Component 3b: Single Agency Assessments in Public Health

Transcription

1 Component 3b: Single Agency Assessments in Public Health The purpose of the Public Health Nurses Single Agency Assessment The purpose of creating a Single Agency Assessment as part of the integrated framework of developing children s well-being is to: Within the integrated pathway for children, Single Agency Assessments feature predominantly within the three responses of: establish a common language across children and family services that is accessible to children, families and all practitioners support consistency in the practice of involving children and families in decisions which affect their lives The family and universal services improve the quality of information used to take decisions about children s lives establish a common outcome focus for all practitioners with a role in developing children s well-being Additional support from within a universal service Joint working - additional support from another agency empower all participants to contribute to a child s well-being, including assessment, planning and action, to their fullest ability establish a structured, streamlined and simplified process of information gathering and analysis across the universal services improve the efficiency of assessment processes and reduce the number of assessments that a child/young person and their family experience break down unnecessary professional barriers that are not in the interests of children facilitate the practice of sharing information where it is in the best interest of children and families improve the confidence and competence of professionals to fully engage with a process with which they are familiar and use regularly. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 95

2 Practice Guide Single Agency Assessments include the following paperwork: Maternity Part I Parental capacity to provide well-being Maternity Part II My World Assessment Triangle Public Health Part I Getting it right for every child encourages an appropriate, proportionate and timely approach to assessing children whether within single agencies or a multi-agency environment. For this reason Lanarkshire has developed two parts to the Single Agency Assessment allowing practitioners to get on and help children where they can without having to gather and analyse information unnecessarily. Part I, using the eight indicators of wellbeing, is designed to allow practitioners to answer the question: What is getting in the way of this child/young person s well-being? Well-being assessment Public Health Part II My World Assessment Triangle Education Part I Well-being screening Education Part II My World Assessment Triangle What I Think Tool 96 Where children s well-being is developing as it should, the role of the Named Person is to ensure that parents are aware of how they are contributing to their child s well-being, thereby reinforcing their capacity to parent with minimal intervention. Where there is an issue which can be addressed quickly by the Named Person, practitioners will take appropriate action ranging from continuous assessment or specific supports to help the child or young person. Do I have all the information I need to help this child/young person? When there is not enough information for public health nurses to assess and respond with confidence, they should consider moving on to the Single Agency Assessment Part II which requires a much more detailed process of gathering and analysing information and creates a better picture of the child s world using the My World Assessment Triangle. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

3 The practice of using Public Health Nurses Single Agency Assessment (This guidance should be read in conjunction with the child/young person s integrated pathway poster.) The public health nursing service in NHS Lanarkshire works with individuals, families and communities to improve and address health inequalities within the continuum for public health practice. The service is based on delivering progressive universalism underpinned by evidence, in a variety of settings, with a multi-skilled team and a focus on families with children from 0 18 years of age. The public health nursing service is based on the principles of health visiting (CTEHV 1977, 1991) which are: the search for health needs the stimulation of an awareness of health needs the influence on policies affecting health the facilitation of an awareness of health need. Public health nursing services are delivered within a framework of professional accountability (NMC 2002) and are underpinned by evidence-based practice, equity and accessibility of service provision and service user involvement. This means that assessment of health needs in the widest sense is a core function of the public health nurse in a dynamic process which is ongoing and centring around the family and the child. For this reason Getting it right for every child has been incorporated into the public health nursing record, reflecting the core function of the public health nurse. Well-being assessments are not standalone documents that must be completed in addition to all other information gathering and recording. Well-being is used as the underpinning structure against which all information gathering, assessment and health improvement activity is carried out and recorded. The public health nursing record, based on the NHS Highland model, is organised into the various contacts that a child will experience from the age of ten days until they attend primary school. The areas of interest for each visit are organised under the structure of wellbeing supporting public health nurses to carry out their role. This guidance should be followed by all public health nursing team members to support the implementation of Getting it right for every child in Lanarkshire. The family and universal services Seventy to eighty per cent of the infants and children in Lanarkshire will grow and develop from birth, entering nursery and primary without the need for any help other than the family, maternity, public health nursing and education services. For families in this situation public health nurses will use the public health nursing record to record and analyse their findings. Well-being assessments will be reviewed at agreed ages and stages contained in the public health nursing record. From the point of first visit contact, public health nurses will be mindful of the baby s right to well-being, to be safe, healthy, achieving, nurtured, active, respected, responsible and included. The priority areas for advice, health improvement and support for each contact are listed as prompts under the well-being structure. This format is not designed as a template and should not restrict assessment activity but serve as a guide of the minimum requirements of each well-being review. Public health nurses will continue in this way, using well-being as the structure for the contact record. This assessment will be updated at each of the agreed reviews until the child begins primary school. For children who require no other support than the core public health nursing service, the agreed schedule and the continuation sheet, or where appropriate and proportionate an assessment of well-being outwith routine contact, will suffice to ensure that the child is growing and developing. Within public health, the assigned Named Person will take overall responsibility for the Single Agency Assessment Part I (well-being) using the public health nursing record and, with appropriate consents, will have authority to share the information. At the point that responsibility for the child s well-being moves to education, with Informed Consent, the Single Agency Assessment Part I (well-being) will be shared with the relevant primary school. Where children attend a pre-school provider, information about the child s wellbeing can also be shared where Informed Consent is in place. The agreed well-being reviews will be confirmed within the child/family health record. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 97

4 Practice Guide Additional support from within a universal service Some families will need additional help from the public health nurse to make sure a child s well-being is developing as it should. This help could take the form of additional contact and support from the public health nurse or supports from other health professionals. For example, some antenatal mothers will require the public health nurse to become involved from 36 weeks gestation. Families who need any kind of additional support from the universal public health service will be assigned a health plan indicator of additional. At the point the family is identified with an HPI of additional, the public health nurse will use professional judgement to decide how much contact is necessary as well as the most appropriate format for recording information, i.e. whether well-being and continuation record is enough, whether additional wellbeing assessments would be more appropriate or whether a Part II My World Assessment Triangle should be used. Help could be related to short term incapacity of the parent, such as post-natal depression, or possible concerns about the baby s health identified through routine contact visits, such as failure to gain weight or developmental delay. Scheduled contact visits, the continuation sheets, chronology and outcome plan may be enough for some families whereas others may need this record plus assessments of well-being outwith routine contacts. Where advice and/or short term support is needed from paediatric physiotherapy, or occupational therapy, it might be that the well-being indicators provide enough information to record the child s needs effectively. However, at any point when more detail is necessary, the information against the well-being indicators can be used as the basis of the Part II assessment (My World Assessment Triangle) and more detail added. For some families the public health nurse will quickly identify that the My World Assessment Triangle is the most appropriate structure to record assessment activity. Where issues present alongside each other, within a vulnerable family experiencing a number of adversities, Part II will be more appropriate. The testing exercise highlighted an overreliance on the well-being indicators, sometimes used inappropriately when a much more detailed picture was necessary. If unsure, public health nurses should seek support through their professional leadership structures. Whether using Part I or Part II, assessment should be an ongoing process, regularly updated to ensure that all relevant information is captured. If there is a need to complete Part I outwith the NHSL agreed times, for example a child moving into the area or a change in circumstances, assessments of well-being outwith routine contacts should be completed. Public health nurses will also decide whether the eight indicators of well-being continue to be appropriate or whether a more detailed picture using the Single Agency Assessment Part II (My World Assessment Triangle) will more accurately reflect the child s needs. Joint working - additional support from another agency The Getting it right for every child framework is designed to promote more effective and efficient processes and should not delay help or act as a barrier. Where public health nurses need help from another agency, well-being or the My World Assessment Triangle should be used, depending on what is most appropriate and proportionate to the child. Where the well-being indicators provide enough information to assess what a child needs and to act, it is not necessary to gather more information. However, where public health nurses don t have enough information to clearly understand, the My World Assessment Triangle should be used to structure and analyse information systematically to make sure that all known information about the child is recorded and analysed. Public health nurses may be supporting a family living with ill health, disability, mental health issues or a range of social issues such as substance misuse, isolation or domestic abuse. The family may have an infant as well as children of school age and public health will have to work closely with education. Where the child s well-being requires the public health nurse to work with another agency, he/she will ask for Informed Consent, Request Assistance and share the most recent well-being review, assessment of well-being outwith routine contact or My World Assessment Triangle. Equally, the public health nurse may be made aware of other agencies already working with a family at the point he/she becomes the Named Person for a new child and may identify that the Single Agency Assessment Part II is more appropriate from the outset. * The need to move to integrated working or compulsory intervention Integrated working Where a child s well-being depends on professionals from different agencies regularly sharing information, knowledge and expertise, an Integrated Assessment and Child s Plan will be required. Public health nurses contributing to or instigating integrated working can transfer information from the Single Agency Assessment Part II (My World Assessment Triangle) to the Integrated Assessment and Child s Plan format and add further detail as necessary. Compulsory intervention Where colleagues in children and families social work have a statutory role and require information from other agencies, public health nurses should share any information gathered using the Single Agency Assessment format as quickly as possible. Where no assessment activity has taken place, public health nurses should commence a Single Agency Assessment Part II. 98 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

