Please be aware that this section contains information prepared in 2009 and may now be out of date. Some links may no longer work. We are reviewing this section.
Children on the autism spectrum often need access to a wide range of services and need a co-ordinated package of support. They should be able to benefit from services which are easily accessibly at key transition points in their lives, designed around the child and family, and delivered in a coordinated and timely manner. Multi-agency working has been shown to be an effective way of supporting children and young people with additional needs, and securing real improvements in their life outcomes.
There are a number of ways of delivering multi-agency services:
- Multi-agency panels or networks - the 'team around the child' - practitioners remain employed by their home agencies but meet on a regular basis to discuss children and young people with additional needs who would benefit from multi-agency input.
- Multi-agency teams made up of practitioners seconded or recruited into the team, making it a more formal arrangement than a multi-agency panel. The team works with universal services to support families and schools as well as individual children and young people.
- Integrated services which bring together a range of provision, usually under one roof, such as school or early years setting. Staff work in a co-ordinated way to address the needs of children, young people and families providing services such as all-year-round, inclusive education; care and personal development opportunities for children and young people; and specialist support for children and families.
Context for multi-agency working: Every Child Matters
In the last ten years, under the Every Child Matters programme, the Government’s aim has been to improve outcomes for all children and young people through inter-agency governance, strategy, processes and delivery.
Inter-agency governance: The delivery of integrated frontline services to improve outcomes for children and young people requires robust governance arrangements for inter-agency cooperation which set the framework of accountability for the improvement and delivery of effective services. The local authority Director of Children's Services is responsible for establishing and leading the cooperation with partners - including public, private, voluntary and community organisations - in order to create a shared vision and improve outcomes for children and young people. Each local authority also has to designate a lead member to take responsibility for children's services.
Integrated Strategy: This includes joint assessment of local needs involving children, young people and parents, a single plan shared between all children's services reflecting national and local priorities for improved outcomes, pooling of budgets to supported joint commissioning of services and joint area reviews to inspect local children's services
Integrated Processes: The delivery of integrated frontline services to improve outcomes for children and young people are supported by more integrated processes which drive multi-agency working. The development of children's trusts involves integrated processes, centrally driven by government, such as:
- The Common Assessment Framework: a national, common process for initial assessment to identify more accurately and efficiently the additional needs of children and young people at risk of poor outcomes, reducing duplication of assessment, ensuring a shared language across agencies and improving referral between agencies (see below)
- Better information sharing between professionals: development of national standards for information sharing across local children's services, clear guidance for practitioners covering health, education, social care and youth offending, and creation of database/index systems to facilitate information sharing
Integrated delivery: This includes more integrated, accessible and personalised services built around the needs of children and young people, not around professional or service boundaries; a shift to prevention and improved safeguarding; services co-located in places like children's centres and extended schools and a workforce reform to ensure sufficient, suitably trained staff. All staff working with children have a common core of knowledge and understanding about children's needs and increased understanding and trust between professionals and there are multi-disciplinary teams and lead professionals
A number of initiatives such have been put in place to promote effective ‘joined up’ multi-agency working to support vulnerable children:
- The Children's Plan set out some ambitious goals to improve the lives of families, children and young people by 2020. Local authorities play a key role in delivering these reforms, and it is vital that they are enabled to operate within a performance management framework that allows them greater flexibility to focus on the issues that really matter to local communities, while at the same time ensuring a focus on national goals for children, young people and their families. On special educational needs (SEN) and disability, The Children’s Plan announced a renewed focus on raising expectations of what children with SEN should achieve – across the five Every Child Matter outcomes. It announced a package of measures, costing £18m, to:
- improve the skills of the workforce in meeting the needs of children with SEN;
- enhance the role for school SEN co-ordinators; and
- improve data to identify whether SEN pupils are making good progress.
- For disabled children and their families it also announced an additional £90m to improve equipment, facilities and buildings for short break services. Ofsted was asked to lead a full review into the quality of SEN provision, to start in 2009.
- The Early Support Programme is the Government programme which aims to achieve better co-ordinated, family-focused services for young disabled children and their families. It is a national programme being introduced and used in local authorities, hospitals and community-based health services across England. The Early Support Programme provides a standard framework and set of materials that can be used in many different circumstances, and a set of expectations about how services should work with families. Families are held at the heart of discussion and decision-making about their children. The programme integrates service planning and delivery, particularly when families are in contact with many different people and agencies.
- The introduction of major changes to the children’s workforce. A comprehensive curriculum for training all practitioners who work with children is currently being developed by government. While this is not going to make all professionals knowledgeable about disabilities such as autism, they should have the basic skills to recognise a possible developmental delay, be able to support parents emotionally and, crucially, to know when to signpost parents on for more expert advice. Working with children is a key component of the core training curriculum which recognises, for example, that some children do not communicate verbally and that practitioners need to adapt their communication to the needs and abilities of the child or young person.
- New ways of sharing information are being developed to avoid duplication, children slipping through the net and excessive bureaucracy. The government has developed ContactPoint, a database holding information on every child in England from birth to 18 years of age, possibly longer for children who are disabled or looked after. With greater electronic recording of personal information resulting in wider access in some cases, issues confidentiality are of concern to disabled people. Cross-professional legal guidance sets out how information sharing should happen and covers confidentiality in some depth.
