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For Scotland's children report

Chapter 8 action plan

This Action Plan identifies the steps that can be taken now by local agencies to improve services and avoid the difficulties that were identified by the Action Team, namely:

• Some children are "Born to Fail."
• There are children who are invisible to services.
• Co-ordination of services is not widespread.
• The most vulnerable children can be excluded by services: GP de-registration, school exclusion, eviction.
• No consistent "helper" is available for each child requiring special assistance.
• There are difficulties in information sharing between agencies.
• There is a shortage of skills in working with families.

Other key findings by the Action Team, such as:

• Scottish Executive policy is perceived to be insufficiently integrated, and
• Predicated/hypothecated funding is seen as directing finance and attention into marginal project development rather than improving mainstream services and encouraging an integrated approach,

are set out with recommendations to the Scottish Executive in Chapter 9.

The main aim of this Action Plan is to ensure that agencies work together effectively to provide services to children. All of those consulted by the team agreed that children's services that were better integrated would be better services, and have better outcomes for children and families.

In those areas that have moved toward more integrated services, the team found a number of shared characteristics:

• A clear vision of children's services working together
• A shared commitment to improve services
• Clarity about the roles and responsibilities of agencies/departments/professions
• Transparency in sharing information between agencies, particularly in relation to resources, including financial resources.

These have a high positive impact in two main ways:

• A positive perception of services by service users
• High morale within an energised and positive workforce.

Better integrated working is about making better use of existing resources. The Changing Children's Services Fund will support this way of working. There is a substantial workforce in children's services in Scotland. Some are wholly engaged within services to children while others, such as GPs, have a wider range of responsibilities. Overall, though, there are around 100,000 staff and the total annual budget for children's services in Scotland is, at a very conservative estimate, more than £3 billion. We have, therefore approximately one member of staff for every 10 children and a budget of around £3,000 per child. We must move beyond our current service boundaries and concerns, to make best use of all the resources available in the best interests of Scotland's children. This will require a change in the way all children's services are provided. This Action Plan provides the framework for that change.

Action Points

I. Consider children's services as a single service system

II. Establish a joint children's service plan

III. Ensure inclusive access to universal services

IV. Co-ordinate needs assessment

V. Co-ordinate Intervention

VI. Target Services

Action Point 1

Consider Children's Services as a Single Service System

In many parts of Scotland services are not pulling together. Children and families experience services as having different objectives which are sometimes in conflict. From a more organisational perspective, changes are made in one agency which significantly impact on other agencies, but these changes and their effects are not shared with these other agencies. These are all manifestations of workers believing themselves to be part of a profession/a department/an agency operating autonomously in relative isolation.

The Action Team did consider whether there was an organisational solution to these difficulties through restructuring existing agencies towards an integrated children's services agency. This remains the preferred option of some of those consulted. The Action Team does not, however, recommend such organisational change for the following reasons:

• There has already been considerable organisational change within both local authorities and the NHS over the past five years.
• It is difficult to envisage a reconstituted children's service which brings together all agencies which work with children, particularly those whose remit is wider (for example GPs and police).
• Any centrally imposed organisational structure is unlikely to be sufficiently sensitive to the evolving approaches to integrated work in local areas.
• A centrally imposed organisational structure is unlikely to meet the particular requirements of all localities in relation to specific issues of significance, e.g. deprivation, poverty, rurality.

The Action Team has noted with considerable interest the different organisational structures which have developed in Scotland since local government reorganisation in 1996:

• Joint social work/housing departments
• Joint education/social work department
• Multi-departmental strategic departments
• Children's services departments
• Joint political structures (without departmental restructuring).

The Action Team's reluctance to prescribe a single organisational solution should not be interpreted as a signal to agencies that they should remain content with the status quo. The Action Team has been particularly impressed by the vision of service improvement that has motivated changes in Stirling and Highland. Other authorities should similarly be considering the optimum arrangements for their own locality.

The Action Team does, however, wish to see a national approach which facilitates a new way of working across the existing agencies and organisational structures.

We need a much more robust approach to putting children and families at the centre of the service network. That will be facilitated by treating all services for children as part of a Children's Services System and by all staff perceiving themselves as operating within that single system.

This is the fundamental change required of agencies upon which all of the other Action Points depend. It will require cultural change in many areas of children's services.

Treating services as a single system should provide:

• Access by potential service users at any point in the service network.
• Multi-agency and multi-disciplinary consideration of optimum responses to need.
• Financial and resource planning across all of the boundaries which currently divide services.
• The ability to make best use of the expertise of the full range of staffing in children's services so service users experience seamless services.

To effect this change will require clear and powerful leadership. From the NHS side, Our National Health confirms that joined up children's services is a new priority for the NHS, to be addressed at all levels from strategy set at Board level to locality based service delivery. NHS Boards - with their strong local authority representation - must from their inception prioritise full integration with their partners of services and activities which benefit children's health and care. The Executive needs to ensure that the high profile of this issue is maintained over time through its NHS Performance Assessment Framework. Local authorities similarly need to give children's services the highest priority, as stressed in guidance issued on planning for children's services. Therefore within each children's services planning area, services should be jointly led by a senior member of the Council (Chair of Children's Services or equivalent) and a senior figure from the NHS.

There have already been moves towards such an approach in Scotland, particularly in Highland.