5 The role of the public health nurse in implementing Single Agency Assessments The role of the public health nurse in implementing Single Agency Assessments is: to support and encourage families to understand and contribute to their child s well-being as fully as possible, including participation in any assessment process as the Named Person from the age of days until the child attends primary school, to be responsible for the professional contribution to a child s well-being using the Single Agency Assessment documentation appropriately (targeted contact with some antenatal mothers will be necessary whilst maternity services act in the role of Named Person) to use the Single Agency Assessment Part I (well-being) from the first contact visit with a family, gathering evidence of positive and negative indicators of well-being in a continual process of assessment, planning and review for as long as the public health nurse judges this to be appropriate and proportionate to their needs to use professional judgement to decide at any point in contact with a family to use Single Agency Assessment Part II (My World Assessment Triangle). The Single Agency Assessment Part II should be used proportionately to gather the detail necessary to assess the child and their unique circumstances to seek help at any time if unsure of any aspect of the Single Agency Assessment documentation using existing professional leadership structures to use the information from the Single Agency Assessment to contribute to an Integrated Assessment and Child s Plan when necessary to develop a child s well-being to share Single Agency Assessments as quickly as possible when requested, as part of integrated working or compulsory intervention to develop a child s well-being to continue to reflect on the experience of implementing the Single Agency Assessment making suggestions for improvements. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 99

6 Practice Guide 100 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

7 Index NHSL Public Health Nursing SINGLE AGENCY ASSESSMENT PART I Guidance on assessment of well-being outwith routine contact H.I. a Personal details and reason for well-being assessment H.I. b Well-being indicators: 0 1 year old assessment guidelines Well-being indicators: 1 2 year old assessment guidelines Well-being indicators: 3 4 year old assessment guidelines H.I. c Conclusions and recommendations Exemplar: Jack 114 SINGLE AGENCY ASSESSMENT PART II Guidance: My World Assessment Triangle H.II. a Personal details and reason for well-being assessment H.II. b What I need from the people who look after me How I grow and develop My wider world H.II. c Conclusions and recommendations H.II. p Single agency plan *119 and 123 *120 and 126 *122 and Exemplar: Mary 132 * Two sets of guidance notes are available for each of these sections Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 101

8 Practice Guide Date started: CHI number: From point well-being is recorded H.I.a As recorded GUIDANCE NHSL Public Health Single Agency Assessment PART I Guidance on Assessment of wellbeing out with routine contact HPI Core HPI Additional Named Person (name and full contact details): The member of PHN team who has taken, or been given, the role of Named Person between days and attending primary school Lead Professional, if any (name and full contact details): This section should record the professional who is responsible for gathering information from a number of agencies and for bringing agencies together to analyse the findings and agree the Child s Plan Personal details Child/young person s forename: Child/young person s surname: The name on the birth certificate The name on the birth certificate Address: Date of birth: The date on the birth certificate The address the child is currently residing Post Code: Essential to include this detail School or nursery if any: Only if the child is attending at time of recording Date of admission to education: date child began using pre-school or school place Name of parent/carer 1: The parent with whom the child is residing or the primary carer Telephone: A number the parent/carer can be reached on Name of parent/carer 2: The other adult with whom the child is residing or who is recognised as having parental rights and responsibilities Telephone: as above Address of parent/carer if different from above: Ensure that post code is inserted so that parent/carer can be reached if required Legal status Child protection status Looked after at home: (if known by PHN at this point) Child protection register: (if known by PHN at this point) Looked after away from home: (if known by PHN at this point) Child protection investigation: (if known by PHN at this point) Previously either of the above: (if known by PHN at this point) Any past child protection activity: (if known by PHN at this point) The reason for completing a Single Agency Assessment Part I (well-being assessment) As part of a routine process of allocating/reviewing the HPI As part of transition planning A change in circumstances which requires further assessment In response to a Request for Assistance/ tification of Concern Other please detail: there may be reasons other than the above such as families moving in to the area. Use where appropriate. Planning status (please circle any that are relevant) This section should detail where you are in the assessment process) Any previous Single Agency Assessments Part I (well-being) Any previous Single Agency Assessments Part II (My World Assessment Triangle) Child s well-being plan Chronology in process Information sharing protocol Previous Requests for Assistance Review date: date when you will raise the issue of consent again Confirm whether any separate tool used to gather the child/young person s view is attached. Otherwise use the well-being assessment capturing the child/young person s own words wherever possible (the What I Think Tool can be used where it is appropriate for the age and stage of the child/young person). Any other relevant information: Please insert any information that will allow the external reader to quickly understand the context of this assessment The well-being guidance you have already done should go in here followed by the conclusions and recommendations sheet which you have already done 102 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

9 Well-being indicators assessment guidance Practitioners should know that a child s development assessed through well-being includes emotional, physical, intellectual, social, moral and character growth and that these can all affect one another. The well-being of children is at the heart of Getting it right for every child. The eight indicators of well-being: safe, healthy, achieving, nurtured, active, respected, responsible and included are the basic requirements for all children to grow, develop and reach their full potential. Children will progress differently depending on their circumstances, but every child and young person has the right to expect appropriate support from adults to allow them to develop as fully as possible across each of the well-being indicators. See below for some examples to aid in your assessment. H.I.b GUIDANCE NHSL Public Health Well-being indicators: 0 1 year old assessment guidelines 1/3 Well-being Safe Evidence of understanding and appropriate action in relation to: SIDS (sudden infant death syndrome) car safety home safety animal safety pram and cot safety sleeping pattern/bed sharing/position/ temperature (see prevention of cot death) carers routine/lifestyle medicine storage safety accommodation and surroundings is safe artificial feeding preparation safety Impact of poverty and poor social circumstances Impact of disability carer/child Impact of a stressful childhood on a household member (abuse, period in care, poor physical health) Temporary accommodation Healthy Sleeping pattern (moving from long periods of sleep interspersed with short periods of wakefulness to longer periods of wakefulness including feeling fretful/crying/periods of calm) Feeding appropriate for age Baby full term at birth Weight and length at expected level Baby normally well Hearing satisfactory (neo-natal hearing screening) Immunisations up to date parents/carers have an explanation as to why if not up to date Gross motor skills age appropriate Vision and fine motor skills age appropriate Skin care bathed regularly, nappy changed regularly Handwriting tables kept Head circumference/fontanel/umbilicus Premature infant Infant withdrawal symptoms Milestones not reached Disability/chronic illness Acute period of illness Poor physical and/or mental health of parent/carer Interrupted sleep patterns Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 103

10 Practice Guide H.I.b GUIDANCE NHSL Public Health Well-being indicators: 0 1 year old assessment guidelines 2/3 Well-being Achieving Reaching developmental milestones (speech language and communication/social behaviour and play/hearing/gross motor skills/vision and fine movements) Appropriate play routine parent/carer reads/talks/ sings/floor play Parent/carer gives appropriate stimulation (praise, encouragement) Parent/carer unable to give appropriate responses (over or under stimulation) Infant has disability that could inhibit parent/carer Poor physical/mental health of parent/carer Nurtured Carer/parent expresses and illustrates love and emotional warmth towards baby (is loved unconditionally) Parent/carer readily responds to infant s emotional needs ( in tune with baby s needs for comfort) Parent/carer seeks appropriate help and advice if experiencing difficulties managing baby Parent/carer calm and consistent when dealing with baby s distress Baby responds with obvious pleasure to loving attention and cuddles Baby is calm and comfortable with parent/carer Siblings show obvious love and affection towards baby Physical needs of baby attended to by parent/ carer Parent/carer spends sufficient time with baby to sustain a strong relationship A limited number of safe adults deliver intimate care Parent/carer has sufficient empathy with baby to be able to respond appropriately Baby is exposed to frequent criticism/hostility Conflict and hostility within family environment (continued abusive and stressful situations) Mental/physical health of main carer continuity or stability in care of infant (many and varied carers for baby) social support for parent/carer Traumatised infant becomes hyper vigilant/hyper aroused Active Play time appropriate (bath/floor/cuddles) Parent/carer may attend local groups (Bounce and Rhyme) Walking outdoors in pram Taken out to visit family/friends/shops/local community Despite a physical disability, the parent/carer does not isolate child Parent/carer socially isolated and therefore unable to participate with child in any activity Parent/carer physical/mental health concerns (depression can affect capacity to care about the baby) Baby socially isolated Developmental delay 104 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

