4.2 Thresholds for Intervention

AMENDMENTS

This Chapter was amended January 2010, minor amendments throughout, and a new Section 18, Glossary of Terms.

General Health
Physical Development: Gross and Fine Motor Skills
Speech and Language (0-5 years)
Emotional, Social and Behavioural Development
Development of Child/Young Person - Identity, Self Esteem, Self Image and Social Presentation
Development of Child/Young Person - Family and Social Relationships
Development of Child/Young Person - Self Care Skills and Independence
Development of Unborn Baby, Infant, Child or Young Person Foundation Stage (3-5 years)
Development of Unborn Baby, Infant, Child or Young Person Primary KS 1 & 2 (5-11 years)
Development of Unborn Baby, Infant, Child or Young Person Secondary KS 3, 4 & post 16 (11-16 years)
Parents and Carers - Basic Care, Ensuring Safety and Protection
Emotional Warmth and Stability
Guidance and Boundaries
Family and Environmental - Family History, Functioning and Wellbeing
Family and Environmental - Wider Family
Family and Environment - Housing, Employment and Financial Considerations
Social and Community Elements
Glossary of Terms

1. General Health

This section needs to be read in conjunction with national guidance and local care pathways e.g. relating to feeding to thrive, growth monitoring, newborn hearing loss, audiology, palliative care, ASC, epilepsy, enuresis, pathway for children with visual impairment (to be developed), Down Syndrome (to be developed), allowing a natural death (in draft)

	Need	Potential Response
General Additional Needs	Access to universal health services.	Ensure registered with a GP, local dentist, known to health visitor/school nurse, fully immunised, hearing (newborn) and vision (school entry) screening undertaken.
	At risk of poor growth or concern regarding growth.	Monitoring of height and weight and dietary advice by Health Visitor, School Nurse or paediatrician.
	At risk of or mild visual problems, e.g. squint or refractive error.	Monitoring of vision by Health Visitor, School Nurse, paediatrician or at Eye Hospital and provision of glasses or other intervention as appropriate.
	At risk of hearing loss, e.g. because of glue ear, underlying condition, family history	Audiology +/- Ear Nose Throat (ENT) follow up.
	Constipation or delay in achieving continence.	Advice given by Health Visitor, School Nurse or paediatrician.
	Epilepsy well controlled on oral medication.	Follow up by paediatrician, epilepsy advice and training for parents, carers, educational staff.
	Respiratory condition well managed by medication	Paediatric follow up.
	Other chronic illness.	Medical and nursing follow up as appropriate
	Acute illness, injury.	Management by GP, hospital as appropriate.
	Mild concern regarding development or learning - reading in conjunction with Section 2, Physical Development:Gross and Fine Motor Skills, Section 3, Speech and Language (0-5 years) and Sections 8 - 10 inclusive.	Monitoring, advice or input by community based teams, e.g. health visitor, early years worker, community speech therapist, teacher.

Significant Additional Needs	Requiring access to additional health services	For example, refer to community or hospital dentist if complex needs or if unable to access local dentist.
	Poor feeding or growth not responsive to above advice.	Referral to hospital/community paediatrician for monitoring, investigation, treatment and dietary advice and involvement of feeding to thrive team if needed.
	Visual impairment with correction.	Investigation and follow up at Eye Hospital, referral to proposed multi-agency team which may include developmental paediatrician, education (e.g. PRESENS, sensory needs team), Portage and social work team for further assessment and intervention.
	Functional hearing with aids	Audiology +/- ENT follow up, investigation re aetiology with specialist paediatrician if appropriate, referral to sensory needs team, input by PRESENS and portage where appropriate, implementation of appropriate strategies in educational setting.
	Incontinence, soiling or constipation not responsive to advice given.	Referral to enuresis clinic (and to paediatrician if there is daytime wetting), special needs health visitors for continence programme or supplies, use of oral/nasal medication if appropriate, dietary advice.
	Epilepsy not controlled on oral medication.	Investigation and follow up by paediatrician (referral to paediatrician with special interest/tertiary paediatric epilepsy service if appropriate), epilepsy advice and training for parents, carers, educational staff including use of emergency medication.
	Respiratory condition with need for oxygen intermittently, e.g. when asleep or unwell.	Paediatric follow up (generally paediatrician with special interest in respiratory medicine), support and training by community and specialist nurses, liaison with school, implementation of respiratory care plans at home and school.
	Chronic illness requiring medication in school, equipment or school absence.	Paediatric follow up, support and training by community and specialist nurses, liaison with school, implementation of care plans at home and school.
	Moderate delay in development or learning - reading in conjunction with Section 2, Physical Development:Gross and Fine Motor Skills, Section 3, Speech and Language (0-5 years) and Sections 8 - 10 inclusive.	Paediatric assessment and investigation to look for underlying cause and treatment if appropriate. Consider referral to CAMHS, Child and Adolescent Mental Health Service if needed