• In Highland, a series of "Looking Ahead" dinners established a consensus, through bringing together a cross-section of the community, that a focus on young people was needed, so that young people would be proud of living in Highland, would be well-educated and would stay there as adults to live and work. The Well Being Alliance was established between the partner agencies and this led to the Joint Committee on Children and Young People. This joint committee has been chaired by the Chair of the Education Committee with the Chair of the NHS Board acting as Vice-Chair. After the first year of operation these two positions have been exchanged. Having senior representation from the NHS Board and the primary care trust, together with directors and leading managers from a range of agencies, has enabled the Joint Committee to undertake a radical programme of change to realise the Highland vision. Two jointly funded management posts report to health, education and social work. A framework for a strategy for children's services, linked to developing the Children's Services Plan, has been drawn up. Locality planning is being established. A review of family support services is underway and a programme of "Healthy Promises" has been published. Planning for the future is founded on consultations which focus on the long-term, such as discussions with 16 and 17 year olds about the sexual health provision they would like to see for their own children. These initiatives ensure that the vision is translated through a sense of common purpose into actions which impact on practice.

Action Point 2

Establish a Joint Children's Services Plan

The contents of children's services plans have been looked at by a small working group involving the Scottish Executive, the Convention of Scottish Local Authorities, the Association of Directors of Social Work, the Association of Directors of Education in Scotland and voluntary organisations. Guidance on planning services, in the light of this exercise, is being issued. This takes full account of the Action Team's findings and particularly stresses the need for children's services plans to be seen as a joint task for local authorities and other partners, especially NHS Boards.

The Children (Scotland) Act 1995 emphasises the importance of the local authority working in close consultation with NHS Boards and others in preparing the plan. It is now right to move beyond this towards a position where NHS Boards and local authorities see these as joint productions, while still involving the voluntary sector, the children's reporter and other interested parties.

Local authorities and NHS Boards should now agree the children's services planning area for each locality. This may continue to be the local authority area or may now be the NHS Board area including a number of local authorities. The Scottish Executive will need to give further consideration to those areas where there are problems of coterminosity between local authorities and NHS Board boundaries.

The major tasks for the children's services planning process are:

• Engage all relevant interests
• Assess need
• Develop a local vision
• Agree funding
• Deliver services
• Develop services
• Monitor and Evaluate.

Those leading the children's services planning process must ensure that arrangements are inclusive and that, in particular, children, parents and relevant voluntary organisations are involved as full participants.

• The Children's Commission in Falkirk has brought together all children's services, establishing its membership and terms of reference with careful account taken of the need to ensure clarity of decision-making. The Joint Strategy Group in Glasgow, and the Children's Services Group in Dumfries and Galloway have undertaken reviews of their planning processes to ensure a clearer vision for the future which can be translated into priorities for action. Working Groups are being rationalised so that priorities can be fed into more than one planning process: an accommodation working group in Glasgow and a working group on looked after children both feed into planning processes for community care as well as for children's services.
• The Glasgow Joint Sub-committee on Children's Services and the Glasgow Joint Strategy Group have all the main agencies in the city involved, with links with the Glasgow Alliance which is responsible for the SIPs across the city. At a local level, the Area Children's Services Forums in Highland are being established to include local managers and practitioners from agencies working in each locality. An LHCC in Renfrewshire has established a Children's Network to share information and practice between services for children in the LHCC area. The Strategic Policy Group for Child Health in Forth Valley Health Board area draws together representatives from the health board, the primary care and acute trusts and three local authorities to identify priorities and plan actions to address these. Childcare partnerships across Scotland were evaluated by the University of Glasgow's Faculty of Education in October 2000: These partnerships have brought together representatives of local authorities, health services, private and voluntary sector providers and other partners to address a wide range of complex issues, making significant progress in meeting national targets for high quality, affordable and accessible childcare.

Resources

At a local level, children's service plans should consider the full range of resources available, including staffing, and state clear plans for future resource use, including a multi-disciplinary approach to workforce planning.

Finance

The joint nature of future plans will make it even more necessary for there to be financial transparency between agencies with cost sharing and pooled budgets being developed. The Action Team heard of time-consuming and administratively costly arrangements to cross charge between departments and agencies. These arrangements were, of themselves, often sources of considerable tension between agencies and departments.

For example, many of the most difficult issues related to costs associated with transport. Transport costs should be minimised and use of transport resources maximised through a shared transport strategy between agencies. Within each children's service planning area, cross charging arrangements should be reduced or, better, removed and replaced by
cost sharing.

The Action Team heard of many positive examples of new approaches to cost sharing including pooled budgets:

• Often as a result of seeking to retain children in or close to their own communities, multi-disciplinary placement groups are being established. This involves education and social work colleagues, sometimes with support from health services, agreeing to pool funding for placements, especially for those in residential schools or receiving other "high-tariff" packages of support. Highland, Stirling and Moray are examples of such arrangements.
• Quarriers Family Resource Project in Ruchazie, Glasgow, was initiated during the last year following negotiations to agree a capital funding package between Quarriers, Greater Glasgow Health Board, Glasgow City Council Education and Social Work Departments, Greater Easterhouse SIP, the big step SIP and Scottish Homes. The project operated in temporary premises during its first months but its new £1 million purpose built premises opened in summer 2001. The building provides family support services, including support for young parents who were previously looked after, a Sure Start nursery for under-threes, the Starting Well health demonstration project and community facilities.
• Falkirk Council and Forth Valley Health Board are working to establish a new Young People's Drug and Alcohol Offending Service to provide both preventative services and direct services to young people already experiencing difficulties. The initiative is being funded through a creative combination of sources: the Health Innovation Fund, the Rough Sleepers Initiative, funding from the Scottish Executive following the review of youth crime and funding from the council. Staff will be seconded from the primary care trust, the community education service and social work, and will be based in housing services.

