with their emotional and behavioural development.
8. Recording the Child's MovementsIt is the responsibility of the child's social worker (or Family Placement Services worker by agreement) to record each complete movement for planned short breaks. This information can be used either to initiate payment for some carers (on WSS019) and/or to gather statistics regarding Looked After Children.
Information shared about any child receiving breaks are confidential. Foster carers therefore should keep any written information in a lockable box and should give careful and sensitive consideration as to what information they divulge to family members.
10. Keeping Records
During the child's stay, short break carers are required to keep a daily log and detailed medical/clinical recordings as stated in medical and clinical procedure for short term break carers (WSS652, WSS307, WSS651). In addition they may keep a diary of activities and events that the child has been involved in, this is often produced at reviews especially in the event that the child is unable to attend or contribute verbally at the review.
11. Health and Medical Care
Young people subject to short breaks will have their health monitored via consultant appointments and their education statement. Changes of medical needs will be notified by parents to short break carers. Parents hold responsibility for medicals and medical appointments including eye and dental checks.
A child receiving short breaks will remain registered with their family GP. If a child becomes unwell during a short break, efforts should be made to contact the parent/carer. If this is not possible the child's GP or care's own GP (if significantly nearer) should be consulted. Carers are specifically trained to care for and meet the needs of children requiring medication or clinical procedures including invasive procedures.
If there is a medical emergency e.g. a child has an epileptic seizure instructions pre-arranged on the emergency protocol form WSS956 should be followed. For serious accident emergencies, carers should remove the child to hospital with urgency but ensure parents are notified immediately. In the event of parents being unavailable the child's social worker or a duty worker should be notified by carers, any accident should then be reported to the link worker as soon as possible and recorded accurately.
12. Food and Diet
Due to their disability or medical condition some young people receiving short breaks may have special nutritional or dietary needs. Others may be tube fed via an oro/naso gastric or gastrostomy tube. Carer will be trained by a medically qualified worker and/or the parent carer so that they are able to provide consistent care to the young person. They will be required to record on a specific form, WSS307 when how and what they have give to the young person.
13. Parental Contact
Due to the nature of short term break care, short term carers liaise closely with parents/full time carers to provide a consistent care package. Young persons who have short breaks therefore generally do not have contact with their parent/carer during their break. However, should a parent/carer request a child return home during a break they are free to do so as long as this is a safe arrangement for the young person. If in doubt carers should contact Children's Services out of hours service or the child's social worker. Failing this a link or duty worker can be contacted at Family Placement Services or duty worker at the appropriate team if within office hours.
14. Providing Care in the Child's own Home
The key to providing safe care to children in their own homes is the same as the provision of safe care elsewhere and it is essential that safe recruitment practices are followed, that staff properly trained and supervised and that the requirements of the Vetting and Barring Scheme are complied with.
Where the local authority provides a sitter or overnight carer in the child's own home, the child is not being provided with accommodation by the local authority and is therefore not a looked after child. Such services are provided would form part of a short break provided under Section 17 Children Act 1989.
However, caring for or supervising children unsupervised, or providing Personal Care to them, will come within the definition of Regulated Activity under the Safeguarding Vulnerable Groups Act 2006 as amended by the Protection of Freedoms Act 2012, and the requirements of the Disclosure and Barring Service in relation to regulated activities will apply.Where such care is provided by parent/carers utilising a Direct Payment, the requirements of the local authority's Direct Payment scheme will be followed.
15. Providing Care in the Carer's own Home or in the Community
It is essential that individuals providing care in their own homes as part of an agreed short break package are recruited using safe recruitment processes, are subject to full employment and personal checks and that they are provided with induction, training and ongoing supervision.There are no requirements for agencies to register with Ofsted or the Care Quality Commission if they provide services to support disabled children in their own home or within the community, unless they provide Personal Care. If Personal Care is provided that the provider of these services must register with the Care Quality Commission and comply with all relevant national standards, and the activities will be Regulated Activity.