Critical/Complex Needs	Poor weight gain associated with or motor difficulties and/or complex disability not responsive to the above.	Discuss at nutrition meeting with a view to consideration for alternative feeding methods
	Profound or severe visual impairment.	Investigation and follow up at Eye Hospital, referral to proposed multi-agency team which may include developmental paediatrician, education (e.g. PRESENS, sensory needs team), Portage and social work team for further assessment and intervention.
	No functional hearing.	Audiology +/- ENT follow up (may consider cochlear implant), investigation re aetiology with specialist paediatrician if appropriate, referral to sensory needs team, input by PRESENS and portage where appropriate, implementation of appropriate strategies in appropriate educational setting
	Continence or toileting problems not responsive to above measures.	Referral to gastroenterologist/hospital paediatrician/paediatric surgeon, specialist nurses/special needs health visitor for training and provision of equipment, use of enemas, stomas, catheterisation, implementation of programmes in home, respite and educational settings.
	Frequent or prolonged fits despite oral medication.	Investigation and follow up by paediatrician with special interest/tertiary paediatric epilepsy specialist/epilepsy surgery service, epilepsy advice and training for parents, carers, educational staff including use of emergency medication, appropriate educational setting.
	Respiratory condition requiring continuous oxygen or ventilatory support.	Paediatric follow up by paediatrician with respiratory interest, support and training by community and specialist nurses and physiotherapist, liaison with school, implementation of respiratory care plans at home and school.
	Chronic illness causing prolonged school absence, high level or nursing or therapy input	Paediatric follow up, support and training by community and specialist nurses, liaison with school, implementation of care plans at home and school, referral to the palliative care team if appropriate
	Terminal illness.	Paediatrician to discuss end of life planning (refer to draft policy - Allowing a Natural Death). Discussion in progress regarding palliative care support locally.
	Severe delay in development or learning - reading in conjunction with Section 2, Physical Development:Gross and Fine Motor Skills, Section 3, Speech and Language (0-5 years) and Sections 8 - 10 inclusive.	Paediatric assessment and investigation to look for underlying cause and treatment if appropriate. Consider referral to Child and Adolescent Mental Health Severe Learning Difficulties Team CAMHS if needed.

2. Physical Development: Gross and Fine Motor Skills

	Need	Potential Response
General Additional Needs	Child has some difficulties with gross/fine motor/self care skills. e.g. some delay in physical development, however progress anticipated in line with other domains.	Advice to pre school/school settings. Written advice to parents.

Significant Additional Needs	Child has specific or substantial difficulties with gross & fine motor skills and or sensory/perceptual skills, which impact on their ability to function at a developmentally appropriate level in school, play/leisure or self care skills. e.g. child whose functional difficulties affect their ability to achieve physical or academic potential and/or impact on social and emotional development. Physical skills falling behind skills in other areas. Risk of reduction in physical abilities without intervention.	Individual advice/strategies/activity programmes for school and/or home settings. Liaison with educational services: PRESENS, Nursery & School settings Specific Occupational Therapy Physiotherapy intervention if required, individual or group. Attendance at a multidisciplinary intervention group. May require assessment for assistive technology at home/school. May require assessment of their home/school environment by an Occupational Therapist or Physiotherapist in order to promote functional ability.

