Promoting Inclusion: Shared Assesment:
Multi-Agency Planning and Practice

Presented in March, 2004

Preschool Community Teams Project

Supported by Changing Children’s Services Fund

Consultation with the parents

• Faster response
• Easy access to services
• One-door referral system
• Coordinated services
• Better communication
• Keyworker

3 Team Model

Management Team: strategic planning and overview
Community Team: taking referrals and coordinating services
Core Team: working directly with individual families

Referral criteria

Preschool children with significant additional support needs requiring input from two or more services, other than universal services.

Aims

Streamline the referral process.
Coordinate services from the start.
Include a keyworker system.
Ensure families have a written family support plan.
Ensure that families are central to the whole process.

Community Team

• Integration manager (coordinated)
• Physiotherapist
• Paediatrician
• Speech & language therapist
• Occupational therapist
• Community children’s nurse
• Clinical psychologist
• Educational home visitor
• Social worker

Role of Community team

• Consider referrals
• Meet with family
• Identify appropriate services/supports
• Action referrals within own service
• Review to ensure appropriate service/supports are in place.

Benefits of Community team

Single access point

Earlier identification

Quicker response to referral

Consistent information

Coordinated services from the start

Families central to the process.

Role of Core team

The essence of the core team is that professionals from the different agencies and the child’s parents come together on equal terms at regular family-friendly meetings to discuss the child’s and family’s needs in detail and to agree a coordinated approach documented in a Family support plan. The core team is individual to each child and family.

Benefits of Core team

For families:

• Keyworker
• Regular meetings
• Less conflicting advice/information
• Time efficiency
• Coordinate care/support package
• Easy access to services
• Link to community team
• Central to process

For professionals:

• Regular meetings
• Reduced duplication – information/tasks
• Responsibilities clarified
• Workload reduced?
• Holistic view of child and family
• Increased partnership across agencies
• Sharing expertise
• Supportive

Keyworker

A keyworker is both a source of support for the family and a link by which other services are accessed and used effectively. The have responsibility for working together with the family and with professionals from their own and other services and for ensuring delivery of the Family support plan for the child and the family.

Evidence on effects of keyworkers

• Better relationships with and satisfaction with services
• Higher morale
• Less isolation and feelings of burden
• Improvements in receipt of information, access to services and fewer unmet needs
• Partnership and family involvement
• Increased inter-professional cooperation
• Increased job satisfaction for staff.

Elements of a quality keyworker service

• Pro-active regular contact
• A supportive, open relationship
• A family-centred approach
• Working across agencies
• Working with families’ strengths and ways of coping
• Working for the family rather than an agency

Service Coordination system

• Family focused
• Needs led
• Service coordination
• Flexibility
• Stability
• Continuity

Outcomes

• Families at the centre
• Streamlined referral system
• Coordinated services
  • regular core team meetings
  • family support plan
• Keyworker

Achieved to date

• Full consultation with staff groups
• Multi-agency training
• 6 Community Teams in place
• Integration managers as coordinators
• Keyworker training identified
• Publicity materials in draft
• Administration system in draft

Next stage

• Finalise publicity and administration materials
• Teams to take referrals by June 04
• Keyworker trainers trained
• Further keyworker training
• Support and supervision systems
• Evaluate effectiveness of system

Promoting inclusion