Continuum of Need & Guidance Documents

Continuum of Need - Thresholds for Intervention

Revised December 2018 Version

1. Introduction +

This document is for all professionals and services who work with children from or in the London Borough of Lewisham. Its purpose is to provide guidance on thresholds for different levels of need and intervention which meet the needs of all children in the borough. This threshold document provides guidance for responding to a concern about a child under the age of 18 years, based on the London Child Protection procedures, which should be followed by all staff and volunteers in the London Borough of Lewisham.

This guidance is a vital tool that underpins the local vision to provide the right support for children and their families at the earliest opportunity - right through to specialist and statutory interventions, when needed to ensure the welfare and safety of vulnerable children and young people. It aims to offer a clear framework and promote a common understanding of thresholds of need for all practitioners within all agencies.

Lewisham Safeguarding Children Partnership (LSCP) is clear that by collectively working together we can make improvements and a real difference to the outcomes and life chances of the children and young people living in our area who need it most. Understanding thresholds for support and levels of need detailed within this guidance should strengthen local arrangements and help everyone to work together to identify the best way to help an individual child, young person and their family or carers across the spectrum of need. LSCP aims to ensure that responsive and flexible support is available to meet any additional needs that arise for a child or their family at the earliest opportunity. This will be achieved through working in partnership to collectively achieve good outcomes for the child.

The LSCP should publish a threshold document that includes:

The process for the early help assessment and the type and level of early help services to be provided; and the criteria, including the level of need, for when a case should be referred to local authority children’s social care for assessment and for statutory services under:
Section 17 of the Children Act 1989 (children in need, including those with disabilities);
Section 47 of the Children Act 1989 (reasonable cause to suspect children suffering or likely to suffer significant harm);
Section 31 (care orders); and
Section 20 (duty to accommodate a child) of the Children Act 1989, Safeguarding and promoting the welfare of children can be defined as:

Protecting children from maltreatment.
Preventing impairment of children’s health or development.
Ensuring that children grow up in circumstances consistent with the provision of safe and effective care.
Taking action to enable all children, including those with disabilities, to have the best outcomes.

Organisations in the London Borough of Lewisham should also comply with additional LSCP local protocols and practice guidance that are published on the LSCP website.

2. Legal and policy context +

Working Together to Safeguard Children (2018) sets out a clear expectation that local agencies will work together and collaborate to identify children with additional needs and/or disabilities and provide support as soon as a problem emerges. Providing early help is far more effective in promoting the welfare of children – and keeping them safe – than reacting later when any problems, for example neglect, may have become more entrenched. The importance of using a child-centred approach in following the child’s journey is also emphasised. All services which are provided must be based on a clear understanding of the needs and views of the individual child in their family and community context.

Regulation 5 of the Local Safeguarding Children Board’s Regulations 2006 sets out the functions of the LSCP, in relation to section 14 of the Children Act 2004. One function is to develop policies and procedures for safeguarding and promoting the welfare of children in the area of the authority, including policies and procedures in relation to:

The action to be taken where there are concerns about a child’s safety or welfare, including thresholds for intervention.

It is a guidance tool that all agencies, professionals and volunteers can use to consider how best to meet the needs of individual children and young people. The majority of children living in Lewisham will have their needs met through support from their own family or carers and by accessing universal services. We know that some will need early help services at different stages of their development. The LSCP expects that all those in contact with children know how to complete an early help assessment and are able to identify and respond to concerns about actual or likely significant harm under the definition of the Children Act 1989.

Everyone has a responsibility to refer a concern about abuse and neglect to the Multi-Agency Safeguarding Hub (MASH), using the standard MASH referral form (see Appendix B).

Employers must ensure that staff and volunteers are equipped with the knowledge and skills to fulfil safeguarding responsibilities under the S.11 duty of the Children Act 2004.

LSCP partners are all signed up to comply with London Child Protection procedures: http://www.londoncp.co.uk/

This multi-agency threshold guidance document informs agencies in Lewisham on how to assess and identify a child’s level of need and how to access the right level support. The threshold guidance is divided into four levels:

Tier 1 - No Additional Needs
Tier 2 - Early Help/ Early Support
Tier 3 - Children with Complex Multiple Needs
Tier 4 - Children in Acute Need

This document should be used in conjunction with The London Child Protection Procedures: http://www.londoncp.co.uk/

LSCP has procedures and processes in place in relation to child sexual exploitation (CSE). The CSE strategy lays the foundation for a co-ordinated multi-agency response. A detailed risk assessment tool is available to all working in the borough to assist them in assessing the risk a young person is at in relation to CSE. There is a clear process in place, as also highlighted in the risk assessment, in referring cases to the multi-agency Missing, exploited and trafficked panel (MET). The CSE strategy, risk assessment tool and risk assessment referral form can be accessed via the LSCP website .