Critical/Complex Needs	Child has complex physical difficulties that have substantial impact on their ability to function in all aspects of daily life:- Mobility - non ambulatory / requires assistive technology Self Care - needs full or substantial assistance School - needs support to facilitate access to curriculum Play/Leisure - needs support to access play/leisure activities. This may include children with deteriorating conditions, or acute need for intervention e.g. following orthopaedic surgery.	Multidisciplinary/multi-agency team planning input and review. Specific Occupational Therapy / Physiotherapy intervention if required, individual or group. Assessment of home and school environments with regard to promoting functional ability. Recommendations for assistive technology to support postural management, daily living equipment and mobility needs for home/school. Referral to appropriate services e.g. wheelchair service, posture clinic. Occupational Therapy assessment of housing environment with advice to facilitate maximum independence or enable daily care e.g. housing adaptation, re-housing. Advice regarding access suitable play/leisure activities.

3. Speech and Language (0-5 years)

	Need	Potential Response
General Additional Needs	Some difficulties in the following areas in comparison with typical for age identified at 18 months/30 months:- Social communication Language understanding Developing first words/simple or complex sentences Developing intelligible speech	Initial speech and language assessment at Community Clinic/Children's Centre. Intervention may include:- Advice to parents and review date set Regular therapy - group/individual, block/continuous SLT, Speech and Language Team advice to other professionals and services SLT advice to Early Years provision Referral to Audiology if required Information given e.g. music group Training offered on speech, language and communication by SLTS e.g. 0-3, 3-5 years

Significant Additional Needs	Persistent delay in the following areas in comparison with typical for age. Quality and/or frequency of social interaction affecting the child's ability to share activities socially Language understanding Expressive language Development of speech, intelligibility, maybe due to atypical speech development or physical reasons Fluency/stammering	Further Speech and Language assessment. Referral-on process Referral into Integrated Care Pathway via ICDDS, Integrated Child Development and Disability Service referral Referral into education services (PRESENS, ICAN, JSC) Referral into portage Referral into Audiology Referral into other appropriate agencies Referral into specialists SLT colleague Intervention Regular therapy, group/individual, block/ongoing SLT advice to other agencies Information/advice given re child's needs and difficulties Advice given re appropriate local and national organisation Advice given by Specialist SLTs if child in Community Clinic May involve transfer from Community clinic to Specialist SLT Input to pre-school Educational Panels: JSC, ASC, Lang. Units Liaison where appropriate with Special Education services Local EY provision ICDDS professionals Specialist SLT Social Services Children's Centres Acute Service SLT and professionals CAMHS and CAPS Chailey Check DLA CAF completion Parent courses Wider training for involved professionals

Critical/Complex Needs	Substantial and persistent difficulties in comparison with typical for age in the following areas. These may be specific or part of wider complex needs. Development is frequently atypical rather than simply delayed:- Social communication disorder/ASD Language understanding disorder Communication and expressive language Disordered speech and severe intelligibility problems Need for Augmentative/alternative Communication System	Further Speech and Language assessments Referral-on process Referral into Integrated Care Pathway via ICDDS referral Referral into Education services (PRESENS, ICAN, JSC) Referral into portage Referral into Audiology Referral into other appropriate agencies Intervention Intervention is frequently part of a planned multi-agency team approach Speech and Language Therapy is most commonly delivered by the Specialist SLT within the specialist provision Where regular therapy is provided in Community clinic, then advice and support is provided by the Specialist SLT Provision may involve transfer from a Community Clinic to the Specialist SLT Regular therapy, group/individual, block/ongoing is frequently in association with multi-professional input SLT advice to other agencies Information/advice given re child's strengths, difficulties, needs and aims,objectives, approaches, strategies and activities Advice given re appropriate local and national organisations Input to pre-school Educational Panels, JSC, ASC, Lang. Units Liaison where appropriate with Special Education services Local EY provision ICDDS professionals Specialist SLT Social Services Children's Centres Acute Service SLT and professionals CAMHS and CAPS Chailey Check DLA CAF completion Parents courses Wider training for involved professionals

Children and young people in mainstream schools access Speech and Language Therapy according to the Special Educational Needs Thresholds for Intervention.