These financial arrangements should not be seen as operating merely at the margins in relation to joint projects, but should be used to make significant improvements to mainstream services. Three year budgeting will assist in this.

Staffing

All of those consulted saw the present mix of professions and other staff in children's services as something that had developed accidentally, sometimes opportunistically, and not something that would be designed by anyone developing a coherent children's service system. Most of those consulted felt, though, that this was the current reality that had to be worked with.

There was, however, a significant minority view that a "new profession" was required. Some argued for this in the emerging area of pre-5 services where staff have a range of backgrounds including nursing, social care and education, but many are unqualified and some untrained.

A separate area where some wish to see the replacement of existing professions with a new profession was that covered by social workers/guidance teachers/health visitors. The Action Team regards this as an effort to provide a form of service that is widely seen to be missing from the current service network - workers able to work with families to effect positive change in the lives of children. The Action Team also found that the family, rather than only the child, was seen as the locus for intervention in many circumstances, including the most entrenched cases, but that no staff are currently specifically trained to work with families. This was seen to have resulted in unproductive activity - vaguely supportive in intent but failing to achieve real improvements - in the lives of vulnerable children. A much more robust and change-orientated approach to working with families is generally seen to be required.

The displacement of those with professional expertise and experience into consultancy or management is outlined in the full report from the Action Team.

Each children's service should ensure that a range of staff is available who are skilled and experienced in working with families (perhaps over an extended timescale). Local services should take early steps to ensure that staff able to provide this key service are identified, resourced and supported.

The Action Team has recommended to the Scottish Executive the establishment of a single workforce planning exercise which sets out arrangements for the recruitment, training, and professional development of the entire children's service workforce in Scotland (see chapter 9).

The remit of a workforce planning group should extend to joint training and staff induction. There is, however, no need for local children's services planning partners to wait for detailed national guidance to establish joint post qualifying training events and staff induction to the local children's service network before introduction to the employing agency/setting. Joint training was widely recognised as the most effective local mechanism to improve collaborative working.

• The value of joint in-service training is well recognised and there are good examples particularly in child protection training overseen by Child Protection Committees, and more recently in New Community Schools. Stirling Council's programme of multi-agency training, which has emphasised work-shadowing, was positively evaluated by a team of researchers from the Universities of Sheffield and Stirling: the commitment to staff development was recognised to be linked to a commitment to community-led change. In the same area, the child and adolescent mental health service had utilised a Health Innovation Fund allocation to set up the Triple P parenting programme which included intensive training for 40 local professionals from all local services working with children. Practitioners in Highland identified a need for groupwork skills across a number of agencies and have undertaken a joint programme of training to address this.

Infrastructure

Local agencies can go a considerable way to improving communication, reducing costs, and enhancing integrated work, through a shared approach to elements of infrastructure. The potential for an integrated transport strategy has already been mentioned. The Action Team also believes that local agencies should consider options for co-location and examine opportunities to develop joint information technology arrangements.

Informal Services

Informal services provide a very significant element within the network of children's services. Pre and after-school activities and attractive, accessible services for teenagers have become important components of the service network (often provided by voluntary organisations or through social inclusion partnerships). All of the existing informal services should be identified within each children's services planning area, and arrangements established to support the level of such services identified as being required within the area.

Minority Groups

Within each children's service planning area there should be continuing consultation with ethnic and other minority groups, with feedback provided on how service adjustments have been made to ensure that services are sensitive to and acceptable to minority groups in the area. These arrangements should apply to travelling families and, where relevant, asylum-seekers/refugees as well as to more settled groups.

Locality

Agencies frequently define geographical areas in different ways. And there is often no link between these areas and the "natural communities" identified by local people. Moving towards co-terminosity in service boundaries, and linking these to perceived natural communities should be another key theme within each children's service planning area.

Planning Structure

The significance of drugs issues requires that children's service plans be effectively linked to the work of Drug Action Teams (DATs). Similarly, children's service plans will require to link to the COMMUNITY CARE PLAN in relation to children with illness/disability and carers.

It is expected that, given the significance of economic, environmental and other service issues to children and families, children's service planning will be set within a more general planning framework, usually the Community Plan. Progress has been made in some areas towards this kind of developed planning framework.

• North Lanarkshire Council has established arrangements to set all relevant planning activities within a structured approach, within the context of the community plan, with the commitment of its planning partners.

Those leading children's service planning will make use of quantitative and qualitative data in relation to children's services. They should ensure that robust mechanisms are in place to provide accurate data to inform service improvement and the achievement of best value. They will also wish to be informed directly about services by listening at the grassroots - to children, parents and frontline staff.

• The big step in Glasgow has a development worker to support the involvement of young care leavers in its planning and decision-making processes. A range of support mechanisms is in place to ensure young people's participation in, for example, its Board meetings.
• South Coatbridge SIP has been working with LHCCs, setting up focus groups involving young people from homeless units, the streets and some involved in drugs research to take soundings on what services should be provided. Working with Inverclyde they are also considering pregnancy and pre-pregnancy issues, looking at support services for young mothers with focus groups on developing services in family settings immediately after birth.

The Children's Services Plan should also include the detailed arrangements for access, assessment and service co-ordination as set out in the remainder of this Action Plan.