3. Levels of Need +

This guidance provides a summary of thresholds for intervention in Lewisham which is based upon the London Continuum of Need. The London Continuum of Need provides descriptors for four levels of need. These should form the basis for planning and provision of services for all children in the Borough. The descriptors are meant to aid planning, they are not set in stone and as a continuum there should be flexibility across all levels of need. Thresholds are semipermeable boundaries between services that enable children to receive the right help at the right time and the right level to assist them in meeting their full potential.

Level 1 – Children and Young People with Universal Needs – Children with no identified additional needs. These are children for whom all their health and developmental needs will be met by universal services alone. Children and young people at this level are achieving expected outcomes. There are no identified unmet needs, or the need is at a low level and can be met by the universal services or with some limited additional advice or guidance. Children, young people, parents and carers can access services directly.

Level 2 – Children and Young People with Additional Needs – Low risk to vulnerable. These are children whose needs are not clear, not known or not being met. They may be vulnerable and showing early signs of abuse and/or neglect. Children and young people at this level are in need of coordinated early help and support from services. This is the threshold for a multi-agency early help assessment to begin (the Lewisham EHA).

Level 3 – Children and Young People with Multiple/Complex Needs. These are children with high level additional unmet needs. They are unlikely to achieve or maintain a satisfactory level of health or development, or their health and development will be significantly impaired without the provision of services. They can also be children who are disabled. They may require longer term intervention from statutory and specialist services and need support by a clear, co-ordinated action plan. This is the threshold for an assessment led by children’s social care under Section17, Children Act 1989 (Child in Need).

Level 4 – Children and Young People with Acute/ Specialist Needs. This is a smaller group of Children who require intensive help and specialist support. This could be due to safeguarding issues where there is no risk of actual or likely significant harm, but needs are acute and multi-agency plans are not effective; or because there are child protection issues where there is actual or likely significant harm and intervention is required under Section 47, Children Act 1989. During the course of an assessment the concerns about the child may become so great that the Local Authority may seek to make arrangements for the child to be looked after outside of their usual family home (usually known as Children Looked After (CLA) or Looked After Children (LAC)). This may be a voluntary agreement with parents (Section 20) or through the courts to seek shared parental responsibility for the child (Section 31). Young people being worked with by the Youth Offending Services also meet this level of need.

4. Referral to MASH +

The MASH is a model for managing and responding to referrals to Children’s Social Care or requests for Targeted Early Help in Lewisham; Referrals to MASH can be made by:

Secure Email – mashagency@lewisham.gov.uk

Email: - mashagency@lewisham.gov.uk

Phone: 020 8314 6660

The MASH is in operation Monday-Friday, 9am to 5pm. Concerns identified outside of these hours should be reported to the Lewisham Out of Hours Service on 020 8314 6000 by asking for the out of hours duty social worker.

The routes out of MASH are:

A referral to the Early Help Team where threshold for a statutory response by children’s social care is not met and existing attempts to provide early help services have not improved the child’s circumstances.
Referral back to Universal Services as it does not meet the criteria for Early Help.
A referral to Children’s Social Care for either a CIN assessment under s17 CA 1989or a child protection enquiry under s47 CA 1989

All Referrals to MASH should be supported by a completed Multi agency referral form. A fully completed Multi agency referral form is required to provide a comprehensive summary of the concerns and what support and interventions have already been tried with the child and family which can be used to inform decision making and, if required, the agency checks process.

Multi Agency Safeguarding Hub (MASH)

The MASH consists of co-located agencies (Children’s Social Care, Police, Health, Housing and Education) and virtual links with (Probation, CGL (Community Mental Health services), Youth Offending Services, Adult Social care and Domestic Violence services. They research information on children and their families to provide timely and improved information sharing pathways for decision making, where there are concerns about a child. Multi-agency discussion and subsequent decisions will in some circumstances take place in a daily MASH meeting. By bringing representatives from other agencies together, more case specific information is available, leading to better informed decisions about children’s needs and the most appropriate way for those needs to be met in a timely way and sound assessments of risk. This will ultimately result in better decisions being made, leading to better outcomes for children and young people.