Children and young people in special schools access Speech and Language Therapy assessment which will prioritise their needs.

4. Emotional, Social and Behavioural Development

	Need	Potential Response
General Additional Needs	Transient or mild emotional behavioural disturbance often but not always environmentally generated.	Advice from existing professional involvement, .e.g. school/GP/HV/School Nurse. Information re local and national support organisations. Access to local parents group if available.

Significant Additional Needs	Ongoing persistent or behavioural difficulties sufficient to cause disruption to life and functioning of child at home or at school.	In addition to services provided in low need. Referral to Community CAMHS or educational psychologist or specialist CAMHS assessment and possible referral on for multidisciplinary work. Assessment by an Occupational Therapist regarding access to a safe home environment.

Critical/Complex Needs	Threat of harm to self or others and high risk of family breakdown to	In addition to services provided in medium need referral on to inpatient or residential provision (Tier 4).

5. Development of Child/Young Person - Identity, Self Esteem, Self Image and Social Presentation

	Need	Potential Response
General Additional Needs	Child presenting with low self esteem and lack of self confidence. Some indications of anxiety or depressive symptoms. Potential risk of discrimination due to developmental needs or issues relating to race/religion/sexuality.	Advice, information and support from existing professional involvement e.g. school, health visitor, GP, etc. Sign post information re social/leisure services. Access to local parenting groups/support organisations if available.

Significant Additional Needs	Child presenting with depressive symptoms. Child presents as anxious. Reduction in school achievement. Child presenting with oppositional behaviour. Inability to express self or understanding of self. Inconstant or inappropriate communication methods in place.	Referral to CAMHS/SLD Team. Home visit by Duty SW to consider integrated and specialist family support services. Liaison with professional network e.g. school.

Critical/Complex Needs	Child presenting indicators of mental health issues. Child presenting self injurous behaviour and putting self or others at risk. High risk of discrimination due to disability. Continued and prolonged exposure to negative comments and perceptions from family/others. Clothing not adequate to meet basic needs of child. Cultural needs of child not met by family.	Social Worker to be allocated. Involvement from CAMHS/SLD Team. Multi-disciplinary approach. If indication of child protection concerns, consider child protection investigation.

6. Development of Child/Young Person - Family and Social Relationships

	Need	Potential Response
General Additional Needs	Unstable family environment. Single parent/carer. Limited social activities and opportunities outside of family home.	Advice re family support groups. Referral to Young Carers/Amaze. Advice and information re social and leisure activities in the local area.

Significant Additional Needs	Significant changes in the family/household composition. No significant involvement with the community or wider family network. Presented concerns re the attachment between child and parent/carer.	Referral to CAMHS/SLD Team. Consideration for Family Support Services - Outreach provision or parenting group of parenting support. Consider social work involvement.

Critical/Complex Needs	Risk of family breakdown. Child/young person presenting challenging/antisocial behaviour and impact upon family relationships, parents, siblings and in the community. Social isolation of child and family. Insecure or lack of attachment between child and parent/carer.	Involvement by CAMHS/SLD Team. Social Work Allocation. Consideration for respite provision. Referral for Family Group Conference - SW Team. Consideration to Child Protection Procedures.