11 H.I.b GUIDANCE NHSL Public Health Well-being indicators: 0 1 year old assessment guidelines 3/3 Well-being Respected Good family routine creating structure, continuity and stability Parent/carer appropriately responds to needs of baby Any physical abnormality accepted Respecting and providing boundaries and a controlled environment Language and tone of that language used appropriately Involved in decisions that affect them Developmental delay Insecure attachment to parent/carer Responsible Appropriate modelling of behaviour Taking cues and responding appropriately Sense of identity Level of resilience apparent Allowing baby to make choices where appropriate Baby s needs are regularly satisfied by familiar carer sense of control Baby s emotions and behaviours ignored Included Support from family/friends (siblings/ grandparents) Development of secure attachment Access to family support Access to community support Expectation of infant to be liked by carers sees adult as dependable and trustworthy If parent shows apathy towards child, this can result in identity problems Anxious attachment Summary for 0-1 year Concerns for child 0-1 year: the child s health and developmental problems may be exacerbated by living in a poor physical environment children may fail to develop a positive identity because they are rejected and are uncertain of who they are a lack of commitment and increased unhappiness, tension and irritability in parents may result in inappropriate responses which lead to poor attachment cognitive development of the infant may be delayed through parents inconsistent, under-stimulating and neglecting behaviours Protective factors for children 0-1 year: secure, early relationships sufficient income and good physical standards in the home regular support and help from primary care and local authority presence of an adult who responds and prioritises the developmental needs of the baby the primary task to be accomplished during the first year of life is for the baby to develop trust in others (Fahlberg 1991) Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 105

12 Practice Guide H.I.b GUIDANCE NHSL Public Health Well-being indicators: 1-2 year old assessment guidelines 1/3 Well-being Safe Appropriate home safety precautions (safety gates, cupboard locks, medicine storage) Understands simple commands (responds to no, give it to me) Achieving developmental milestones Immunisations up to date Infant has a range of safe toys to play with Accidental injuries appropriately dealt with by parent/carer Infant physically at risk (left alone with no regard for safety) Parent/carer unable to anticipate danger and unable to provide infant with feelings of safety Unsuitable housing and surrounding environment Insecure attachment poor interaction between parent/carer and child Inappropriate discipline of child (smacking, shaking) Healthy Infant is normally well Developmental milestones achieved Infant has age appropriate diet nutritious and adequate, always supervised Parent/carer responds appropriately to any symptoms of illness Immunisations up to date Illness of child not seen as priority to parent/carer develops into more serious condition Child unable to communicate their distress Physical neglect (unwashed and unfed) Achieving Reaching developmental milestones Appropriate play routine parent/carer reads/talks/ sings/floor play Parent/carer gives appropriate stimulation (praise, encouragement) Infant likes parent/carer to be within sight and hearing Affection demonstrated to familiars Parent/carer unable to give appropriate responses (under or overstimulation) Infant has disability that could inhibit parent/carer Poor physical/mental health of parent/carer 106 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

13 H.I.b GUIDANCE NHSL Public Health Well-being indicators: 1-2 year old assessment guidelines 2/3 Well-being Nurtured Carer/parent expresses and illustrates love and emotional warmth towards child (is loved unconditionally) Parent/carer readily responds to infant s emotional needs ( in tune with child s need for comfort) Parent/carer seeks appropriate help and advice if experiencing difficulties managing child Parent/carer calm and consistent when dealing with child s distress Child outgoing and smiles and talks needs parent/carer close by Parent/carer takes pleasure in observing interaction between child and others Child s sense of self begins to develop Parent/carer spends sufficient time with baby to sustain a strong relationship and child begins to separate emotionally from parent/carer Parent/carer has sufficient empathy with child to be able to respond appropriately and becomes the safe haven for child from which to explore Learns that their name is important part of their identity Child is exposed to frequent criticism/hostility Conflict and hostility within family environment (continued abusive and stressful situations) Mental/physical health of main carer continuity or stability in care of child (many and varied carers) social support for parent/carer Traumatised child becomes hyper vigilant/hyper aroused Child becomes listless and uninterested Parent/carer can inhibit child s sense of identity (too controlling, too protective) Active Parent/carer ensures child has plenty of opportunity and encouragement to develop motor skills Play time appropriate (bath/floor/cuddles) Parent/carer may attend local groups (Bounce and Rhyme, toddlers, playgroups) Walking outdoors Taken out to visit family/friends/shops/local community Despite a physical disability, the parent/carer does not isolate child Parent/carer socially isolated and therefore unable to participate with child in any activity Parent/carer physical/mental health concerns (depression can affect capacity to care about the baby) Weight gain under/over expected centiles Respected Continued evidence of secure attachment to primary carer Parent/carer provides positive attention and appropriate explanation to child Verbal language and tone used appropriately Parent carer encourages child to learn to communicate their needs, including verbalising Developmental delay Insecure attachment to parent/carer Inappropriate tone or sanctions Insufficient attention to encourage development of communication skills Failure to understand limitations of communication Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 107

14 Practice Guide H.I.b GUIDANCE NHSL Public Health Well-being indicators: 1-2 year old assessment guidelines 3/3 Well-being Respected Parent/carer demonstrates ability to understand despite limited communication skills Child communicates using gesture or emerging verbal skills Child is responded to appropriately - being lifted, fed, changed, cuddled etc Child is understood as an individual Any physical or mental abnormalities accepted Inappropriate response to attempts by child to communicate Parent struggling to accept any physical or mental abnormalities Responsible Appropriate modelling of behaviour Taking cues and responding appropriately Sense of identity Level of resilience apparent Allowing child to make choices where appropriate sense of control If child witnessing domestic violence they may try to protect the victim (patting, touching) Included Support from family/friends (siblings/grandparents) Development of secure attachment Access to family support Access to community support Expectation of infant to be liked by carers sees adult as dependable and trustworthy If parent shows apathy towards child, this can result in identity problems Anxious attachment Summary for child 1 year - 2 plus years Concerns for chlld 1 year - 2 plus years: child may have their physical needs neglected the child s physical health is in danger when parents physical capacity to care is limited by mental illness, substance misuse, domestic violence inconsistent parenting damages parent/child attachment child could learn inappropriate behavioural responses when witnessing domestic violence. Protective factors for child 1 year - 2 plus years: consistent caring adult, responding to child s cognitive and emotional needs sufficient income and good physical standards in the home regular support and help from primary care and local authority presence of an adult who responds to developmental need of child. 108 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

15 H.I.b GUIDANCE NHSL Public Health Well-being indicators: 3-4 year old assessment guidelines 1/3 Well-being Safe Appropriate home safety precautions (safety gates, cupboard locks, medicine storage) Achieving developmental milestones (walks alone upstairs, usually jump from bottom stair!) Immunisations up to date Child has a range of safe toys to play with Accidental injuries appropriately dealt with by parent/carer Child physically at risk (left alone with no regard for safety) Parent/carer unable to anticipate danger and unable to provide child with feelings of safety Unsuitable housing and surrounding environment Insecure attachment poor interaction between parent/carer and child Inappropriate discipline of child (smacking, shaking) Healthy Child is normally well Developmental milestones achieved if child has physical or learning difficulties should be receiving continued professional input Infant has age appropriate diet nutritious and adequate, always supervised Parent/carer responds appropriately to any symptoms of illness Immunisations up to date Illness of child not seen as priority to parent/carer develops into more serious condition Child unable to communicate their distress Physical neglect (unwashed and unfed) Achieving Reaching developmental milestones Appropriate play routine parent/carer reads/ talks/sings/floor play Parent/carer gives appropriate stimulation (praise, encouragement) Infant likes parent/carer to be within sight and hearing Affection demonstrated to familiars Parent/carer unable to give appropriate responses (over or under stimulation) Infant has disability that could inhibit parent/carer Poor physical/mental health of parent/carer Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 109

16 Practice Guide H.I.b GUIDANCE NHSL Public Health Well-being indicators: 3-4 year old assessment guidelines 2/3 Well-being Nurtured Carer/parent expresses and illustrates love and emotional warmth towards child (is loved unconditionally) Parent/carer readily responds to child s emotional needs ( in tune with child s need or comfort) Parent/carer seeks appropriate help and advice if experiencing difficulties managing child Parent/carer calm and consistent when dealing with child s distress Child outgoing and smiles and carries on simple conversations Parent/carer takes pleasure in observing interaction between child and others Child is exposed to frequent criticism/hostility Conflict and hostility within family environment (continued abusive and stressful situations) Mental/physical health of main carer continuity or stability in care of child (many and varied carers) social support for parent/carer Impact of poor parenting can be more damaging in some areas than in others child can blame themselves for parent s problems, taking too much responsibility and being physically and emotionally neglected Active Parent/carer ensures child has plenty of opportunity and encouragement to develop motor skills Play time appropriate (drawing copies circle, builds tower with cubes, builds bridge with cubes) Parent/carer may attend local playgroups or receive place at local authority nursery Walking outdoors, climbing outside Has a level of self-control Taken out to visit family/friends/shops/local community Despite a physical disability, the parent/carer does not isolate child Play really important at this age Parent/carer socially isolated and therefore unable to participate with child in any activity Parent/carer physical/mental health concerns (depression can affect capacity to care about the child) Weight gain under/over expected centiles Respected Good family routine creating structure, continuity and stability Parent/carer appropriately responds to needs of child Any physical abnormality accepted Respecting and providing boundaries and a controlled environment Language and tone of that language used appropriately Involved in decisions that affect them Developmental delay Insecure attachment to parent/carer If behaviour seen as frustrating to parent/carer this can be detrimental to child s sense of being worthwhile and capable (can become more dependant later on in life) positive identity if rejected and uncertain who they are 110 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