If any agency or professional is unclear about whether the identified needs or risks to a child meet the criteria for a referral into the Lewisham MASH they can ask for a consultation with a Social Worker in the MASH on 020 8314 6660.

Early Help

The Early Help Team receives in specific circumstances contacts for children that do not meet the threshold for statutory intervention by Children’s Social care. Most Early Help support can and should be provided by those agencies who already know the child and family. This work can be carried out by a single agency or a number of agencies employing a Team Around the Family Approach. When this approach is not making a difference to the unmet needs of the child or concerns about the child are escalating but do not yet meet the criteria for a referral to Children’s Social Care a referral should be made to the Early Help Team via the Lewisham MASH where a Targeted Early Help offer will be considered.
Lewisham has developed its own Early help Assessment and review forms with associated guidance. These are accessible from the Lewisham MASH website or the LSCP website. Any agency or professional can contact the Early Help Team for advice or guidance about how to use the early Help Assessment tools, employ a Team Around the Family approach to working with the family and find out what other sources of support both local and national are available to provide support and services.

Early Help is entirely consent based and every effort must be made to work closely with the child and family to agree on the nature of any concerns or unmet needs and to develop a plan to address these. Consent is also required to make a referral to the MASH for Targeted Early Help. Refusal of consent and /or non-engagement with the TAF process need to be considered when deciding if an escalation necessitating a referral to Children’s social Care is appropriate. If in any doubt a consultation should take place with a social worker in the Lewisham MASH (see above).

There may be times when Lewisham MASH does not accept a referral and the referring agency may disagree with this decision. Lewisham Safeguarding Children Partnership has a process for challenging these decisions and escalating concerns. This process can be found on LSCP website – available here : Lewisham Children's Social Care and LSCP are keen that partners do not sit on concerns that a threshold may have been wrongly applied. “If in doubt please speak out”. Working Together 2018 supports this challenge.

Concerns about a child suffering actual or likely significant harm can occur at any point across the four levels of need. If you have serious child protection concerns, contact MASH immediately. Outside of office hours the police and the Out of Hours Social work team should be contacted.

Children's Social Care works with children at Level 3 and 4 of the London Continuum of Need. This includes:

Section 17 children who are in need
Section 47 children who are in need of protection
Section 31 children who are looked after by Children's Social Care for whom the council has or shares parental responsibility for the child.
Section 20 children who are looked after by Children's Social Care but for whom parental responsibility is with the parent and not the council.

THRESHOLD CRITERIA:

In addition, the following threshold criteria also apply.

Section 47, Children Act 1989: Child Protection enquiries (Tier 4)

The table below is an indicator guide of the type of circumstances which would lead to a S.47 assessment. This table is intended as a guide and is not exhaustive. Reference should also be made to the London Child Protection Procedures 5th edition: http://www.londonscb.gov.uk/procedures/

Any allegation of abuse or neglect or any suspicious injury in a pre- or non-mobile child.
Allegations or suspicions about a serious injury/ sexual abuse to a child.
Two or more minor injuries in pre-mobile or non-verbal babies or young child (including disabled children).
Inconsistent explanations or an admission about a clear non-accidental injury.
Repeated allegations or reasonable suspicions of non-accidental injury.
A child being traumatised injured or neglected as a result of domestic violence.
Repeated allegations involving serious verbal threats and/or emotional abuse.
Allegations/ reasonable suspicions of serious neglect.
Medical referral of non-organic failure to thrive in under-fives.
Direct allegation of sexual abuse made by child or abuser’s confession to such abuse.
Any allegation suggesting connections between sexually abused children in different families or more than one abuser.
An individual (adult or child) posing a risk to children.
Any suspicious injury or allegation involving a child subject of a current child protection plan or looked after by a local authority.
No available parent and child vulnerable to significant harm (e.g. an abandoned baby).
Suspicion that child has suffered or is at risk of significant harm due to fabricated or induced illness.
Child/ren subject of parental delusions.
A child at risk of sexual exploitation or trafficking.
Pregnancy in a child aged under 13.
A child at risk of FGM, honour based violence, or forced marriage.