Action Point 3

Ensure Inclusive Access to Universal Services

Those leading children's services must ensure that all children have access to the universal services of health and education. In most areas this will simply require effective mechanisms for information sharing between agencies. In some areas though, predominantly the cities, with more transient populations, careful consideration should be given to active methods of identifying and maintaining contact with all families. This should particularly include those who have a disorganised lifestyle or who are without a regular domicile. Health services and, where appropriate, education services must be maintained to the children of such families.

Within each children's services planning area, arrangements should be established to ensure that all children are identified and that contact is maintained with them.

Those leading children's services must also ensure that, at critical points of potential service discontinuity, arrangements are in place to ensure ongoing service to children (and their families). The issues that will require closest attention are:

• Eviction

The most common reason for children being lost to services appears to be through homelessness.

• GP de-registration

A significant difficulty experienced by the children of parents who themselves present difficulties to agencies (through disruptive behaviour, drug use etc.) was being de-registered by a GP and being refused registration by other GPs in the area.

• School exclusion

In 1999-2000 there were 38,769 exclusions from local authority schools in Scotland, involving 21,229 pupils, i.e. 51 exclusions per 1,000 pupils.

Housing

All local authorities should put in place arrangements to consider the needs of the children of families potentially facing eviction, with a view to avoiding physical eviction. Local authorities should also seek to make complementary arrangements, with the same purpose, with all housing associations within the area.

• Angus Council has a protocol requiring joint consideration in these circumstances by its housing and social work departments.
• The social work and housing services in Falkirk are now part of the same department of the council. Colleagues recognised that they shared concerns about a particular group of young people: housing had been concerned about the high turnover of 16-18 year olds in their tenancies, and social work were concerned about young people taking on tenancies with no family or other support, for example care leavers. If these young people failed in their first tenancies, this might hinder future approaches for services. A partnership with the Link Housing Association was established to focus on 16-18 year olds formerly in care especially in areas where the highest turnover occurred. It was decided not to make this a direct council service because of young people's perceptions arising from previous experiences. The eight team workers in the Tenancy Support and Aftercare Team are from multi-disciplinary backgrounds - community education, mental health and housing management - working to provide more supported environments for young people with the most complex needs.

Primary Care

There are already existing mechanisms to ensure that children should have access to GP services and thereby to primary care team supports. NHS Boards should ensure that they work with their partners in the local authority and voluntary sector to ensure that all children can receive comprehensive continuing health support.

• The Homeless Families Healthcare Service in Glasgow is a team of health visitors, a staff nurse, and recently a GP, who provide health visiting services, based in the council's housing department, for up to 2000 families with children in homeless accommodation each year. These families are not able to access services in their former home neighbourhoods and would otherwise be without primary healthcare during very stressful periods in their lives, when their vulnerability to a range of difficulties is high. The team also works with other agencies such as other primary care services, social work, voluntary organisations, schools and the Pre-5 Homeless Support Service to link families with services they would otherwise not access from temporary accommodation. Families with a history of several addresses can also have recent links with a different part of a service across the city - for example, contact with several social work area teams. The Healthcare Service helps to minimise risk to children by re-establishing contacts which are needed. The service also continues as families are resettled, with the health visitors liaising with services in each family's new neighbourhood to ensure needs are met immediately, at a time when families particularly need a range of supports.

Education

Each Education Authority should have in place arrangements to ensure that full education service continues to be provided to those excluded from a school.

The Standards in Scotland's Schools etc Act 2000 placed a new requirement on Education Authorities to provide education to those excluded from school. Every Education Authority should ensure that it has appropriate arrangements in place to secure this.

Universal Services

Whenever possible, children's needs should be met from within universal services unless multi-disciplinary inclusive assessment of needs indicates otherwise.

There may be instances where children are inappropriately presented to more specialist services, who could have their needs met within universal provision. Particularly helpful in this regard are:

• The supportive involvement of pre-school, nursery school staff.
• The developed role of guidance staff in schools.
• The role of the health visitor in working with families.

The Action Team found examples of highly effective work taking place in relation to these:

• As a result of collaboration between Fair Isle Nursery in Kirkcaldy and their colleagues in health and social work services, together with the Cottage Family Centre, informal case conferences are arranged to agree packages of local support to meet the needs of children in the nursery, and their parents where appropriate. Nursery nurses act as keyworkers with their groups of children and play a key role in multi-agency case conferences, providing detailed information which would not otherwise be available.
• At Inchyra Nursery in Grangemouth a Mellow Parenting programme provides groupwork for parents focused on parenting skills, and Reach Groups introduce professionals to meetings arranged to discuss issues identified by parents.
• Lochend Secondary School has used its integration team as the foundation for a broader grouping which brings together key members of teaching staff, especially guidance teams, and other local agencies such as Psychological Services and the attendance officers. The team involved is working on a range of initiatives such as supporting young people with records of frequent exclusion from school, and establishing joint assessment records.
• The demonstration project Starting Well in Glasgow is founded on the practice of frequent visits to new mothers in disadvantaged areas, starting in the antenatal period and providing intensive support in the first years.

The Action Team was struck with the generally positive perception that existed in relation to the majority of pre-5 services. It appeared that these services, particularly Sure Start Scotland, tended to operate as a service to the family, rather than only to the child, something that was perceived to alter when the child began primary school, and the family often felt no longer supported (or even felt excluded).

• Services for parents are increasingly seen as important, with the development of family support services often located in the same premises as services for children. Quarriers Family Resource Project in Ruchazie providing a Sure Start nursery and incorporating the Starting Well health visiting team is an example of this approach.