7. Development of Child/Young Person - Self Care Skills and Independence

	Need	Potential Response
General Additional Needs	Support with development of self care skills due to developmental delay. Need for opportunities for social inclusion for independence skills. Need for development of self care skills due to developmental delay.	Advice and support from schools or nurseries, Health Visitor, School Nurse. Advice and sign posting re opportunities for social inclusion i.e. After School Clubs, Youth Clubs, Play Schemes.

Significant Additional Needs	Lack of consistent boundaries. Inappropriate boundaries for age and development of child. Inappropriate level of support from parents/carers for the age and development of the child. Need for independence from family. Challenging behaviour causing significant difficulties re self care of child/young person with personal care, washing and dressing. Transportation difficulties.	Home visit by Social Worker. Referral to CAMHS/SLD Team re boundaries. Educational Transition Review - Year 9. Transition Assessment to be completed by Social Worker/Transition Worker. Occupational Therapy assessment of home environment with advice to promote self care and independence. Support from School Nurse. Parenting support and advice. Consider social work involvement.

Critical/Complex Needs	Risk to child and others due to lack of boundaries/supervision. Risk to health and development due to challenging behaviours i.e. smearing of faeces/wetting and soiling, washing and dressing.	Involvement by CAMHS/SLD Team. Social Work Allocation. Consideration for respite provision. Referral for Family Group Conference - SW Team. Referral to Family Resource Team. Consideration to Child Protection Procedures.

8. Development of Unborn Baby, Infant, Child or Young Person Foundation Stage (3-5 years)

	Need	Potential Response
General Additional Needs	Ongoing difficulties with acquisition of skills within the foundation stage despite setting/taking appropriate action. Lower levels of attainment in all areas of development and learning than the majority of age equivalent peers.	Further specialist assessments may be necessary from external agencies such as PRESENS. Need to include the child in programme planning to maximise child's motivation to engage and persevere with activities. Regular opportunities for individual or small group support. Targets broken down into small achievable steps. Range of strategies including adult demonstration, verbal and visual prompts and physical assistance to support successful completion of appropriate activities. Parental involvement in individual planning. Liaison with other agencies as appropriate.

Significant Additional Needs	Persistent difficulties with the acquisition of skills within the Foundation Stage Curriculum despite child specific targeted interventions. Predicted long-term needs associated with severe learning difficulties	High level of individual and small group support required to access the curriculum. Likely to need support with personal care or safety needs. Modified learning materials and small steps learning with an emphasis on practical approaches and repetition. Opportunities and support to transfer and generalise new skills to other situations. Individualised approach to curriculum planning in all developmental areas including augmentative communication aids. Parental involvement in individual planning. Liaison with other agencies as appropriate.

Critical/Complex Needs	Unable to acquire the skills within the Foundation Stage Curriculum despite child specific targeted interventions. Predicted long-term needs associated with severe and complex learning difficulties.	As for Significant Additional Needs level PLUS: Will need support with personal care or safety needs. A high level of inter-agency planning and monitoring can be expected regarding day-to-day care.

9. Development of Unborn Baby, Infant, Child or Young Person Primary KS 1 & 2 (5 - 11 YEARS)

	Need	Potential Response
General Additional Needs	Difficulties with the acquisition of language, literacy and numeracy skills, which may be related to issues of access/attendance and engagement with school life. Parent/carer support for the child and school may be an issue.	Differentiation of the curriculum to match child's level of functioning. Small steps approach to target setting and planning with specific targets in literacy, language and/or numeracy, with the child involved to maximise motivation. Keeping tasks simple and other strategies that enable successful learning and the expected response from the child. Adaptation of teaching materials. Small group work needed with opportunities for individual work. Further assessments/liaison may be necessary from external agencies e.g. CAMHS, Social Care. Parental involvement in individual planning.