17 H.I.b GUIDANCE NHSL Public Health Well-being indicators: 3-4 year old assessment guidelines 3/3 Well-being Responsible Appropriate modelling of behaviour Taking cues and responding appropriately Sense of identity Level of resilience apparent Allowing child to make choices where appropriate sense of control If child witnessing domestic violence they may try to protect the victim (patting, touching) Included Support from family/friends (siblings/grandparents) Development of secure attachment Access to family support Access to community support Expectation of child to be liked by carers sees adult as dependable and trustworthy Happy to follow instructions You do this and I ll do that Increased vocabulary means child can ask and say what they want less frustration Has joined local pre-school nursery, playgroup If parent shows apathy towards child, this can result in identity problems Anxious attachment Summary for child 3 years - 4 pre-school years Concerns for child 3 years - 4 pre-school years: child may have their physical needs neglected the child s physical health is in danger when parents physical capacity to care is limited by mental illness, substance misuse, domestic violence inconsistent parenting damages parent/child attachment child s cognitive development may be delayed through lack of stimulation, disorganisation and failure to attend pre-school activities child could learn inappropriate behavioural responses when witnessing domestic violence. Protective factors for children 3 years - 4 pre-school years: consistent caring adult, responding to child s cognitive and emotional needs sufficient income and good physical standards in the home regular support and help from primary care and local authority presence of an adult who responds to developmental need of child. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 111

18 Practice Guide H.I.c GUIDANCE NHSL Public Health Conclusions and recommendations What is the analysis of the child/young person s well-being? (summary analysis using information from the well-being indicators) Are there any particular issues which are getting in the way of this child/young person s well-being? Using all evidence gathered against the well-being indicators and your professional knowledge and experience summarise the current situation for this child/ young person. What are the desired outcomes for this child/young person? What developments in well-being are you hoping for this child/young person at this point in time? What are the next goals or targets in relation to physical, emotional, psychological, social and intellectual growth and development? What are you as a public health nurse doing to help develop this child/young person s well-being? (please refer to any support or specific service you are providing) What supports are in place within the NHS to develop the child/young person s well-being, i.e. advice to the parent, short term help from colleagues such as physiotherapy or speech and language therapy, one-to-one support, social supports such as parent groups, home support, etc? Do you have all the information you need to help this child/young person s well-being? If it is possible from the information contained in this assessment to act then should be circled and action taken. If this is not the case, information should be requested from colleagues and Part II considered. What additional help or advice might you or the child need from within the health service to develop the child/young person s well-being? Are there any other services within NHSL that would benefit the child s well-being such as parenting classes, specialist nurses or other clinical intervention? Help should be appropriate and proportionate; if a child s well-being is developing without the need for further intervention, this should be encouraged. What additional help, if any, may be needed from professionals in another agency? Are there any other services you think may help the child/young person s well-being at this time? If additional support is identified, do you think a Single Agency Assessment Part II (My World Assessment Triangle) would help to provide a more detailed picture of the child? If additional support is identified, do you believe an Integrated Assessment and Child s Plan might help to bring all available information and relevant professionals together to develop the child/ young person s well-being? What are the parent/carer s views about the child/young person s well-being? (please summarise using their own words wherever possible) Parents should be made aware that information is being gathered against the well-being indicators to make sure the child s wellbeing will develop. Part of this process must be to ask for the parent s own view on their child s well-being. Their own words and perceptions should be recorded in this section rather than paraphrasing what they say. In line with Getting it right for every child parenting strategy, public health nurses should make every attempt to include both parents views wherever possible, part of which is to reinforce the crucial role male parents have. What are the child/young person s views about their own well-being? (based on the child s age, stage and capacity to communicate) The child/young person s views must be encouraged and recorded, even where support is necessary for them to express their views. The child/young person s own words and perceptions should be captured wherever possible. Where the child is not at the age and stage to verbalise, their behaviour and responses should be observed and recorded. Health Plan Indicator: Public health nurses should assign and record the Health Plan Indicator by circling as appropriate. Core Additional 112 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

19 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 113

20 Practice Guide Date started: CHI number: H.I.a HPI Core EXEMPLAR NHSL Public Health Single Agency Assessment PART I Assessment of well-being outwith routine contact Exemplar: Jack Smith X HPI Additional Named Person (name and full contact details): Anne Brown Lead Professional, if any (name and full contact details): N/A Personal details Child/young person s forename: Child/young person s surname: Jack Smith Address: Date of birth: Main Street Motherwell Post Code: ML1 111 School or nursery if any: ne Telephone number: Date of admission to education: N.A, Name of parent/carer 1: Mary Smith Telephone: Name of parent/carer 2: John Smith Telephone: Work and home Address of parent/carer if different from above: Legal status Child protection status Looked after at home: Child protection register: Looked after away from home: Child protection investigation: Previously either of the above: Any past child protection activity: The reason for completing a Single Agency Assessment Part I (well-being assessment) As part of a routine process of allocating/ reviewing the HPI As part of transition planning A change in circumstances which requires further assessment In response to a Request for Assistance/ tification of Concern Other please detail: Assessment of well-being outwith routine contact is being used because family has recently moved to the area Planning status (please circle all relevant) Any previous Single Agency Assessments Part I (well-being) Any previous Single Agency Assessments Part II (My World Assessment Triangle ) Child s well-being plan Chronology in process Information sharing protocol Previous Requests for Assistance / tification of Concern Review date: Confirm whether any separate tool used to gather the child/young person s view is attached. Otherwise use the well-being assessment capturing the child/young person s own words wherever possible (the What I Think Tool can be used where it is appropriate for the age and stage of the child/young person). Any other relevant information: 114 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

21 H.I.b EXEMPLAR NHSL Public Health Well-being: Jack Smith 1/2 Well-being Safe Practical care, i.e. home safety. Physical, social, emotional dangers, i.e. bullying. Parental support concerns and identifiable risk factors, i.e. parental drug and alcohol problems, child protection, family of concern Mum handles Jack appropriately for age and stage of development Jack is physically well cared for in a safe environment There is some evidence of parental awareness of safety and measures in place to protect. For example Jack is placed on his back in his crib when left unattended Healthy Vision, hearing, growth, immunisations, medical conditions, i.e. asthma, epilepsy, attention deficit disorder, developmental disorder, allergies, skin conditions, enuresis and encoparesis Breastfeeding is established and Jack appears to be thriving, gaining weight, plenty of wet and dirty nappies, mum aware of childsmile programme Achieving Communication, language acquisition and expression and developmental milestones Jack is responsive, smiling, following moving object Quietens to mother s voice Mum observed to stimulate Jack and reqularly talks and sings to Jack. Nurtured Provides love, emotional warmth, attachment, play stimulation and encouragement, physical and emotional care and an educationally rich environment. Access to parenting programmes and accesses health care appropriately Mum responds to Jack s cues for attention and communicates openly with him Jack is experiencing love and emotional warmth from mum Jack appears to be developing a secure base which will help foster resilience Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 115

22 Practice Guide H.I.b EXEMPLAR NHSL Public Health 2/2 Well-being: Jack Smith Well-being Known physical disabilities, receives stimulation and encouragement to learn. Child able to access play and leisure activities Active Jack is given the opportunity for floor play and tummy time Respected Any prejudices and tensions within family or community. Self-esteem, involved in decisions that affect them Mum is responsive to Jack and offers positive, dedicated attention She is connected to the baby/child s cues and responds appropriately using varying tones Mum reports dad spends quality time with Jack when not at work Responsible Level of resilience and sense of identify, encouragement to develop independence in every day life Mum is making progress in establishing routines and structures. For example bathtime/bedtime. Jack appears stable and content. Included Level of support from family, community. Child has friends. Appropriate attendance at playgroups /nursery 116 Limited extended family support following house move Mum reports to be socially isolated as just moved into the area Information given about local groups and mum encouraged to explore local facilities for Jack Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