Each pre-5 service should have as an objective the support of the family. The transition from pre-school to primary school provision should be carefully managed by agencies, including consideration of continuing support to parents. The current piloting of transition materials across Scotland will assist in this process.

Co-Location

Single Entry Points

Some authorities have developed single entry points to local services (sometimes known as One Stop Shops). Many local authorities have ensured that all council services can be accessed through one local office. Some have gone further and developed approaches in conjunction with the NHS.

• Services are taking opportunities to bring developments into the same premises, siting staff together to enable closer and more effective working and more convenient access to a range of services for families.
• Sure Start Scotland programmes have prompted successful models of co-location of local services, for example locating nurseries and family support services in New Community Schools. In Girvan, there is an example of this where Girvan Family Connections is located in Girvan Primary School.
• Reconsideration of the siting of service headquarters also provides opportunities for closer collaboration: in Dumfries and Galloway the NHS Board and social work services are now located in the same premises.
• Falkirk Council has established two posts which are now placed in the Authority Reporter's Office in Falkirk. These two posts of education liaison officer and social work liaison officer are jointly managed by council services and the Reporter. This improves services to children, for example in supporting a child's educational placement to preclude compulsory measures of supervision; it also has a positive impact on people's awareness of other services and on working practices across the services.

New Community Schools

New Community Schools provide a further important opportunity for inclusive access to universal services. Integrated provision of school education, family support and health services is central to the New Community School approach. The ethos of new community schools is to bring services together on the school campus. Some local authorities have made commitments to universalise community schools in their area. Within some new community schools, though, primary care health services are absent. Earlier consideration of this issue has suggested that the key is to emphasise the role of school nurses, and for them to be fully integrated into the local health care co-operatives (LHCCs). National evaluation of the pilot programme is currently underway and due to produce an interim report in April 2002. It is intended in extending the New Community School approach across Scotland to build on best practice so that experiences gained during the pilot programme will be reflected in future development.

Health Centres/Healthy Living Centres

Some attempts have been made to consolidate services within health centres, particularly where these have developed a broader range of services including healthy living centres. Education services are generally absent from such arrangements and social work services within health settings tend to be related more to community care.

None of the co-location arrangements being developed brings together all of the major elements of services to children. Unless schools and health centres were co-located (an option about which there are many reservations) it will remain impossible to have a single entry to every service provided from a single site. Each of the current arrangements does, however, have positive aspects and it will be helpful to consider the evaluations of each in informing future service developments.

Action Point 4

Co-ordinate Needs Assessment

The majority of children can have their needs met by their families and the universal services - health and education.

Those leading children's services should now move beyond the implicit arrangements that lead, in practice, to the NHS taking the co-ordinating role for children before they enter formal education services, and education fulfilling that role once children are at school. These responsibilities should now be made explicit. These arrangements should be clearly set out within children's services plans and associated public information.

At every stage, every child should have a named individual who can function as the main point of information/reference for the child, and who can co-ordinate arrangements for considering whether other, more specialist, services are required for the small proportion of children who will need these. These arrangements should be seen less as a new burden than as a formalisation of what already takes place today through guidance teachers in secondary schools, the class teachers/head teacher in primary schools, key workers in the pre-school/nursery sector and, historically, by health visitors for younger children. For the vast majority of children, with a supportive family, the role of the named individual will be minimal and should involve only screening for potential requirement for other services and facilitating transitions e.g. home from maternity unit, into pre-school provision, to primary school, to secondary school, through school leaving.

In each children's service planning area, arrangements will be required to manage the transition from health led co-ordination to education led co-ordination.

Assessment

Both service users and agencies consulted by the Action Team deplored the still increasing proliferation of assessment methodologies. This results in:

• Duplication of information-giving by children and families.
• Inability to co-operate within a single multi-agency assessment format.
• Inability to compare data across agencies.

Many of those consulted urged the production of a single, modular assessment format which could be utilised by all agencies, sharing basic identifying data and sharing other information as agreed and required. Many consultees felt that it was particularly wasteful and time-consuming to develop different formats in local areas and within individual professions and agencies, when there was an opportunity to develop a multi-professional, multi-agency format for all Scottish children's services. Children, young people and parents are usually comfortable with information being shared if this is done with care, respect and consent.

• In Glasgow a common assessment format has been developed which is being implemented for use by all agencies.
• Lothian Cross Trust Group has developed a shared assessment format used by health, education and social work agencies to assist decisions related to children with high dependency needs.
• The research team at the big step SIP has developed an interagency protocol which, now it has been agreed, enables data sharing on individual young people for research purposes, overcoming previous difficulties associated with confidentiality issues.

Staged/Tiered Intervention

In some areas there has been considerable effort to develop the methodology of providing services from within mainstream resources and making more appropriate use of more specialist resources. This is commonly termed staged intervention or tiered intervention.

• Agreed protocols for determining the appropriate involvement of different agencies in interventions can be very helpful in co-ordinating multi-disciplinary support. Staged intervention was first widely promoted through the HMI's Effective Provision for Special Educational Needs, and tiers of intervention are developing in mental health services.
• Angus Council has set out the arrangements between social work and housing to work with families presenting difficult issues to both services, to determine a council position rather than two departmental views. The same council has procedures for education and social work services to meet children's needs jointly in the case of:
• Children in need
• Child protection
• Special educational needs
• Nominated social work contact
• Looked after children
• Exclusion from school
• Residential educational placements.

The procedures contain 5 levels of joint approach including first level support e.g. from a teacher through networking and case conference to a high level Resource Management Team and finally Joint Directorate. Similar approaches have been developed between education and social work services in other areas such as Stirling and Falkirk.