Significant Additional Needs	Persistent difficulties with the acquisition of language, literacy and numeracy skills despite appropriate interventions. May have associated difficulties with attention, co-operation, social interaction and organisation which affect their learning. There may be issues around access/attendance and engagement in school life. Appropriate parent/carer support for the child may be an issue.	Further specialist assessments/intervention may be necessary from external agencies. Further differentiation of the curriculum by learning objectives, access and teaching style. Need to include the child in programme planning to maximise child's motivation to engage and persevere with activities. Regular opportunities for individual support. Targets broken down into small achievable steps and specific to language, literacy and numeracy. Range of strategies including adult demonstration, verbal and visual prompts and physical assistance to support successful completion of appropriate activities. Parental involvement in individual planning. Liaison with other agencies as appropriate.

Critical/Complex Needs	Severe and long term difficulties with the acquisition of language, literacy and numeracy skills despite child specific targeted interventions. Predicted long-term needs associated with severe and complex learning difficulties. Pupil relies on/is dependent on adult/peer support at home and school. There may be associated difficulties of access and engagement and behavioural difficulties. An individualised curriculum may be needed in all areas and augmentative communication systems.	As for Significant Additional Needs level PLUS: High level of individual and small group support required to access the curriculum. Likely to need support with personal care or safety needs. Mobility needs met. Modified learning materials and small steps learning with an emphasis on practical approaches and repetition. Use of specialist approaches. Opportunities and support to transfer and generalise new skills to other situations. Individualised approach to curriculum planning in all developmental areas including augmentative communication aids. For highly complex needs, a high level of inter-agency planning and monitoring can be expected regarding day-to-day care. Provision of specialist equipment and facilities, communication aids and software. Staff trained or experienced in teaching a highly differentiated curriculum. Provision of therapy services in school and integration of this with educational programme. High level of parental involvement and home/school liaison.

10. Development of Unborn Baby, Infant, Child or Young Person Secondary KS 3, 4 & post 16 (11 - 16 YEARS)

	Need	Potential Response
General Additional Needs	Ongoing difficulties with the acquisition of language, literacy and numeracy skills, which may be related to issues of access/attendance and engagement with school life. Parental/carer support for the child and school may be an issue.	Differentiation of the curriculum to match child's level of functioning. At Key Stage 4 and post 16 - modification of 'entry level' courses. Use of Youth Award Schemes. Guidance from connexions. Small steps approach to target setting and planning with specific targets in literacy, language and/or numeracy with the young person involved to maximise motivation. Keeping tasks simple and other strategies that enable successful learning and the expected response from the child. Adaption of teaching materials and use of ICT. Small group work will need to be the norm with opportunities for individual work. Out of hours learning opportunities, e.g. leisure activities. Parental involvement in individual planning.

Significant Additional Needs	Persistent difficulties with the acquisition of language, literacy and numeracy skills despite appropriate interventions. May have associated difficulties with attention, co-operation, social interaction and organisation which affect their learning. There may be issues around access/attendance and engagement in school/college life. Appropriate parent/carer support for the child may be an issue.	Further specialist assessments/intervention may be necessary from external agencies. Further differentiation of the curriculum by learning objectives, access and teaching style. Further modification of entry level courses and use of Youth Aware Schemes and guidance from specialist Connexions PAs. Need to include the young person in programme planning to maximise their motivation to engage and persevere with activities. Use of ICT. Regular opportunities for individual or small group support. Targets broken down into small achievable steps and specific to language, literacy and numeracy. Range of strategies including adult demonstration, verbal and visual prompts and physical assistance to support successful completion of appropriate activities. Parental involvement in individual planning. Liaison with other agencies as appropriate and in line with transition protocols.

Critical/Complex Needs	Severe and long-term difficulties with the acquisition of language, literacy and numeracy skills despite young person specific targeted interventions. Predicted long-term needs associated with severe and complex learning difficulties. Young person relies on/is dependent on adult/peer support at home and school. There may be associated difficulties of access and engagement and behavioural difficulties. An individualised curriculum may be needed in all areas and augmentative communication systems.	As for 'medium' level and in addition: High level of individual and small group support required to access the curriculum. Likely to need support with personal care or safety needs. Mobility needs met. Modified learning materials and small steps learning with an emphasis on practical approaches and repetition. Use of specialist approaches. Opportunities and support to transfer and generalise new skills to other situations. Individualised approach to curriculum planning in all developmental areas including augmentative communication aids. Life skills embedded in the curriculum. For highly complex needs, a high level of inter-agency planning and monitoring can be expected regarding day-to-day care. Ensure local transition protocols followed. Provision of specialist equipment and facilities, communication aids and software. Staff trained or experienced in teaching a highly differentiated curriculum. Provision of therapy services in school and integration of this with educational programme. High level of parental involvement and home/school liaison.