Further Guidance on the levels of need and possible service responses are detailed within the tables provided on pages 10-15 of this document. The lists are not exhaustive, and practitioners should be mindful that individual circumstances for children and young people may not fit neatly into any one specific category. The level of need tables are aimed at providing a quick reference point to support professional practice and are designed to help all practitioners who are working with children and their families to:

Identify the holistic needs of a child or young person.
Inform assessments by understanding the needs of the child or young person within the context of their family and community.
Act by working with the child, young person, family members / carers to develop mutually agreed solutions where additional support can be accessed when it is needed.

It should be noted however that professional judgement is equally important within this context and practitioners should continue to make decisions based on their experience, knowledge and practice and seek further advice from their own manager, designated or named safeguarding / child protection lead or Lewisham MASH they are unsure about the most appropriate action to take.

5. Information Sharing and Consent +

Whilst professionals should in general discuss any potential concerns with the young person themselves and/or their parents/carers, and whenever possible seek their agreement to contact Lewisham MASH, this should only be done where such discussion and agreement-seeking will not place the child or others at increased risk of suffering significant harm. Consent / agreement is not required for child protection referrals; however, you, as the referring professional, would need to, where possible, discuss with and inform parents/carers that you are contacting MASH or making a child protection referral as stated above, unless by alerting them you could be putting that child or others at risk.

If a discussion about contacting MASH has not been held with the young person and/or parents/carers, the reason for this should be clearly shared with the MASH at the time of the contact or referral being made. In cases where parents/ carers have expressed an unwillingness to agree to the assessment process, Children’s Social Care may be able to help manage this difficulty.

It is important to note however, that children, young people and their families should be able to feel confident that their personal information is kept safe and secure. They should also trust practitioners to maintain the privacy rights of individuals whilst sharing information that is necessary to deliver better services. All services except those provided through Section 47 or by court direction can only be provided through parental consent.

Provision of services to children without parental consent can only be on the basis that the child is likely to be suffering significant harm or that the child has reached a sufficient understanding and intelligence to be capable of making up their own mind in the matter (Gillick Competent).

When Children's Social Care is carrying out a Section 47 investigation partners can share information with Children's Social Care without having direct consent of the parent.

Practitioners should use their professional judgement to decide whether to share or not, and what information it is appropriate to share. Further detail on Information Sharing (including The Seven Golden Rules for information Sharing) can be found in the Government document ‘Information sharing advice for safeguarding practitioners’, see the link below:

Information sharing advice for safeguarding practitioners

6. Stepping Up or Stepping Down through the levels of need+

It is important to note that a child or young person can move throughout the four levels of need as their own needs and circumstances change and as interventions are put in place to meet those needs. It is not the intention that children and young people are ‘labelled’ at any level. This guidance should be used only to aid practitioners in making decisions as to what types of service can provide the right help at the right time. Well managed escalation and de-escalation between levels is therefore a critical element of effective multi-agency practice.

7. Continuum of Need and Thresholds +

continuum of need and thresholds wiper graph

The tables below set out the four levels of need showing features of children/young people, parents and carers at each level as well as possible indicators of need. It also indicates the type of assessment potentially required and how to access that pathway.

It should be noted that these are not a definitive list and professional judgement must be applied when deciding the level of intervention and where to refer.

Level 2

Level 2: Children and Young People with Additional Needs

Children and young people at this level are in need of coordinated early help and support from services. The need cannot be met by a universal service/setting alone but can be met by a single service or one group of single services using the Early Help Assessment process.

Assessment Process:

Additional needs at this level can be met within a universal setting with some identified additional support and universal assessment processes may be sufficient to help the child and their family, however it is important that children receive the right help at the right time and the sooner needs are identified and action taken, the greater the chance that positive change will take place. The expectation is that all practitioners who come into contact with children will respond when they see a child is not making the progress expected and ensure they support a family to access the services that can improve outcomes. This is known as Early Help.

The Lewisham Early Help Assessment (EHA) has been developed from the Signs of Safety and Well Being methodology. The practitioners work with a parent(s) or young person to gather information and build a picture of what is currently happening, including where there are strengths and what the concerns are. This assessment helps practitioners to analyse current needs, develop an action plan and set goals that can be used at Team Around the Family (TAF) meetings to review if progress is being made. The assessment is shared with other services and is used as a tool for referral into other services when required.