In some instances, these arrangements extend to the consideration of measures to resolve disputes. In what is not yet a wholly integrated service but is nevertheless a good example of such an approach, within Angus Council, the Chief Executive established arrangements to ensure binding resolution of disputes between service departments, i.e. education/
social work; housing/social work, through the solicitor to the council. While it may seem negative in the context of better-integrated services to consider unresolvable issues between departments and agencies, it is clearly helpful to have such resolution arrangements in place in advance, rather than attempt to initiate mechanisms at the point of crisis.

Each children's service planning area should establish a model for staged intervention (tiered intervention) which sets out the responsibilities of universal and specialist/targeted services; identifies characteristics which indicate the potential requirement for higher stage service; and establishes information-sharing and assessment arrangements. A standard element of such a model is a single assessment format which should be established within each children's service planning area and agreed for use by all agencies. Each staged intervention model should also incorporate a mechanism for the resolution of disputes. All of these elements are already in place in different parts of Scotland.

Action Point 5

Co-ordinate Intervention

A variety of circumstances may lead to something more than a named individual being required, including:

• An identified need for a consistent long-term contact with the child/family
• The intensity of intervention required with the child/family
• The complexity of the range of services required by the child/family
• The high cost of services required by the child/family.

In such circumstances and within a staged/tiered intervention model in place, a care
co-ordinator should be identified. In some circumstances this may continue to be the named individual (particularly if the objective is to provide consistency of contact) resourced for the task and with the consent of their agency. More often, for the small proportion of children requiring such a service, a worker from another setting will function as the care co-ordinator, e.g.:

• Social worker
• Guidance teacher
• Educational psychologist
• Child and adolescent psychiatrist
• Paediatrician
• Other professional.

Leaders of children's services may wish to identify the characteristics in training, experience and skills required of a care co-ordinator for children.

A consultee representing ADES took the view that such a role was a valid component of the Head Teacher's remit:

"Where multi-disciplinary services are required, the head teacher can convene and chair discussions, and co-ordinate services."

Those leading children's services may also wish to establish an administrator working with all relevant agencies to identify all children requiring a care co-ordinator, identify the care co-ordinator for each child, arrange for service reviews and ensure the proper distribution of information.

Arrangements should in future avoid the accident of the entry point to services determining the service provided. The development of a multi-disciplinary, multi-agency model of staged/
tiered intervention will enable more rational consideration of the optimum response to the child/family from within the service network. It will be important for all agencies to have a good understanding of the remits, responsibilities and services provided by other agencies within the service network, including the identification of service thresholds outlining the characteristics of children eligible for such specialist provision.

• East Renfrewshire Council and Argyll and Clyde Health Board are working together to develop a model of care co-ordination for children with health needs in primary schools. The model will include:

a) Avoidance of duplication for families

b) Covering all legislative requirements, addressing health, education and care needs, in one annual meeting

c) Identification of a keyworker for each child, from the most appropriate agency according to the child and family's needs, who will convene the multi-agency meeting

d) Delegation of resource decisions to the meeting

e) Ultimately, shared assessment and pooled resources.

• Lothian Health and its four local authority partners have developed a joint approach to meeting the needs of children with or affected by disabilities and their main carers. This involves health, education and social work staff.

Action Point 6

Target Services

Each children's services plan should set out how two main aims will be achieved:

• Providing excellent universal services for all
• Targeting additional services to meet need and reduce inequalities.

Within each children's services planning area there may be localities identified as areas of deprivation that require additional support. Some will be within Social Inclusion Partnership areas (SIPs) but some, particularly small areas, may not currently be included in SIPs. Similarly, in more rural communities, the full range of services may not be available. Children's services plans should demonstrate how targeted services will be provided in these areas.

It would clearly be helpful if all agencies had a common understanding of the characteristics of Children in Need. Many approaches to this simply generate a list of characteristics of children with no concept of how these characteristics are to be identified and no consideration of at what point on the spectrum of variability within each characteristic the child can be identified as requiring a service. The Action Team found that, in some parts of Scotland, an actual incident of harm to the child was required before specialist services were considered. On the basis of their visits and interviews, and largely developed from good practice around Scotland, the Action Team has developed a simple framework for considering the characteristics of Children in Need to help better target services:

I. Children sought out by agencies

II. Children coming to the attention of agencies

III. Emerging issues

IV. Predictability.

For children in all of these categories consideration should be given to managing the transition out of children's services as well as the arrangements for accessing services. For disabled children, for example, this will require operational arrangements set out in both the Children's Services Plan and the Community Care Plan.

I. Children Sought Out by Agencies

Some individual children may have illness, disability or impairment (including transitory presentations), which requires additional support. Staged intervention arrangements should set out how such children are to be identified, what services will be provided, how provided, and how co-ordinated. Similar arrangements should be in place to identify and provide services to children who are carers.

• East Ayrshire Carers Centre works with schools, hospitals and GPs to raise professional awareness and to seek out the names of families where an adult is disabled or chronically ill and where a child may be affected.

II. Children Coming to the Attention of Agencies

Agencies often give least critical attention to this category of children. Some are, however, reviewing historical assumptions and re-considering eligibility criteria and service thresholds. Such exercises need to take place in a multi-agency context. Some agencies distinguish between two reasons why the service would have such children referred.

• Because of things done by them
• Because of things done to them

Children tend to come to the attention of agencies in the first of these categories through behaviour and conduct seen as unacceptable. This might be seen in the home, school or community. The spectrum ranges from inappropriate behaviour/indiscipline through bullying to offending.