11. Parents and Carers - Basic Care, Ensuring Safety and Protection

	Need	Potential Response
General Additional Needs	Child has healthy diet some of the time - need to improve balance of food for healthy development. Child attends dental checks with support. Some support needed for personal care needs of child.	Signpost for advice and information. Parents Groups.

Significant Additional Needs	Child has unhealthy diet. Irregular dental care facilitated by parents/carer. Some concerns re consistency of meeting child/young person's personal care needs.	Consider consultation with Mental Health Worker. Consider home visit by Duty Social Worker to consider Family Support services. Consider multidisciplinary planning meeting. Consider referral to Multidisciplinary Resource Panel.

Critical/Complex Needs	Lack of adequate food provided by parents/carers. Child not able to access adequate healthy diet due to challenging behaviour or severe physical disability. Parents/carers have not ensured dental care of child/young person resulting in poor dental care of child. Parents/care not meeting/unable to meet personal care needs of child/young person.	Referral to CAMHS SLD team. Consider Child Protection procedures. Social work allocation. Multidisciplinary meeting. Referral for Family Group Conference.

12. Emotional Warmth and Stability

	Need	Potential Response
General Additional Needs	Evidence of instability in the family environment. Concern re opportunities for social interaction. Parents/carers experiencing stress.	Signpost for advice and information. Parents Groups.

Significant Additional Needs	Concerns ongoing and some indication of attachment difficulties that are persistent. Risk of parental family breakdown.	Consider consultation with Mental Health Worker. Consider home visit by Duty Social Worker to consider Family Support services. Consider multidisciplinary planning meeting. Consider referral to Multidisciplinary Resource Panel.

Critical/Complex Needs	Significant concern re child's emotional wellbeing with a relationship to parenting capacity. Evidence of attachment difficulties. Evidence of persistent negative comments and attitude. High likelihood of family breakdown.	Referral to CAMHS SLD team. Consider Child Protection procedures. Social work allocation. Multidisciplinary meeting. Referral for Family Group Conference.

13. Guidance and Boundaries

	Need	Potential Response
General Additional Needs	Parents/carers experiencing difficulties re guidance boundaries and stimulation.	Signpost for advice and information. Parents Groups.

Significant Additional Needs	Parents difficulties impacting on child's behaviour at home and in other environments, e.g. school/nursery. Concern re parents' capacity to provide appropriate guidance, boundaries and stimulation. Concerns re family isolation and over-protection.	Consider consultation with Mental Health Worker. Consider home visit by Duty Social Worker to consider Family Support services. Consider multidisciplinary planning meeting. Consider referral to Multidisciplinary Resource Panel.

Critical/Complex Needs	Child beyond parental control and at risk due to lack to supervision and boundaries. Child presenting severe challenging behaviour causing risk to self or to others with lack of appropriate parental response. Risk of family breakdown.	Referral to CAMHS SLD team. Consider Child Protection procedures. Social work allocation. Multidisciplinary meeting. Referral for Family Group Conference.

14. Family and Environmental - Family History, Functioning and Wellbeing

	Need	Potential Response
General Additional Needs	Family history of either physical/mental illness for parents/carers. Multiple needs of siblings and parents/carers and changes in dependency needs. Previous significant family events that have had an impact over a period of time. Step families and impact of changes in family household. Cultural needs of child and family not consistently met.	Advice and information Counselling support - Chailey/school/GP. Referral to Young Carer's/Carers Centre. Other support services, i.e. Relate, Cruze, Mosaic.