23 H.I.c EXEMPLAR NHSL Public Health Conclusions and Recomendations What is the analysis of the child/young person s well-being? (summary analysis using information from the well-being indicators) Jack is thriving and achieving his developmental milestones in a safe, secure and loving environment with adequate stimulation and appropriate care. There is a risk of social isolation because the family is new to the area, although mum reports regular telephone contact with other family members. What are the desired outcomes for this child/young person? For Jack to continue to meet his developmental milestones For Jack to continue to thrive. What are you as a public health nurse doing to help develop this child/young person s well-being? (please refer to any support or specific service you are providing) Providing anticipatory guidance regarding Jack s physical and emotional development. Facilitate mum and Jack to connect with the community by attending baby/child massage classes Supporting to access other community resources that mum may consider to use Do you have all the information you need to help this child/young person s well-being? What additional help or advice might you or the child need from within the health service to develop the child/young person s well-being? ne at this stage What additional help, if any, may be needed from professionals in another agency? ne If additional support is identified, do you think a Single Agency Assessment Part II (My World Assessment Triangle) would help to provide a more detailed picture of the child? If additional support is identified, do you believe an Integrated Assessment and Child s Plan might help to bring all available information and relevant professionals together to develop the child/young person s well-being? What are the parent/carer s views about the child/young person s well-being? (please summarise using their own words wherever possible) I am happy with Jack s progress and reassured that the public health nurse is too. The only problem is that I m new to the area and feel a bit lonely, I don t have any friends here and the days can be really long. I will give the baby/child massage a go and see how I get on, I might meet other mums through this and that would be better What are the child/young person s views about their own well-being? (based on the child s age, stage and capacity to communicate) Jack presents as a contented and relaxed infant Public health nurse (Named Person) Signature: Date: Anne Brown Parent/carer Signature: Date: Mary Smith Signature: Date: Child/young person N.A. Finalise The point at which no further information will be added Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment Authorise for Sharing A signature here means the Named Person is taking responsibility for the information being shared 117

24 Practice Guide Date started: From point well-being is recorded CHI number: As recorded HPI Core H.II.a GUIDANCE NHSL Public Health Single Agency Assessment PART II Guidance on My World Assessment Triangle HPI Additional Named Person (name and full contact details): The member of PHN team who has taken, or been given, the role of Named Person between days and attending primary school Lead Professional, if any (name and full contact details): This section should record the professional who is responsible for gathering information from a number of agencies and for bringing agencies together to analyse the findings and agree the Child s Plan Personal details Child/young person s forename: The name on the birth certificate Child/young person s surname: The name on the birth certificate Address: The address the child is currently residing Post Code: Essential to include this detail Date of birth: The date on the birth certificate School or nursery if any: Only if the child is attending at time of recording Date of admission to education: date child began using pre-school or school place Name of parent/carer 1: The parent with whom the child is residing or the primary carer Telephone: A number the parent/carer can be reached on Name of parent/carer 2: The other adult with whom the child is residing or who is recognised as having parental rights and responsibilities Telephone: as above Address of parent/carer if different from above: Ensure that post code is inserted so that parent/carer can be reached if required Legal status Child protection status Looked after at home: (if known by PHN at this point) Child protection register: (if known by PHN at this point) Looked after away from home: (if known by PHN at this point) Child protection investigation: (if known by PHN at this point) Previously either of the above: (if known by PHN at this point) Any past child protection activity: (if known by PHN at this point) The reason for completing a Single Agency Assessment Part I (well-being assessment) The child s well-being is not developing as expected The health plan indicator has been identified as additional In response to a Request for Assistance/ tification of Concern from another agency To provide information to make a Request for Assistance/ tification of Concern As a result of a significant concern (including child protection) Other There may be reasons other than the above Planning status (please circle any that are relevant) This section should detail where you are in the assessment process) Previous Single Agency Assessments (Part I or II) Child s Plan (integrated) in place Well-being plan in place Request for Assistance/ tification of Concern Chronology in process Information sharing protocol in place Date: Confirm whether any separate tool used to gather the child/young person s view is attached. Otherwise use the well-being assessment capturing the child/young person s own words wherever possible (the What I Think Tool can be used where it is appropriate for the age and stage of the child/young person). Any other relevant information: Please insert any information that will allow the external reader to quickly understand the context of this assessment 118 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

25 Safe Healthy Achieving Nurtured Active Respected Responsible Included A = evidence of needs met B = evidence of unmet need C = further evidence required H.II.b GUIDANCE NHSL Public Health What I need from people who look after me A B C 1. Everyday care and help 2. Keeping me safe 3. Being there for me 4. Play, encouragement and fun 5. Guidance, supporting me to make the right choice 6. Knowing what is going to happen and when 7. Understanding my family s background and beliefs This section should record the information gathered under the seven fields of What I need from people who look after me and should include any evidence of positive indicators focusing on the baby/child s own development which is individual to them. The seven sections are colour coded above to show the relationship between a Part I assessment and Part II. If a Part I assessment has already been completed, the information can be cut and pasted across to Part II (until MIDIS is available) as a starter. PHN staff should be rigorous in considering each of the fields above. Some guidance on the My World Assessment Triangle is also provided. It is important to remember that parents/carers will view the information gathered therefore careful attention should be paid to the language used Pressures/adversities This section should record the information gathered under the seven fields of What I need from people who look after me and should include any evidence of negative indicators identified. Some guidance on each of the fields is also provided. It is important to remember that parents/carers will view the information gathered therefore careful attention should be paid to the language used Assessment of needs/risks This section should provide an analysis of the information gathered and should: clarify the balance between the strengths and pressures in the baby/child s situation use knowledge from the past as well as the present evaluate the impact of the baby/child s situation on their well-being articulate immediate or emerging risks to the baby/child highlight any differences in understanding or views about what the baby/child needs Desired outcomes An outcome means The impact, effect or consequence of help received Outcomes should be: specific to the well-being indicators. It is not necessary to find an outcome for every indicator but to use well-being to structure to the desired outcomes specific to the difficulties identified in assessment. There should be a logical flow from the difficulties and pressures recorded above specific to the individual baby/child. A child s outcome is specific to them rather than the adults who care for them. For example, the desired outcome under nurture may be, improved attachment to the baby/child s primary carer, whilst the action is to improve the mother s mental health. clear as to whether it is short, medium or long term. Actions required Actions should detail what needs to be done to achieve the desired outcome above. It could be advice and support to the parents, additional input from a specialist professional such as psychology, occupational therapy etc, it could be specialist assessments such as addictions to establish the extent of any difficulties. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 119

26 Practice Guide Safe Healthy Achieving Nurtured Active Respected Responsible Included A = evidence of needs met B = evidence of unmet need C = further evidence required H.II.b GUIDANCE NHSL Public Health How I grow and develop A B C 1. Being healthy 2. Learning and achieving 3. Being able to communicate 4. Confidence in who I am 5. Learning to be responsible 6. Becoming independent, looking after myself 7. Enjoying family and friends This section should record the information gathered under the seven fields of How I grow and develop and should include any evidence of positive indicators focusing on the baby/child s own development which is individual to them. The seven sections are colour coded above to show the relationship between a Part I assessment and Part II. If a Part I assessment has already been completed, the information can be cut and pasted across to Part II (until MIDIS is available) as a starter. PHN staff should be rigorous in considering each of the fields above. Some guidance on the My World Assessment Triangle is also provided. It is important to remember that parents/carers will view the information gathered therefore careful attention should be paid to the language used Pressures/adversities This section should record the information gathered under the seven fields of How I grow and develop and should include any evidence of negative indicators identified. Some guidance on each of the fields is also provided. It is important to remember that parents/carers will view the information gathered therefore careful attention should be paid to the language used Assessment of needs/risks This section should provide an analysis of the information gathered and should: clarify the balance between the strengths and pressures in the baby/child s situation use knowledge from the past as well as the present evaluate the impact of the baby/child s situation on their well-being articulate immediate or emerging risks to the baby/child highlight any differences in understanding or views about what the baby/child needs Desired outcomes An outcome means The impact, effect or consequence of help received Outcomes should be: specific to the well-being indicators. It is not necessary to find an outcome for every indicator but to use well-being to structure the desired outcomes specific to the difficulties identified in assessment. There should be a logical flow from the difficulties and pressures recorded above specific to the individual baby/child. A child s outcome is specific to them rather than the adults who care for them. For example, the desired outcome under achieving may be increased interaction betwen mother and baby whilst the action may be to improve mother s mental health clear as to whether it is short, medium or long term. Actions required Actions should detail what needs to be done to achieve the desired outcome above. It could be advice and support to the parents, additional input from a specialist professional such as psychology, occupational therapy etc, it could be specialist assessments such as addictions to establish the extent of any difficulties. 120 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