The second category of children includes the victims of bullying and those abused or neglected by their parents. There seem at present to be few arrangements to support children who are the victims of crime where the parents are not the perpetrators. Each children's service area should identify the criteria for accessing services, including arrangements to ensure the optimum service response.

• Glasgow Child Protection Committee identified a growing concern with children at risk from prostitution for whom usual child protection procedures were not appropriate. The committee worked to establish its Vulnerable Children's Guidelines for this group and for other young people whose behaviour was placing them at risk, but who might not perceive themselves as in need of protection.

III. Emerging Issues

Other children may, like young carers, be difficult to identify, but may be in need of assistance, including children using drugs/alcohol and children whose parents have characteristics that cause difficulty for the child- parental drug/alcohol use, parental illness (including mental illness), a parent in prison, etc. Arrangements should be made, probably through their named individual, to identify such children to determine whether their informal support networks are sufficient to meet their needs.

Three "emerging issues" have been identified:

• Drugs
• Psychiatric diagnosis
• High dependency.

Drugs

The Action Team found little evidence that children were presenting to agencies with difficulties relating to drug use. Such drug use was, however, frequently found among those children coming to attention of agencies for other reasons. Professionals working with children have little doubt that, for many children, problems associated with drug use were gestating and, for a proportion of children, would lead to serious problems in adult life.

A more striking and currently more serious issue identified by the Action Team is the number of children being cared for by drug using parents. All of those consulted who work in child protection expressed concern at the circumstances of those children, particularly very young children, in families where the parents were drug-users. Consultees from a range of settings spoke of the unpredictability, irresponsibility and incapacity of these parents.

While considerable effort is being made in preventative services, particularly innovative programmes within schools and youth services, the Action Team found serious gaps in drug services:

• There are no widespread drug services targeted on/available to adolescents.
• Services for drug abusing adults are generally blind to the circumstances of the children of those adults.

The Action Team did, however, find that the Year 1 funding within the Changing Children's Services Fund, was promoting new attention to both the above areas of concern.

The leaders of the children's service planning process should liaise closely with the local Drug Action Team (DAT) to ensure that drug services are sensitive to adolescents requiring services and to the children of adult drug-users.

Psychiatric Diagnosis

Some years ago the main emphasis within psychiatric approaches to children seemed to be in relation to good mental health and emotional well-being. There was little doubt among those consulted that the main issue now is the increase in psychiatric diagnosis including earlier diagnosis of "adult" mental illness; diagnosis of autism in its various forms; and, particularly, the diagnosis of attention deficit hyperactivity disorder (ADHD) and its variants.

The Action Team found there to be a general consensus among mental health professionals consulted that the increased diagnosis of ADHD was as a consequence of improved sensitivity to the condition. However, a few dissenting voices among the specialists were more in tune with the more sceptical attitude found more generally. Many of those working with children expressed concern that what had previously been identified as a behaviour/conduct problem, sometimes in the context of problematic family relationships, was now being labelled in a different way which made approaches other than medication unavailable, and which removed children from the potential assistance available within a multi-disciplinary approach. This latter concern was also shared by the mental health professionals consulted, who wished to maintain appropriate multi-professional service to such children and families. This was the only area of children's service considered by the Action Team where comment was made regarding the potential negative impact of the benefits system: children diagnosed as having ADHD who are on medication are eligible for disability benefits. This was seen by some consultees as a financial disincentive for the child to improve.

This is a difficult and sensitive area, and one where the Scottish Executive will wish to consider the best available evidence, including international experience, in providing guidance to medical practitioners and others. In the meantime, the Action Team believes that no medical/psychiatric diagnosis should remove a child from the potential assistance available within the range of multi-disciplinary children's services.

High Dependency

Improvements in antenatal and neonatal care, particularly through the development of new technologies, have led to a greater number of children with profound medical difficulties surviving than was previously the case.

To ensure the optimum quality of life for such children often involves further use of new technologies and often highly intensive personal care. This can present major challenges to agencies, but the Action Team heard of examples of good multi-disciplinary practice directed to meeting the needs of such children.

• Lothian Universities NHS Trust, working with the NHS Board and local authority partners in four council areas, set up the Cross Trust Group to address the needs of a growing number of young children with high dependency needs including the need for technological supports. To ensure that the children can live in as normal circumstances as possible, for example living at home and attending a local school, innovative arrangements are made to put in place packages of care for each child. These generally involve the training of identified carers by the health services. Agreement is reached by the Cross Trust Group for the funding of each child's package of supports: this is based on a shared assessment in which parents participate and which enables decisions to be taken regarding the extent to which each child's needs are judged to be health, educational or social in nature.

The expertise and resources required to operate such a service may not be available within every NHS Board area. In such circumstances NHS Boards should, on behalf of children's services planning partners, ensure access to such resources from regional centres, i.e. generally, specialist paediatric hospitals.

These are issues which are increasing in volume and which require better co-ordinated responses from agencies. Each requires early attention within each children's services planning area.

IV. Predictability

Those leading children's services should consider those children who, because of characteristics in the family, are not receiving the positive start which all children deserve. Many services have identified that they can "predict" those children who will require services in the future. This knowledge should be translated from passive waiting to active preventative work. Services should aim to provide responses to such families, which prevent the children experiencing difficulties and potentially presenting problems later.