- The Common Assessment Framework (CAF) aims to provide a more standardised and preventive approach to identifying need and making provision and operating across professional boundaries. Some children may be identified as having a possible disability such as autism via this route. Disabled children and their families should benefit from the integration of assessment processes, with shared information and shared basic assessments. The Common Assessment Framework provides a gateway to more specialist assessments where necessary.
- The lead professional is a key element of integrated support. They take the lead to coordinate provision and act as a single point of contact for a child and their family when a range of services are involved and an integrated response is required. Appointing a lead professional is central to the effective frontline delivery of services for children with a range of additional needs. When the role is delivered in the context of multi-agency assessment and planning, underpinned by the Common Assessment Framework or relevant specialist assessments, it ensures that professional involvement is rationalised, coordinated and achieves the intended outcomes.
- Every local authority (except the best performing four star authorities) has to have a Children and Young People’s Plan (CYPP). The CYPP covers all local authority services affecting children and young people including early years and extended schools and out-of-school child care, education, youth services, children’s social services. It also includes services provided by relevant youth justice agencies and health services for children and young people, including child and adolescent mental health.
Aiming High for Disabled Children
Under the Every Child Matters Programme the Government has launched a specific strand of improvements under the banner Aiming High for Disabled Children (AHDC), launched in May 2007. This is a transformation programme for disabled children's services. Supported by substantial new funding and measures designed to make the system work better, the AHDC programme aims to deliver:
- Access and empowerment for disabled children and families: setting a clear standard of service provision for disabled children and their families from public services
- Responsive services and timely support: Providing co-ordinated, timely, integrated service provision to disabled children and their families.
- Improved service quality and capacity: increasing the provision and quality of key services for disabled children and their families, including short breaks and childcare provision.
Despite strong examples of successful coordination in the planning and provision of innovative services, for example through the Early Support Programme which is encouraging multi-agency working and some local areas pioneering the use of local performance indicators to give clear signals to services about what they should achieve in responding to identified local priorities; there is more that needs to be done to tackle remaining coordination problems. This includes differing eligibility criteria, differing referral systems and cultures, and differing and inconsistent data about the disabled children population across agencies.
Transition Support Programme
There is currently a lack of consistent multi-agency working to ensure that disabled young people are given a real choice about their futures and there are barriers to smooth transition to adult services for children with disabilities which include the lack of multi-agency working to support transition and confusion over roles and responsibilities in transition planning.
Under Aiming High for Disabled Children the Government have launched the Transition Support Programme which consists of two main elements:
- The national transition support team, which will coordinate the work with local authorities, PCTs and regional advisers and existing experts
Support for change at local level through a combination of direct grants and regional adviser activity.
In December 2008 the Government announced that every local authority area is receiving £10,000 to assess their current support for transition including drawing in the views of young people and families and completing a self assessment questionnaire; and 13 Local Authorities are receiving an additional £37,500 to extend their practice in the following areas:
- engagement with disabled young people and also their families
- joint assessment processes in children’s and adult services
- education, employment and training options at 16+
- strategic partnership working
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Every Child Matters: a comprehensive website detailing the Government's programme for co-ordinated children's' services, including: setting up multi-agency services, the Common Assessment Framework, Role of the lead professional and Children and Young People's Plan.
Aiming High for Disabled Children: details about the Government's programme of reform
Early Support Programme
Children's Workforce Strategy the 2020 Children and Young People's Workforce Strategy. This sets out the Government's vision that everyone who works with children and young people should be
Contact Point an online directory, available to authorised staff to find out who else is working with the same child or young person, making it easier to deliver more coordinated.
The National Autism Plan for Children: This is the completion of the work of the National Initiative: Autism Screening and Assessment, and was published in March 2003. Among its recommendations is the need for better multi-disciplinary and multi-agency working.
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Islington This project which developed, piloted and evaluated a multi-agency pathway for children and young people and their families with suspected autism came up with a number of key recommendations around parental participation, early identification and multi-agency working. It concluded that developing multi-agency services needed to be done in the context of reviewing all other children services as a whole across agencies. More detailed recommendations included the need for protocols to be clear and detailed to ensure that all involved understand their role and expectations. Agreed protocols needed to be consistently shared with all teams through service heads. There needed to be ongoing review of the way services were organised and structured to make best use of resources.
Well-resourced, integrated multi-agency teams required time to work collaboratively, to be co-located, to include planning and decision making (with parents, nurseries and schools), to include parents and schools in the assessment planning, diagnostic and intervention process and to be able to meet national timescales.
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Wolverhampton through the Local Authority’s Child Development Service (CDS) it coordinates the “Team Around the Child” programme. The programme involves a single assessment of need; a multi-agency referral panel; a well defined flexible model of early intervention and continuing support; an emphasis on empowering families by listening to their needs; and a training programme for key workers and professionals in the team. Drawing on funding from the Department of Health as well as from the Early Support Programme, Wolverhampton has set up the Gem centre – a brand new building that co-locates education, care and health services for young children with complex needs. The CDS occupy one wing, while the others house audiology, physiotherapy and paediatrics departments, and Child and Adolescent Mental Health Services. The centre is equipped with state of the art facilities. Staffing is planned around the needs of families, and services are integrated to provide a single experience for children and their parents. Key workers employed by the CDS use the centre as their base, but also work directly with families in their homes. (source: Aiming High for Disabled Children: Better support for families, HM Treasury & Department for Education and Skills 2007)
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