Significant Additional Needs	On-going and persistent issues re family functioning over a sustained period of time, i.e. bereavement, separation, drug misuse, criminality. Inconsistent parenting styles.	Home visit by Social Worker - Social Work Assessment to assess family strengths and protective factors. Referral to CAHMS/SLD Team. Parenting group and parenting support. Possible involvement of Drug misuse support services, i.e. Adaction or Probation. Referral to Multidisciplinary Resource Panel.

Critical/Complex Needs	Risk of family breakdown due to family functioning. Risk to child/young person due to lack of protection. Risk to child/young person due to significant changes in family composition exposing child/young person to an unsafe situation or environment. Social isolation of family due to cultural needs/communication issues.	Referral for Family Group Conference. Consideration for respite/Outreach services. Referral to RISE Consideration for implementation of Child Protection procedures due to physical, emotional, neglect, sexual abuse.

15. Family and Environmental - Wider Family

	Need	Potential Response
General Additional Needs	Benefit advice/limited financial capacity. Opportunities for family to spend more time together/some respite needs identified. Support for child to enable parents to work.	Signpost for advice and information. Parents Groups.

Significant Additional Needs	Need for break in caring role. Limited family support referrals leading to social isolation of family.	Consider consultation with Mental Health Worker. Consider home visit by Duty Social Worker to consider Family Support services. Consider multidisciplinary planning meeting. Consider referral to Multidisciplinary Resource Panel.

Critical/Complex Needs	No extended family networks or support networks available and family socially isolated. Risk to family breakdown due to lack of support. Temporary lack of ability to care for child due to parental illness/crisis.	Referral to SLD team. Consider Child Protection procedures. Social work allocation. Multidisciplinary meeting. Referral for Family Group Conference.

16. Family and Environment - Housing, Employment and Financial Considerations

	Need	Potential Response
General Additional Needs	Application for appropriate benefits due to disability/caring role. Housing needs identified. Debt management	Signpost for advice and information. Referral to Amaze for DLA benefit advice . Liaison with Housing department. Referral to CAB

Significant Additional Needs	Overcrowding Potential Adaptation needs Evidence of financial hardship	Referral to Housing Liaison Meeting. Referral to occupational therapist re adaptation process. Charitable applications made for specific needs Referral to the Family Fund Carers needs considered re employment ,use of respite services to facilitate this.

Critical/Complex Needs	Not entitled to public funds e.g. housing benefit which will cause homelessness.	Emergency funding and liaison with NASS and our Legal dept.

17. Social and Community Elements

Need

Potential Response

General Additional Needs

Significant Additional Needs

Critical/Complex Needs

General Additional Needs/Significant /complex

Social and community issues impacting on family or individual quality of life e.g. religious issues lack of places to worship.

Lack of appropriate transport/shopping facilities/Leisure activities

Issues with neighbours /antisocial behaviour

Signpost for advice and information.

Parents Groups / liaison with police/ Youth Offending Team.

Involvement with religious organisations on behalf of family if helpful.

Consider if access to leisure or other essential service is not possible assistance with funding to facilitate this.

18. Glossary of Terms

Acronym	Translation
ASC	Autistic Spectrum Condition
CAF	Common Assessment Framework
CAMHS	Child Adolescent Mental Health Service
CAB	Citizens Advice Bureau
CAPS	Chailey Adjustable Postural Support
DLA	Disability Living Allowance
ENT	Ear Nose Throat
EY	Early Years
GP	General Practitioner
ICAN
ICDDS	Integrated Child Development & Disability Service
HV	Health Visitor
ICT	Information Communication Technology
JSC	Jeanne Saunders Centre
NASS	National Asylum Support Service
PA	Personal Assistant
PRESENS	Pre School Special Educational Needs Service
SLD	Severe Learning Disability
SLT	Speech Language Therapy
SW	Social Worker

End