27 Safe Healthy Achieving Nurtured Active Respected Responsible Included A = evidence of needs met B = evidence of unmet need C = further evidence required H.II.b GUIDANCE NHSL Public Health My wider world: (Environmental factors) A B C 1. Support from family, friends and other people 2. School/nursery/other 3. Local resources 4. Enough money 5. Comfortable and safe housing 6. Work opportunities for my family 7. Belonging This section should record the information gathered under the seven fields of My wider world and should include any evidence of positive indicators focusing on the baby/child s environment. The seven sections are colour coded above to show the relationship between a Part I assessment and Part II. If a Part I assessment has already been completed, the information can be cut and pasted across to Part II (until MIDIS is available) as a starter. PHN staff should be rigorous in considering each of the fields above. Some guidance on the My World Assessment Triangle is also provided. It is important to remember that parents/ carers will view the information gathered therefore careful attention should be paid to the language used Pressures/adversities This section should record the information gathered under the seven fields of My wider world and should include any evidence of negative indicators identified. Some guidance on each of the fields is also provided. It is important to remember that parents/ carers will view the information gathered therefore careful attention should be paid to the language used Assessment of needs/risks This section should provide an analysis of the information gathered and should: clarify the balance between the strengths and pressures in the baby/child s situation use knowledge from the past as well as the present evaluate the impact of the baby/child s situation on their well-being articulate immediate or emerging risks to the baby/child highlight any differences in understanding or views about what the baby/child needs Desired outcomes An outcome means The impact, effect or consequence of help received Outcomes should be: specific to the well-being indicators. It is not necessary to find an outcome for every indicator but to use well-being to structure to the desired outcomes specific to the difficulties identified in assessment. There should be a logical flow from the difficulties and pressures recorded above specific to the individual baby/child. A child s outcome is specific to them rather than the adults who care for them. For example, the desired outcome included may be increased contact with other babies and adults whilst the action might be to encourage mother to attend a mother and baby group clear as to whether it is short, medium or long term. Actions required Actions should detail what needs to be done to achieve the desired outcome above. It could be advice and support to the parents, additional input from a specialist professional such as psychology, occupational therapy etc, it could be specialist assessments such as addictions to establish the extent of any difficulties. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 121

28 Practice Guide GUIDANCE Summary analysis of child/young person s world Consider all the information you know about the child s whole world. Which elements are having the greatest positive and negative impact on the child right now? Place what you consider to be the most important factors within the resilience matrix and use the following section to conclude where the child is now and what they need to develop well-being. GUIDANCE Resilience Matrix This can either be used in a single or multi-agency environment. It supports practitioners to analyse the more complex information in terms of the child s strengths and pressures and plot them on a blank matrix to help gauge the level of resilience or vulnerability the child is experiencing together with the adverse and protective factors that may influence the outcome. Further information on using the resilience matrix is contained in the Getting it right for every child in Lanarkshire Practice Guide. Resilience Guidance on the Resilience Matrix is available in the introduction section of the practice guide Adversity Summary analysis using Resilience Matrix Protective factors Vulnerability 122 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

29 Guidance for PHN on my World Assessment Triangle The My World Assessment Triangle originates from the Department of Health in England and is an evidence-based framework which helps practitioners to consider the holistic needs of a baby/child to understand what supports they may or may not need. It is essential that practitioners consider all the evidence available to them in assessing the unique situation of each (unborn) baby/child. Some indicators have been provided as exemplars to help practitioners less familiar with the My World Assessment Triangle or who are less familiar with the process of assessment. They should be used as guidance and never considered as a definitive list or template for completing assessments. H.II.b GUIDANCE NHSL Public Health What I need from the people who look after me 1/3 Well-being Keeping me safe: keeping the baby/child safe within the home and exercising appropriate protection outside. Practical care through home safety such as sterilisation of equipment, fire guards, stair gate, car seat safety, safe reach etc. Protecting from physical and emotional dangers such as noise, pollution etc. Is the care giver able to protect the baby/child consistently and effectively? Seeking help with and solutions to domestic problems such as mental health needs, substance misuse, violence, offending behaviour. Are there any identifiable risk factors? Safe carers understanding of the baby/child s need to be protected from risk and harm and taking appropriate action (stopping or restricting smoking, alcohol use, for example) consistent structures and boundaries and supervision to keep the baby/child safe the baby/child having a relationship with a reliable adult to communicate needs appropriate contingency plans in place by the carers to provide protection such as extended family or neighbour support physical safety measures such as safe sleeping, bathing, car safety, stair gates, socket and cable protectors, garden fences and gates etc. the baby/child being exposed to danger or harm including violence impaired capacity to protect due to physical or mental health issues, substance misuse, domestic abuse or cognitive difficulties risk taking by the carers such as crime inappropriate relationships or contacts which present risks intolerance to the baby/child s need for attention inappropriate control and discipline (siblings) any sign of physical or emotional abuse or physical neglect other children accommodated Everyday care and help: this is about the ability to care which includes day-to-day physical and emotional care, food, clothing and housing. Meeting the baby/child s changing needs over time. Being able to respond appropriately to the baby/child s needs. Support in meeting parenting tasks and help with carers own needs. basic care needs are met food, drink, clothing, warmth, shelter and hygiene attention to health and development support needs attention to stimulation and learning which are understood and addressed growth and development appropriate to age and stage health issues, including mental health issues, which affect the baby/child any other factors which affect carers capacity to provide everyday care and help such as disability including learning disability, substance misuse, domestic abuse, cognitive difficulties, mental health etc. children taking on inappropriate caring responsibilities for age and stage regular changes in carers other children accommodated inappropriate exposure to parental or sibling emotional distress or family difficulties exposure to aggression or violent behaviour Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 123

30 Practice Guide H.II.b GUIDANCE NHSL Public Health What I need from the people who look after me 2/3 Well-being Being there for me: love, emotional warmth, attentiveness and engagement. Who can be relied on to recognise and respond to the baby/child s needs? What is the level of stability and quality of relationships with primary carer? Are there issues of attachment? Who is of particular significance? Is there sufficient emotional security and responsiveness in the baby/child s current caring environment? What is the level of stability and quality of relationships between siblings, other members of the household? Do issues between parents impact on their ability to parent? Are there issues within a family history that impinge on the family s ability to nurture? Nurtured positive attachment and interaction between carers and baby/child physical, psychological support, encouragement and emotional warmth including positive attention positive family relationships including extended family the baby/child s expectation that their needs will be met easily soothed, settled and satisfied emotional stability, security and confidence attachment disorder frequent change and instability the baby/child s needs being secondary to needs of carers anxiety and hyper-vigilance in the baby/child concerning reactions to or interactions with carers Play, encouragement & fun: engaging positively in preparation for parenthood. Receptiveness to parenthood education and learning. Early attachment and bonding through voice and touch. Interaction with the baby/child? Active access to a stimulating and educationally rich environment including appropriate toys carers providing stimulation or engaging in play activities with the baby/child carers encouragement for the baby/child to explore his or her environment proactive efforts to support the baby/child s learning through play, music, fun and outings lack of resources to provide stimulation and play opportunities for the baby/child carers needs being met to the exclusion of the baby/child s need for stimulation and play health/disability issues which prevent access to play activities carers inability to understand the need to provide stimulation, play, encouragement and fun Responsible Guidance, supporting me to make the right choices: values, guidance and boundaries. Are household roles and rules of behaviour appropriate to the age and understanding of the baby/child? Are responses to behaviour appropriate? Is the baby/child treated with consideration and respect, given space to sleep and eat at appropriate times within a safe and protective environment? Are there any specific aspects which may need intervention? consistency in routines and boundaries appropriate socialisation for a young baby/child positive modelling behaviour inappropriate choices for age and stage of development inappropriate sanctions or reactions to baby/ child violence, aggression, abusive language chaotic activity which disrupts development of regular routines and boundaries 124 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

31 H.II.b GUIDANCE NHSL Public Health What I need from the people who look after me 3/3 Well-being Knowing what is going to happen & when: is the baby/child s life stable and predictable? Are routines and expectations appropriate and helpful to age and stage of development? Are the baby/child s needs given priority within an environment that expects mutual consideration. Who are the family members and others important to the baby/child? Is there stability and consistency within the household? Can the people who look after the baby/child be relied on. Is change controlled and appropriate for the baby/child to cope with? Responsible stability in caregiving and evidence of household routines the baby/child settled and calm the baby/child connecting with the setting they are in positive connections with the community the baby/child s ability to adapt to change regular contact with absent parents/carers/relatives if this is in the baby/child s best interests frequent changes of carers, living accommodation chaotic household without routine fractious baby/child behaviours which indicate insecurity or lack of stability inappropriate adults or activities within the home environment antisocial behaviour current monitoring or investigation activities Included Understanding my family s history, background and beliefs: family and cultural history, issues of spirituality and faith. Do the baby/child s significant carers foster an understanding of their own and their baby/child s background their family and extended family relationships and their origins? Is their racial, ethnic and cultural heritage given due prominence? Do those around the baby/child respect and value diversity? strong sense of individual and family identity understanding of relationships within the family, extended family and community discrimination against any member of the family negative perceptions or expressed views about any member of the family difficulties in understanding family relationships and background Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 125

