A new report confirms that joined-up working has been a positive and significant experience for the majority of those involved.
Children with significant and complex health needs and/or disabilities and their families are often in contact with a wide range of different agencies, and subject to multiple assessments. New research based on six case studies examines a range of different models for joined-up assessment and work with children and young people with significant and complex health needs and/or disabilities.
Overall, this research confirmed the potential of an integrated approach, and the value of flexibility (rather than one particular model) in responding to local circumstances and needs. For the majority of those involved, the development of joined-up working had been a positive and significant experience.
Frameworks for joined-up assessment which targeted a particular age group (such as birth to three) or a defined group of cases appeared able to offer a higher level of support, and were particularly valued by parents. On the other hand, schemes which were more inclusive or operated over a wider age range were able to support more children, albeit at a lower level, and to deal better with transitions, for example to school or to adult services.
New approaches and understandings
Joined-up assessment necessitated new ways of working. There was an emphasis on obtaining a holistic understanding of the child and family’s needs ‘in the round’, and of assessment being a continuous formative process within which reviews (rather than reassessments) were embedded. Professionals involved in collaborative work were moving away from seeing assessment as discipline-specific and deficit-based, towards a more social and integrated model in which the first question was ‘what do families want?’.
New frameworks for joint assessment worked best when they were underpinned by the development of trust, communication and strong working relationships among workers from differing professional backgrounds and agencies.
Links with other assessment frameworks
Assessments in education, and particularly the statutory assessment of special educational needs, were difficult to incorporate within the joined-up assessment process in all but one of the six authorities. In part, this difficulty could be ascribed to wider problems in engaging education services in the process. More specifically, some respondents questioned the extent to which a joint assessment could meet the requirements set out in the SEN Code of Practice.
In most of the case study authorities, the Common Assessment Framework was seen as complementary to the principles and practice of joined-up assessment for children with significant and complex health needs and/or disabilities, offering a useful starting point for considering the family’s needs in the round.
The report concludes with recommendations for the development of joint assessment models aimed at central government, strategic management in local authorities and primary care trusts, and at practitioners and team managers. For the latter, where SENCOs are most likely to be concerned there are three key messages:
- joined-up assessment is a partnership process, dependent on recognising the expertise of other professionals, but also and especially – of the parent and child
- assessment is not an end in itself, and it is important that regular reviews are embedded in the process
- the development of joined-up assessment takes time, and workers must be prepared to be challenged, and to think and communicate in new ways that put children and families at the centre of the process.
Models of Good Practice in Joined-up Assessment: Working for Children with ‘Significant and Complex Needs’. Janet Boddy, Patricia Potts and June Stratham.
Thomas Coram Research Unit, Institute of Education, University of London
Copies of the full report can be accessed at www.dfes.gov.uk/research.
Barriers and facilitators to joined-up assessment
- children’s trust arrangements
- pooled budgets and governance structures
- sharing data and documentation
- face-to-face working through co-location or frequent joint meetings
- key worker and lead professional roles
- common training and cross-agency working groups
- pilot schemes, secondments and service level agreements to test new ways of working
- voluntary sector involvement
- pre-existing relationships across agencies.
Attitudinal and practice factors
- active involvement of parents and young people
- use of non-technical language and cultural interpreting
- regular and responsive review to keep the assessment ‘live’
- strong personalities with commitment to drive change forward.
Difficulties and challenges
- climate of organisational change and uncertain funding arrangements
- separate joined-up assessment and SEN systems
- difficulty in engaging education providers due to autonomous structures and workloads
- number of agencies involved, eg in an authority with multiple PCTs
- joined-up working as an add-on to professionals’ workload rather than a core activity
- timescale for social services core assessment.
Attitudinal and practice factors
- difficulty in agreeing definitions of assessment and complex needs
- different understandings of data protection issues and reluctance to share information
- lack of communication with families, for example about the extent to which services can (or cannot) be provided.