The Action Team found the concept of predictability to be the most contentious issue of their findings. It was perceived by many to be stigmatising and labelling, contaminated by inappropriate value judgements. Some consultees asked for the use of less deterministic terms such as vulnerability or risk. The Action Team believes, however, that what was described by many consultees goes beyond any reasonable application of these terms and justifies the use of the term predictability. What alarmed the Action Team was that no action by agencies followed on from this widespread agreement in identifying the most vulnerable and at risk children.

Some consultees expressed the view that the requirements of the minimum intervention/no order principles of the Children (Scotland) Act 1995 prevented targeted preventative work. This does, however, seem to have influenced practice away from prevention and early intervention in recent years. The majority of those consulted, though, regarded this as a misreading of the Act.

The Action Team believes that it is the responsibility of agencies to apply their shared knowledge of the predictability of children who will require services, to offer an intervention rather than, as at present, await the development of problems.

Informal Services

Many informal services have had considerable success in reaching families, children and teenagers who have been difficult to engage in mainstream services. In many areas, these informal services need to be brought in from the sidelines and properly valued for the particular contribution they can make to the service network. Sometimes these services were linked to statutory provision, e.g. breakfast clubs, after-school care. Sometimes they were community-based services supporting new parents. A growth in the provision of services through drop-in arrangements makes services available at more convenient times and through more accessible approaches.

As well as providing formal services, leaders of children's services should identify the informal services provided within the area and ensure that sufficient open-access services are provided to meet local requirements. Voluntary organisations can be key partners in such services (as well as in highly specialist provision). Informal services might include:

• Breakfast clubs
• After school activities
• Parent support
• Services for teenagers.
• Inverness New Community School's "Any Health Concerns" encourages informal access to health advice and information.
• Breakfast clubs initiated as part of New Community School programmes, such as those at Merkinch Community Centre, Inverness, and at Methilhill Primary School, Fife, are providing opportunities for children, parents, teachers and others working with children such as school nurses, to come together in informal and enjoyable settings. This enhances access to supports and also promotes attendance at school, positive attitudes to school, and healthy eating.
• Buckhaven High School, another New Community School, initiated lunchtime drop-in and information sessions for young people with occasional visiting speakers. The success of this venture in supporting vulnerable young people led to the establishment of a lunchtime Youth Club for these pupils.
• Services for young people are provided in Stirling town centre through two collaborating projects now located in the same premises. Drop-in services including youth information, leisure activities, music and access to new technology in Off the Record are linked to sexual health services provided by a health team, including a GP, in SOS (Sorted on Sex).

Sometimes, they reached out to teenagers who might find it difficult to accept formal services.

• South Lanarkshire Council redesigned its services for young people by topslicing all council budgets and realigning youth work services into integrated youth facilities designed by and for young people. The new Youth Learning Service is delivered principally through the Universal Connections facilities which provide a one-door approach to the services of the council and all its partners, with young people involved in the planning and delivery of services.

Sometimes, they provided highly specialised responses to particularly vulnerable or stigmatised groups:

• 'Access Point' is located in Edinburgh. Three types of service are available to homeless people - health, social work and housing in one location. Developing a service with a specific group in mind has meant doing things differently, for example the average time available for service users for an appointment with a GP in the Homeless Practice is fifteen minutes - twice the time a GP might normally give a patient and more reflective of the complex needs which individuals present to the doctor.

The project is linked up to databases of information in the local authority housing department and the NHS Board although social work systems currently do not allow this. It is funded from the Rough Sleepers Initiative, Lothian Primary Care Trust and the City of Edinburgh Social Work and Housing departments. It emerged from a multi-agency group, the Homeless Planning Group (HPG). The project's clients are not necessarily rough sleepers, but they are all homeless. The project estimates that about 25% of their users are under the age of 21. Mostly they come as a result of word of mouth recommendation.

One academic consultee seen by the Action Team urged the promotion of more informal services, perhaps providing "safe havens" for children experiencing difficulty in their home and local community. The Action Team found that in many areas new approaches were being taken to provide easily accessed services through community organisations and voluntary organisations. In some instances, such approaches had been explicitly supported by Social Inclusion Partnerships.

• Cumnock SIP has established a range of projects which interact together to provide a network of local services. For example, the Community Learning Opportunities Project works with Yipworld.com, a project for young people with a health visitor and a midwife, to introduce its Virtual Baby Programme. This enables young teenagers to experience over a weekend the demands of meeting the emotional and physical needs of a baby, as part of a series of workshop seminars. The long-term outcome is intended to be a reduction in the high number of teenage pregnancies in the area.

Clear information for service users is a key element in improving access to services for children and families. Information is being developed through a range of formats - leaflets, directories, CDs and websites.

• East Ayrshire Carers Centre is addressing the issue of identifying young carers through producing a range of information which is attractive to young people. This is supported by further ranges of materials directly targeted to different groups of professionals to assist their understanding of the challenges young carers face, and the services they need.
• South Lanarkshire Council has published, in conjunction with children's services planning partners, a guide to services for children with a disability. This includes information about health, education, social work, community and leisure, housing and benefits services together with information on voluntary organisations and support groups. Other published leaflets provide information on a range of subjects of interest to parents, such as dyslexia, children's behaviour, school refusal and bereavement. Some of these issues are also addressed in complementary leaflets for young people. An information pack on children's rights, including a CD "A young person's guide to the Children (Scotland) Act" and information on how to make a complaint was produced by the Children's Rights Service following a request from young people.

The identification of the need for, and availability of, informal services within an area in the context of the Children's Services Plan (see Action Point II), will provide a renewed focus on these services and their role within the service network.

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