Scottish Government

Philip Gibson, Norma Baldwin and Brigid Daniel
ISBN 0 7559 2934 9 (Web only publication)
This document is also available in pdf format (124k)

Introduction

This research is an evaluation in two parts of integrated assessment frameworks developed and piloted by the 3 Ayrshire Councils and NHS Ayrshire and Arran, and by West Lothian Council and NHS Lothian. Professionals from all branches of local authorities and health, with a responsibility for children, were involved in the pilots. The frameworks were piloted with children and families considered to be in need under the Children (Scotland) Act 1995.

In the first part, the research explores the management arrangements and processes which were adopted across Ayrshire and West Lothian in order to conduct the pilot. The second part examines the quality of the assessments undertaken and discusses with key stakeholders, including parents of some of the children involved, how the process has enhanced or otherwise their experience of services.

The overarching aim of the research was to understand the potential for integrated assessment to lead to significant improvements in the lives of children in need.

The assessment pilots were developed in separate and quite different ways in Ayrshire and West Lothian. In the 3 Ayrshire local authority areas the emphasis was on children in need in general while in West Lothian the sample consisted entirely of children with disabilities.

Main Findings

First part

Multi-agency agreements on integrated assessment

• There was consultation with children, young people and their families before and during the development process and there is commitment to continuing consultation with users.
• A common format for assessment was agreed and arrangements made about the practical processes of gathering, sharing, recording and assessing information.
• The development of a single assessment process has reduced the need for repeated history taking.
• Staff are of the view that efficiency and effectiveness of assessment has been improved.
• Organisations maximised the potential of the process by incorporating a number of professionals from different disciplines within assessment teams.

Political and managerial support

• At a political level the pilots have been supported by the commitment of funding through the Changing Children's Services Fund and Modernising Government Fund. Additionally the Children's Services Plans and Child Health Plans of each of the pilot authorities contain a specific commitment to develop integrated assessment for children.
• Support has been demonstrated in strong leadership from senior managers in participating agencies, who have formed the steering groups for each of the pilots at local and at cross authority level where appropriate.
• Managers have committed staffing resources to the pilots and have supported the development of training and support for staff undertaking the assessment work.
• A dedicated manager has been available at a sufficiently senior level in both pilot areas to devise, promote and steer a coherent programme of development including the production of protocols and training materials and to seek legal advice concerning the sharing of information among agencies.
• There is a continuing commitment to rolling out the process of integrated assessment across the authorities involved and this will be led by managers in all agencies.
• There is a commitment to invest in IT and management infrastructure development which will facilitate the task of sharing information about children among relevant staff and managers.

Second part

The assessment records

• The level and detail of information which workers had and acted upon was generally greater than that included in the assessment records. The assessment records were of variable quality. Many were disappointing in that they did not provide the level of detail about the lives of the children which the framework expected. There were gaps in information about emotional development, social interactions and networks and in information about the child's experience and reactions. In some cases there was a lack of follow up to potential vulnerabilities or child protection issues. This lack of detail results from workers apparently failing to draw together the evidence available in a variety of agency files and to document the process of analysis leading to recommendation.
• The majority of records did not contain a structured chronology to provide an overview in an accessible form of the child's life to date. Those which did provide a chronology were more accessible to the reader and provided a greater insight into the lives of the children. One member of staff from Ayrshire who was interviewed cited the construction of the chronology as an important way of focusing on the needs of the child leading to a clear, realistic action plan for him.
• The majority of records studied did not provide much documentary evidence of analysis and specific plans for the future. It was not always clear what aspects of need would be worked on, by whom, and what resources would be made available over what timescale.
• The parents who were interviewed were, however, overwhelmingly of the opinion that the assessments had led to clarity of purpose and in the majority of cases an improvement in service delivery through partnership working between parents and professionals.
• This view appears to have been supported by the use of key workers available for the duration of the assessment and afterwards in taking forward the action plan tasks.