32 Practice Guide H.II.b GUIDANCE NHSL Public Health How I grow and develop 1/2 Well-being Being healthy: this includes full information about all aspects of a baby/child s health and development relevant to their age and stage. Developmental milestones, ill health, hospital admissions, any impairments, disabilities or conditions affecting development and health. the baby/child s growth and development in line with their age and stage the family is knowledgeable and confident about medical issues the family readily seek advice and help with health issues carers accepting, understanding of and coping with any health issues, impairments or disabilities affecting the baby/child developmental concerns about the baby/child, for example birth asphyxia or congenital abnormalities the baby/child s medical needs reducing the parents ability to care for them regular visits to A&E or use of NHS24 regular admissions to hospital diagnosed non-accidental injuries sensory impairments or other disabilities which negatively impact on the baby/child s life Healthy Being able to communicate: this includes development of language and communication. Being in touch and communicating constructively with others. Parent s recognising and responding to different cues from the baby/child. Parents emerging understanding of the baby/child s attempts to communicate through crying, early verbalisation or words. parents understanding of and positive responses to baby/child s cues for attention understanding of and use of verbal and non-verbal communication appropriate to age and stage such as soothing, affection, change of tone, eye contact, singing, reading etc. awareness of language and communication appropriate in different situations difficulties in responding appropriately to verbal and non-verbal communication from the carer lack of communication inappropriate communication such as shouting, shaking etc physical difficulties which may impact on ability to communicate unusual communication such as baby/child never crying Learning and achieving: this includes parental interest in the development of the baby/child and cognitive development from birth. Showing an interest in the baby/child from birth - stimulation through talking, touching baby/child massage etc. Evidence of parental learning difficulty which could impact on appropriate stimulation of baby/child. Setting realistic goals and encouraging baby/child to reach them. Achieving parental interest in the development of the baby/ child appropriate stimulation and recognition of need to progress and learn understanding and support to overcome any difficulties with learning carers lack of engagement or co-operation with learning parental impaired learning due to social or emotional difficulties which may reduce the capacity of carers to progress learning such as a learning difficulty or mental health problem barriers to accessing appropriate supports to overcome difficulties such as birth asphyxia or congenital abnormalities 126 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

33 H.II.b GUIDANCE NHSL Public Health How I grow and develop 2/2 Well-being Respected Confidence in who I am: baby/child s temperament and characteristics. Nature and quality of early and current attachments. Emotional and behavioural development, resilience, self-esteem. parental bonding recognition of and respect for individual characteristics in baby/child and emerging personality evidence of self-confidence in baby/child healthy attachment over generalising about baby/child and failure to recognise individuality leaving the child unattended or lacking in attention for unacceptable periods of time use of inappropriate language Learning to be responsible: learning appropriate social skills and behaviour. Consider parental responsibility that will enable the baby/child to develop, learn routines and what is expected of them. Values, sense of right and wrong. Consideration for others. Responsible parental understanding of rights and responsibilities and appropriate pursuit of same understanding of introducing routines, boundaries, structures and expectations at the appropriate time for the baby/child role model of carers demonstrating socially acceptable lifestyle inappropriate social behaviour such as domestic abuse, substance misuse or anti social behaviour etc not recognising or inappropriate responses to the needs of the baby/child frequent changes, lack of stability or reliable carers Becoming independent, looking after myself: the gradual acquisition of skills and confidence needed to move from dependence to independence. Do the parents rely on others to meet the baby/ child s needs? Are the parents overprotective? parental understanding of managing independently themselves ability to adequately care for the baby/child independent of other family support self-reliance of carers and need to prove independence baby/child s motivation to do things independently carers understanding of stages of development and realistic expectations of babies and children carers engagement with health, social services as required poor parenting skills, role modelling chaotic lifestyle non-engagement with services overprotective parenting parents rely too much on family or professionals to support parenting activity Enjoying family and friends: opportunities for parents to make and maintain relationships. Do extended family and social networks exist and are they encouraged? Are there physical inhibitors to connecting with the community such as rurality, lack of transport, telephone connections etc. This links and overlaps with what a child needs from the people who look after him or her in the wider world Included positive and constructive relationships with family and friends a good network of family, friends and social contacts support from adults at a similar stage in parenting external interest in the baby/child s progress parents understanding of good relationships and stability social isolation family conflict discrimination or exclusion from family or community lack of wider family and friends carers poor or inappropriate relationships with family, friends or acquaintances Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 127

34 Practice Guide H.II.b GUIDANCE NHSL Public Health My wider world 1/2 Well-being Comfortable and safe housing: is the accommodation suitable for the needs of the baby/child and family including adaptations needed to meet additional needs. Is it in a safe, well maintained and resourced baby/child-friendly neighbourhood? Have there been frequent moves? Safe accommodation providing adequate space, safety and amenities maintaining a tenancy or mortgage well-maintained accommodation accommodation which offers access to support network and community resources homelessness temporary accommodation inadequate accommodation including overcrowding rurally isolated or separation from support network Achieving Active School: from pre-school and nursery onwards, the school environment plays a key role. What are the experiences of school and peer networks and relationships? What aspects of the learning environment and opportunities for learning are important to the baby/child/young person? Availability of study support, out of school learning and special interests. Can the school provide what is needed to meet the particular educational and social needs of the infant? accessible learning facilities positive relationships with pre-school staff attendance at pre-school provider difficulties in accessing available provision (transport, rural isolation etc) Work opportunities for my family: are there local opportunities for training and rewarding work? Cultural and family expectations of work and employment. Support to remain at home with the baby/ child if desired. carers in employment adequate employment opportunities access to childcare to allow parents to work if required family culture of work and expectations of working support and encouragement to work from extended family, friends or community work experience, skills and abilities which would allow employment unemployment being a positive choice to care for baby/child unemployment family history and culture of unemployment long term plans to rely on benefits lack of work experience, skills, abilities appropriate to employers needs Enough money: has the family adequate income to meet day-to-day needs and any special needs? Have problems of poverty and disadvantage affected opportunities? Is household income managed for the benefit of all? Are there problems of debts? Do benefit entitlements need to be explored? Is income adequate to ensure the baby/child will have what he/she needs? planning and purchasing essential items for the baby/child application for appropriate benefits and grants in place financial support from extended family if necessary poor money management spending beyond means/inappropriate spending no planning evident to meet baby/child s needs non-attendance at essential appointments due to transport costs malnourishment of parents prioritising purchase of substance over essentials 128 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

35 H.II.b GUIDANCE NHSL Public Health My wider world 2/2 Well-being Support from family and friends: networks of family and social supports. Relationships with grandparents, aunts and uncles, extended family and friends. What supports can they provide? Are there tensions involved in or negative aspects of the family s social networks? Are there problems of lost contact or isolation? Are there reliable, long term networks of support which the baby/child or family can reliably draw on? Who are the significant people in the baby/child s wider environment? a support network including extended family, friends and social contacts community resources which facilitate meeting and maintaining relationships external interest by family and friends in the growth and development of the baby/child social isolation including rurality which inhibits the development of a social network family conflict or breakdown which restricts support inappropriate relationships or social contacts which negatively impact on well-being Included Local resources: resources which the baby/child and family can access for health, education, leisure, faith, sport, active lifestyle. Projects offering support and guidance at times of stress or transition. Access to and local information about health, baby/child care, care in the community, specialist services. local amenities, facilities and resources which support the baby/child s well-being such as mother and baby/toddler groups, community centre facilities etc leisure facilities which support the health of mother and baby/child such as post-pregnancy exercise classes, crèches, massage etc poor facilities, amenities and resources lack of access to facilities due to prohibitive cost or only private access lack of infrastructure to access basic health and social care facilities Belonging: being accepted in the community, feeling included and valued. What are the opportunities for taking part in activities which support social contact and inclusion, e.g. mother and baby/ child, environmental improvements, parents and residents groups, faith groups etc? Are there local prejudices and tensions that will affect the baby/child s opportunities to fit in? community involvement and a community network which actively involves parents and baby/child long term family history of connection to the community Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 129

36 Practice Guide H.II.c GUIDANCE NHSL Public Health Conclusions and recommendations What is the analysis of the child/young person s well-being? (summary analysis using information from the well-being indicators) Are there any particular issues which are getting in the way of this child/young person s well-being? Using all evidence gathered against the well-being indicators and your professional knowledge and experience summarise the current situation for this child/ young person. What are the desired outcomes for this child/young person? (consider short term and long term outcomes) What developments in well-being are you hoping for this child/young person at this point in time? What are the next goals or targets in relation to physical, emotional, psychological, social and intellectual growth and development? What are you as a public health nurse doing to help develop this child/young person s well-being? (please refer to any support or specific service you are providing) What supports are in place within the NHS to develop the child/young person s well-being, i.e. advice to the parent, short term help from colleagues such as physiotherapy or speech and language therapy, one-to-one support, social supports such as parent groups, home support etc? Do you have all the information you need to help this child/young person s well-being? If it is possible from the information contained in this assessment to act then should be circled and action taken. If this is not the case, information should be requested from colleagues and Part II considered What additional help or advice might you or the child need from within the health service to develop the child/young person s well-being? Are there any other services within NHSL that would benefit the child s well-being such as parenting classes, specialist nurses or other clinical intervention? Help should be appropriate and proportionate; if a child s well-being is developing without the need for further intervention, this should be encouraged. What additional help, if any, may be needed from professionals in another agency? Are there any other services you think may help the child/young person s well-being at this time? If additional support is identified, do you believe an Integrated Assessment and Child s Plan might help to bring all available information and relevant professionals together to develop the child/young person s well-being? What are the parent/carer s views about the child/young person s well-being? (please summarise using their own words wherever possible) Parents should be made aware that information is being gathered against the well-being indicators to make sure the child s wellbeing will develop. Part of this process must be to ask for the parent s own view on their child s well-being. Their own words and perceptions should be recorded in this section rather than paraphrasing what they say. In line with Getting it right for every child parenting strategy, public health nurses should make every attempt to include both parents views wherever possible, part of which is to reinforce the crucial role male parents have. What are the child/young person s views about their own well-being? (based on the child s age, stage and capacity to communicate) The child/young person s views must be encouraged and recorded, even where support is necessary for them to express their views. The child/young person s own words and perceptions should be captured wherever possible. Where the child is not at the age and stage to verbalise, their behaviour and responses should be observed and recorded. Health Plan Indicator: Public health nurses should assign and record the Health Plan Indicator by circling as appropriate. Core Additional 130 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