Key Services who provide support at this level:

Schools; health services; children’s centres; day nurseries; childminders; play services; youth support; family support services; educational psychology; educational welfare; voluntary and community services; youth crime prevention services; targeted drug and alcohol services; Group Work and Parenting Service; and the Family Information Service

Level 3

Level 3: Children and Young People with Multiple/Complex Needs

Children and young people at this level have complex needs that are likely to require longer term intervention. They will require a named Lead Professional and a TAC. Some children at this level will reach the threshold for Children’s Specialist Services (Section 17 of the Children Act 1989 Children in Need), or other specialist services for children or young people in danger of moving to a higher level of risk if they do not receive specialist support.

If the referral is not accepted by Lewisham Children's Social Care the referrer will receive advice about how to access services or how to gain support to carry out an EHA. There may be times when Children's Social Care does not accept a referral and the referring agency may believe that this is not the correct decision. Lewisham Safeguarding Children Partnership has a process for challenging these decisions and escalating concern . This process can be found on Lewisham SCP website. Lewisham Children's Social Care are keen that partners do not sit on concern that a threshold may have been wrongly applied. If in doubt, please speak out.

Key Targeted and Specialist Services who provide support at this level: Social care services; SEN services; specialist disability services; youth inclusion and support panels; youth offending team; drug and alcohol services; mental health services; family support services; voluntary and community sector services.

These services will be in addition to any universal or preventative services accessed by the child or young person.

Level 4

Level 4: Children and Young People with Acute/Specialist Needs

Acute needs. Children and young people who are at this level on the Continuum of Need will have complex additional unmet needs or complex learning and/or medical needs. This is also the threshold for Child Protection procedures for children or young people who are experiencing significant harm. It also includes Youth Offending Services.

Assessment Process:

Children and young people at this level will require a statutory intervention from one or more specialist services (including Section 47 Children Act 1989 – reasonable cause to suspect child suffering or likely to suffer significant harm, Section 31 – Care Orders, and Section 20 – duty to accommodate a child). This may include child protection or legal intervention and some children and young people may need to be accommodated by the local authority.

S.47 of the Children Act 1989 requires the local authority to make enquiries to enable it to decide whether action is required to safeguard and promote the well-being of the child. Lewisham Children’s Social Care will carry out an assessment as a means of conducting the Section 47 enquiries.

The purpose of the assessment is to determine whether the child is suffering, or likely to suffer, significant harm and to assess whether action is required to safeguard and promote the child’s welfare. Health, education and other services have a statutory duty to help children’s Social Care to carry out the Section 47 enquiry. Social Workers will work with the police in the case of a criminal investigation. The referrer and relevant professionals in the child’s life will be asked to contribute to a S.47 assessment.

The assessment will conclude with a decision about whether the child requires the structure of a child protection plan to protect them from significant harm in which case a child protection conference will be convened. Alternately it may decide that the concerns can be managed as a child in need plan or the plan may be handed back to level 2 agencies to continue to work with the child.

During the course of the assessment the concerns about the child may become too great that the Local Authority may seek to make arrangements for the child to be looked after outside of their usual family home. This may be a voluntary agreement with parents (S20) or through the courts to seek shared parental responsibility for the child (S.31)

S.31 - The Local Authority may, on receipt of information from a referrer or during the course of involvement with a child, apply to the court to seek an order under S.31 Children Act 1989 where they can obtain parental responsibility for the child. This enables the local authority to make decisions about where the child lives and who cares for that child. This is commonly understood as being looked after by the Local Authority under a Care Order.

The Local Authority may decide that the child is at such grave risk of harm that an application is made for an Emergency Protection Order and this gives the Authority 7 days to both look after the child in a safe place and decide whether to proceed with an application for a S.31 Care Order.

S.20 Children Act 1989 requires local authorities to provide accommodation for children in need in their area when those with parental responsibility for the child consent or when:

Social care services; specialist health or disability services; youth offending team; mental health services; family support services; voluntary and community sector services; drug and alcohol services; and any other universal or targeted services as necessary.