Background

The development of integrated children's services is an expectation on councils and health authorities, as part of the Scottish Executive's improvement programme for children in Scotland. The concept of interagency working is not new. There has been joint working between councils, voluntary agencies, health authorities and the police to protect children from harm and abuse for a number of years. The new integration agenda seeks to take the work of agencies further down the road towards providing a wholly integrated and seamless service for all children and especially those children who are identified as being in need. If this new agenda is to succeed much work will be required in the areas of information sharing and collaborative assessment and planning. Effective leadership is required to change organisational cultures and methods for the benefit of children and their families. The aim of the research was to understand the potential for integrated assessments to lead to significant improvements in the lives of children by improving the delivery of appropriate services.

Methodology

A total of 7 assessments were completed in West Lothian. Of 16 started in Ayrshire, 14 were completed at the close of the pilot phase. Professionals who led the assessments included teachers, health visitors, speech therapists, nursery nurses and social workers. The research was undertaken in 2 parts. The first involved interviewing staff and managers who established the pilots and who were responsible for the assessments undertaken with children. The researcher was seeking to discover attitudes among staff and managers about the feasibility of the integrated assessment framework in practice. The second part consisted of an evaluation of the assessments themselves, measured against a grid for good practice. Additionally some parents and staff were interviewed, to establish attitudes to and experience of the work. In particular we were focusing on the likelihood of significant improvements in the lives of the children who were assessed.

Conclusions

The first part of the research focused on organisational issues. The second stage of the evaluation confirmed the importance of this organisational work, if professionals are to have the opportunity, skill and capacity to engage effectively with children and families at the earliest opportunity.

All of these elements have combined to provide professional staff with a supportive environment in which to develop practice. Participants considered that this approach to assessment had enhanced the potential for completing effective joint assessments, which could be more child and family focused and resolve some of the current difficulties associated with different priorities, funding streams and working practices.

Agencies working in partnership to achieve integrated assessment and successful outcomes for children and their families will require to ensure that these elements are in place to support child centred, collaborative services.

Ensuring consistency and coordination

The children chosen to take part in the pilots were all children in need, many of them with complex needs and some with needs for protection. Intervention with these children and their families is necessarily a time consuming process. But it appears that with appropriate intervention a real difference is possible. One of the tests of the effectiveness of an integrated assessment framework will be whether the many layers of specialist assessments which are undertaken for a child with multiple needs are used and coordinated appropriately in the overall process. Success in this area will be dependent on access to and appropriate sharing of information.

Children who have needs which are less complex than the group of children studied here should be able to benefit from this process, too. If an integrated assessment framework is to be effective for all children who may need a service, all individual and specialist assessments will need to be tied together, whether within one agency or across several, to inform a coherent, overarching plan, whether only modest services are to be provided, or a substantial multi agency package of care.

Improving professional practice

The research highlights a number of areas where practice needs to be improved. Skilled observation and information gathering, followed by accurate recording, analysis of evidence and clear and specific action plans, all need development. The report draws attention to the perceived inadequacies in the standard of recording in some cases. This is important as the assessment of a child's needs becomes part of the core record and history of the child as he or she goes through life and any inadequacies may have long term consequences

In the first part of the research there was an overwhelming feeling among staff and some managers that the preparation of integrated assessments was overly time consuming and would not necessarily lead to better service delivery for the children involved. However after a period of several months working with children and families some of the workers involved pointed to the positive relationships which an integrated system had fostered between workers, child and family. Staff felt that despite difficulties experienced with the systems, they had had time and opportunity to engage and intervene to make a real difference in children's lives. Workers valued aspects of the process which brought parties closer together and permitted mutual investment in the child's future. More direct involvement with children and recording of their views and experience is, however, still needed in order to ensure that the assessment process and subsequent action plans are fully child centred. However the reflections of workers make it clear that the assessment process has developed as a dynamic means to become involved with and intervene on behalf of children.

In all the authorities concerned there were real difficulties involved in gathering and sharing information. Continuing investment in user friendly technological solutions to support child focused models of practice will be crucial.

The use of a key worker for a child was common practice in all authorities studied. In some cases the choice of key worker had been given to parents on behalf of their children. This permitted a close relationship to develop with the worker for the benefit of the child. This was much appreciated by parents and would be seen generally as an indicator of good professional practice.

This practice highlights considerable success of these pilots in offering engagement with children and families as an integral part of the assessment process. Further development of these areas of good practice may well prove time consuming, but the early investment of time is likely to result in significantly improved outcomes for children.

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