Level 2 - Indicators of Need

CHILD'S DEVELOPMENTAL NEEDS

Health

Slow to reach developmental milestones
Additional health needs
Missing health checks / routine appointments/immunisations
Persistent minor health problems
Babies with low birth weight in proportion to the mother
Pre-natal health needs
Issues of poor bonding / attachment
Minor concerns re healthy weight /diet/ dental health /hygiene / or clothing • Disability requiring support services
Concerns about developmental status i.e. speech and language problems
Signs of deteriorating mental health of child including self-harm
Starting to have sex (under 16 years)
Is experimenting with drugs and alcohol

Education & Learning

Is regularly unpunctual for school / occasional truanting or significant nonattendance / parents condone absences
Escalating behaviour leading to a risk of exclusion
Experiences frequent moves between schools
Not reaching educational potential or reaching expected levels of attainment
Needs additional support in school
Identified language and communication difficulties
Few opportunities for play/socialization
No participation in education, employment or training post 16 years
Emotional and Behavioural Development
Low level mental health or emotional issues requiring intervention
Is withdrawn / unwilling to engage
Development is compromised by parenting
Some concern about substance misuse
Involved in behaviour that is seen as antisocial
Poor self-esteem / Identity
Some insecurities around identity / low self-esteem
Lack of positive role models
May experience bullying around perceived difference /bully others
Disability limits self-care
A victim of crime

Family and Social Relationships

Some support from family and friends
Some difficulties sustaining relationships
Undertaking some caring responsibilities
Child of a teenage parent
Low parental aspirations

Social presentation

Can be over friendly or withdrawn with strangers
Personal hygiene is becoming problematic

Self-Care Skills

Not always adequate self-care / poor hygiene
Slow to develop age-appropriate self-care skills
Over protected / unable to develop independence

PARENTS AND CARERS

Basic Care, Safety and Protection

Basic care not consistently provided e.g.
non- treatment of minor health problems
Parents struggle without support or adequate resources e.g. as a result of mental/learning disabilities.
Professionals beginning to have some concerns about substance misuse (alcohol and drugs) by adults within the home
Parent or carer may be experiencing parenting difficulties due to mental or physical health difficulties / post-natal depression
Some exposure to dangerous situations in home/community
Teenage parents /young, inexperienced parents
Inappropriate expectations of child/young person for age/ability

Emotional Warmth

Inconsistent parenting but development not significantly impaired
Post-natal depression affecting parenting ability
Child / young person perceived to be a problem by parents or carers / experiencing criticism and a lack of warmth

Guidance, Boundaries & Stimulation

May have a number of different carers
Parent/carer offers inconsistent boundaries e.g. not providing good guidance about appropriate relationships formed, such as via the internet.
Can behave in an anti-social way
Child / young person spends a lot of time alone
Parents struggle to have their own emotional needs met
Lack of stimulation impacting on development

FAMILY AND ENVIRONMENTAL FACTORS

Family History and Functioning

Child or young person’s relationship with family members not always stable
Parents have relationship difficulties which affect the child / acrimonious separation or divorce that impacts on child
Experienced loss of a significant adult / child
Caring responsibilities for siblings or parent
Parents have health difficulties
Poor home routine
Child not often exposed to new experiences
Limited support from family and friends

Housing, Employment & Finance

Inadequate/poor housing
Requiring in-depth guidance and help. At risk of homelessness
Child/young person from asylum seeking or refugee family and has identified additional needs
Children subject to kinship care arrangements made by their own family
Family affected by low income or unemployment
Parents find it difficult to find employment due to basic skills or long-term difficulties.

Family’s Social Integration

Family is socially isolated limited extended family support
Victimisation by others impacts on child

Community Resources

Adequate universal resources but family may have difficulty gaining access to them
Community characterised by negativity towards child/young person

Level 3 - Indicators of Need

CHILD'S DEVELOPMENTAL NEEDS

Health

Child/young person who is consistently failing to reach their developmental milestones and concerns exist about their parent’s ability to care for them
Growth falling 2 centile ranges or more, without an apparent health problem
Learning affected by significant health problems
Experiencing chronic ill health or diagnosed with a life-limiting illness
Mental health is deteriorating and there is failure to engage with services / self-harming
‘Un-safe’ / inappropriate sexual behaviour / risk of sexual exploitation
Problematic substance misuse (drugs and alcohol) / links to risk taking behaviour
Failure to access medical attention for health chronic / reoccurring health needs
Concerns about diet / hygiene / clothing
Conception to a child under 16 years old / concerns about parenting capacity
Disability requiring significant support services to be maintained in mainstream provision

Education & Learning

Short-term exclusion, persistent truanting or poor school attendance
Previous permanent exclusions
Persistent ‘not in education, employment or training (NEET) / this could be as a result of compromised parenting
Alienates self from school and peers through extremes of behaviour
No, or acrimonious home/school links
Statement of special educational needs / failure to cooperate with SEN

Emotional and Behavioural Development

Alienates self from school and peers through extremes of behaviour
Physical / emotional development raising significant concerns
Difficulty coping with emotions / unable to display empathy
Unable to connect cause and effect of own actions
Behaviour is sufficiently extreme to place them at risk of removal from home
Early onset of sexual activity (13-14 years)
Offending /prosecution for offences – resulting in custodial sentences, ASBOs etc.
Puts self or others in danger
Disappears or is missing from home regularly or for long periods

Identity

Subject to persistent discrimination
Is socially isolated and lacks appropriate role models
Self-image is distorted and may demonstrate fear of prosecution
Extremist views that places self or others at risk

Family and Social Relationships

Relationship with family is experienced as negative, critical or rejecting
Regularly caring for another family member - Family no longer want to care for child
Family is experiencing a crisis likely to result in the breakdown of care arrangements
Child or young person has previously been looked after by a local authority
Persistent exposure to violent behaviours within the home

Social Presentation

Appearance reflects poor care and hygiene related health issues
Persistent presentation in unwashed / unsuitable clothing despite advice and support being offered

Self-Care Skills

Absence of or poor self-care skills for age / level of understanding
Severe disability - relies on others to meet needs.

PARENTS AND CARERS

Basic Care, Safety and Protection

Parent / carer is struggling or is unable to provide adequate care / basic care is frequently inconsistent
Child / young person has multiple carers but no significant relationship to any of them / receives inconsistent care
Significant concern about prospective parenting ability, resulting in the need for a pre-birth assessment
Parents have previous history of struggling to care for child or sibling / children previously subject to a child protection plan / looked after
Parents learning disability, substance misuse (alcohol and drugs) or mental health negatively impacts on parent’s ability to meet the needs of the child
Level of supervision does not provide sufficient protection for a child
Either or both parents / carers have previously been looked after and their parenting ability is compromised
Private fostering / young carer
Teenage pregnancy or inexperienced young parent or carer with additional concerns

Emotional Warmth

Child / young person has multiple carers but no significant relationship to any of them / receives inconsistent care
Child / young person receives little stimulation / negligible interaction
Child/ young person is scapegoated
Child / young person is rarely comforted when distressed / lack of empathy
Child / young person is under significant pressure to achieve / aspire / experiencing high criticism

Guidance, Boundaries & Stimulation

Parents struggle to set boundaries / act as good role models
Child or young person’s behaviour out of control
Child or young person is regularly beyond control of parent or carer
Parenting impairing emotional or appropriate behavioural development of child / young person

FAMILY AND ENVIRONMENTAL FACTORS

Family History and Functioning

Parents or carers are experiencing, on an on-going basis, one or more of the following problems significantly affecting their parenting: mental ill health, substance dependency or domestic abuse/ potential honour-based violence / forced marriage
Parental involvement in crime
Family characterised by conflict and serious chronic  relationship problems
Parents or carers persistently avoid contact / do not engage with childcare professionals
Children or young people are subject to Kinship Care arrangements set up by Children’s Social Care Services
Children/young people who are privately fostered
Persistent expectation to care for other household members which impacts on the child / young person’s development and opportunities

Housing, Employment & Finance

Statutorily overcrowded / temporary accommodation / family are homeless
Prosecution/eviction proceedings
Serious debts / poverty impacting on ability to care for the  child/ young person
Home in poor state of repair, deemed unfit for habitation

Family’s Social Integration

Family is socially isolated/excluded
Victimisation by others; places child and family at risk
Has poor relationship/s with extended family

Community Resources

Parents / carers do not access or there is significantly poor access to local facilities and targeted services to meet assessed need
Lack of community support/tolerance or hostility towards the child, young person or family
Multiple problems preventing a YP engaging with opportunities

Level 4 - Indicators of Need

CHILD'S DEVELOPMENTAL NEEDS

Health

Clear allegation of harm and/or disclosure of harm
Suffering or at risk of suffering serious physical, emotional or sexual harm or neglect
Growth faltering and no ‘organic’ cause identified
Failure to access medical attention for chronic / reoccurring health problems despite support and advice – including severe obesity and dental decay
Development significantly impaired due to parenting
Health impaired due to neglectful parenting
Sexual exploitation / abuse
Sexual activity under the age of 13
Conception to a child under the age of 14
Disability requiring the highest level of support
Subject to a section under the Mental Health Act / diagnosed mental health issues which places themselves or others at risk
Self-harming likely to have a serious effect on the child or young person’s health or wellbeing
Persistent and significant substance misuse (alcohol and drugs)
Child or young person is missing from home regularly or for long periods.
Fabricated / induced illness

Education & Learning

Permanently excluded from school or at risk of permanent exclusion
Significant developmental delay due to neglect / poor parenting
Emotional and Behavioural Development
Puts self or others in danger / including risk taking behaviour / self-harm or suicide attempts / substance misuse of drugs and/or alcohol / eating disorders
Failure or rejection to address serious (re)offending / anti- social behaviour
Significant emotional / psychological problems as a result of neglect / poor parenting
Frequently missing from home for long periods placing them at risk
Presenting sexualised behaviour
Child who abuses others
Identity
Socially isolated and lacking appropriate role models
Poor self-worth that results in extreme behaviours towards themselves and others
Participates in gang activity / involved with serious or organised crime
Demonstrates extremist views

Family and Social Relationships

Child in care (looked after) or care leaver
Family have abandoned child
Subject to physical, emotional or sexual abuse / neglect
Adoption breakdown
Is the main carer for a family member
Unaccompanied asylum-seeking child / young person
Forced marriage of a child / young person under 18 years

Social Presentation

Poor / inappropriate self-presentation / hygiene related health issues

Self-Care Skills

Absence / neglect of self-care skills due to other priorities such as substance misuse
Takes inappropriate risks in self-care
Severe lack of age-appropriate behaviour and independent living skills likely to result in harm

PARENTS AND CARERS

Basic Care, Safety and Protection

Parent / carers is unable to provide consistent parenting that is adequate (good enough) and safe
Parents have seriously abused/neglected the child
Previous child(ren) has been removed from parent’s care
Parent’s own learning disability /mental health / substance misuse significantly affects their ability to provide adequate and safe care
Parents do not recognise or accept danger and protect child/young person from harm
Persistent use of inappropriate care-givers
Child / young person has no one to care for them
There is no relevant stimulation appropriate for age
Exposed to pornography or other exploitative/ harming material
Consistent instability / violence/ domestic abuse within the home
Teenage pregnancy / young inexperienced parents with additional concerns that could place the unborn child / child at risk of significant harm
Individuals in family present a risk to children/young people and are likely to be in contact with them
Child / young person subject to public law proceedings in family court
Parents / carers involved in criminal activity
Allegations of harm by a person in a position of trust

Emotional Warmth

Parents / carers inconsistent, highly critical or apathetic towards child / young person
Parents / carers are negative and abusive towards the child / young person
Child / young person is rejected or abandoned
Carers persistent hostility to the child / young person leads to their isolation

Guidance, Boundaries & Stimulation

There are no effective boundaries set by parents
Regularly demonstrates anti-social behaviour in the community
Child / young person is beyond parental control
Subject to a parenting order which may be related to their child’s criminal / anti-social
behaviour or persistent absence from school

FAMILY AND ENVIRONMENTAL FACTORS

Family History and Functioning

Family life is chaotic and there is significant and persistent parental or carer discord /domestic abuse / honour-based violence / forced marriage
Family members have physical or mental health needs which place the child / young person at risk of harm
Re-occurring / frequent attendances by the police to the family home
Child / young person is being cared for by a non-relative under private fostering arrangements
Parents are deceased and there are no family / friends to care for the child / young person
Parents are in prison and there are no family / friends to care for the child / young person

Housing, Employment & Finance

Housing accommodation places child / young person in danger / at risk of harm
No fixed abode / homeless
Extreme poverty / debt impacting on ability to care for the child / young person
Household income is used to fund parent or carers own prioritised needs (e.g. substance misuse / gambling) leading to significant neglect of the child / young person

Family’s Social Integration