37 H.II.p GUIDANCE NHSL Public Health NHS Lanarkshire PHN Record/Single Agency Plan Name: DOB: CHI: (OR USE LABEL) What is the desired outcome for this child/young person? The positive changes in wellbeing should go here What we are going to do? (these are the actions that are needed to achieve the desired outcomes) How will we know? (the evidence that will indicate improvements or deterioration in well-being) This section should list the wellbeing indicator first followed by the desired outcome. Each box should be used to record a separate outcome even if it refers to the same well-being indicator. The plan can be continued at subsequent visits and new outcomes can be added as appropriate This section should list the actions which will take place to try to achieve the desired outcome What signs are you looking for to indicate that the desired outcome is being achieved? By when? (the latest acceptable date to achieve positive change) Review Date: The date for reviewing this outcome Date Achieved: The date evidence suggests that the outcome has been achieved Review Date: Date Achieved: Review Date: Date Achieved: Review Date: Date Achieved: Who is helping me? (which professional will be responsible) The name of the professional who is responsible for the action should be entered here Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 131

38 Practice Guide Date started: CHI number: H.II.a HPI Core EXEMPLAR Nhsl Public Health Single Agency Assessment Part II My World Assessment Triangle Exemplar Mary Smith HPI Additional Named Person (name and full contact details): Ann Brown Public Health Nurse Lead Professional, if any (name and full contact details): Jean Jones - Social Worker Personal details Child/young person s forename: Child/young person s surname: Mary Smith Address: Date of birth: Karkshaw Street, Coatbridge Post Code: ML1 001 School or nursery if any: Little Tykes Nursery Date of admission to education: Telephone number: Name of parent/carer 1: Lucy Anderson Telephone: Name of parent/carer 2: Bob Anderson Telephone: Address of parent/carer if different from above: 22 Fern Street Cotbridge Legal status Child protection status Looked after at home Child protection register Looked after away from home Child protection investigation Previously either of the above Any past child protection activity The reason for completing Single Agency Assessment Part II (circle all relevant) The child s well-being is not developing as expected The health plan indicator has been identified as additional In response to a Request for Assistance/ tification of Concern from another agency To provide information to make a Request for Assistance/ tification of Concern As a result of a significant concern (including child protection) Other Previous Single Agency Assessments (Part I or II) Child s Plan (integrated) in place Well-being plan in place Request for Assistance/ tification of Concern Chronology in process Information sharing protocol in place Planning status (please circle all relevant) Date: 20/05/11 Confirm whether any separate tool used to gather the child/young person s view is attached. Otherwise use the well-being assessment capturing the child/young person s own words wherever possible (the What I Think Tool can be used where it is appropriate for the age and stage of the child/ young person). Any other relevant information: 132 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

39 Safe Healthy Achieving Nurtured Active Respected Responsible Included A = evidence of needs met B = evidence of unmet need C = further evidence required H.II.b EXEMPLAR Nhsl Public Health How I grow and develop: Mary Smith A B C 1. Being healthy 2. Learning and achieving 3. Being able to communicate 4. Confidence in who I am 5. Learning to be responsible 6. Becoming independent, looking after myself 7. Enjoying family and friends Mary has good relationships with maternal grandmother Mary is a bright, sociable child at nursery and an able communicator for her age Mary is physically healthy with normal growth and development Mary does demonstrate age appropriate ability to self-care. Pressures/adversities Both parents are misusing alcohol which is adversely impacting on their capacity to parent Mary is exposed to domestic abuse The lack of routines and family structure which results from the substance misuse results in poor attendance at nursery which in turn impacts on Mary s educational opportunities to achieve her full potential At times Mary has to self-care more than is age appropriate Mary often presenting with poor hygiene and wearing dirty clothes Poor routines within the family home resulting in Mary feeling tired and presenting as hungry at times Mary s opportunities for learning are impacted because she is not taken to nursery regularly, her ability to communicate is affected when parents are preoccupied with substance use or communicating through intoxication, her learning to be responsible is affected by the lack of routines, boundaries and structures. Her ability to become appropriately independent is affected because she is having to be self-sufficient whilst they are intoxicated and her ability to enjoy family and friends is affected by reduced opportunities to meet people Assessment of needs/risks Mary needs to grow up in a loving, safe and stable environment where her needs are identified, prioritised and met. Currently Mary is at risk of not achieving her potential in all areas of her development due to neglect and emotional abuse. Desired outcomes Evidence that Mary feels safe and secure in her home environment, not exposed to domestic abuse Mary presents as clean and well cared for Mary benefits from appropriate routines and structure within the family and attends nursery regularly and frequent absences are eliminated Actions required The public health nurse will offer support, information and advice to the maternal grandmother, to enable her to support Mary. The public healthy nurse will work with other agency colleagues to assess the family situation within the home. The public health nurse will contribute to the child s plan. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 133

40 Practice Guide Safe Healthy Achieving Nurtured Active Respected Responsible Included A = evidence of needs met B = evidence of unmet need C = further evidence required H.II.b EXEMPLAR Nhsl Public Health What I need from people who look after me: Mary Smith A B C 1. Being healthy 2. Learning and achieving 3. Being able to communicate 4. Confidence in who I am 5. Learning to be responsible 6. Becoming independent, looking after myself 7. Enjoying family and friends Maternal grandmother has agreed to voluntarily care for Mary in the short term Parents have contacted GP to be re-referred to addictions service Pressures/adversities Chaotic parental addictions make them unable to provide appropriate care, supervision, structures and consistency to meet Mary s needs. Assessment of needs/risks Mary s parents need to engage with addictions services and comply with treatment to reduce the negative impact of their lifestyle on Mary s development. Desired outcomes Mary is nurtured and physically cared for in a safe environment Mary s right to education is respected and she is supported to attend nursery Mary s home life is stable with daily routines and structures in place Mary s parents to manage their substance misuse to enable them to provide appropriate parental care and supervision. Actions required 134 Support for maternal grandmother to care for Mary voluntarily until the family home can be assessed and improved Public health nurse will support parents to engage with addiction services. Assist the parents to understand the impact of their lifestyle on Mary s development. Support the development of their parenting capacity. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

41 Safe Healthy Achieving Nurtured Active Respected Responsible Included A = evidence of needs met B = evidence of unmet need C = further evidence required H.II.b EXEMPLAR Nhsl Public Health My wider world (Environmental factors): Mary Smith A B C 1. Support from family, friends and other people 2. School/nursery/other 3. Local resources 4. Enough money 5. Comfortable and safe housing 6. Work opportunities for my family 7. Belonging Grandmother is willing and able to support the family in the meantime by caring for Mary Nursery will offer additional sessions for Mary Pressures/adversities Family home regularly frequented by other substance misusers who are intoxicated Financial constraints due to unemployment and addictions Assessment of needs/risks Mary is currently safe with maternal grandmother and her daily care needs being met Family home remains unsuitable due to current situation Financial problems Mary needs her parental home to be safe. Family income needs to be optimised. Desired outcomes Mary to have a safe, loving home environment with her parents where her needs are recognised, prioritised and met. Financial situation to improve Actions required Continued support to grandmother to support Mary to reside with her until she can be provided with a safe environment at home Circle worker to assess family needs Ongoing assessment of parenting capacity and parenting skills. Ongoing assessment of engagement and compliance with addiction services leading to a positive sustained change. Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment 135

42 Practice Guide EXEMPLAR Summary analysis of child/young person s world Consider all the information you know about the child s whole world. Which elements are having the greatest positive and negative impact on the child right now? Place what you consider to be the most important factors within the resilience matrix and use the following section to conclude where the child is now and what they need to develop well-being. EXEMPLAR Resilience Matrix This can either be used in a single or multi-agency environment. It supports practitioners to analyse the more complex information in terms of the child s strengths and pressures and plot them on a blank matrix to help gauge the level of resilience or vulnerability the child is experiencing together with the adverse and protective factors that may influence the outcome. Further information on using the resilience matrix is contained in the Getting it right for every child in Lanarkshire Practice Guide. Resilience Mary is a sociable child who is developing age appropriately. Adversity Domestic abuse Parental substance misuse History of family break-up Poverty Poor housing Summary analysis using Resilience Matrix Mary is a very vulnerable child who has been exposed to significant adversities as a result of her parents addictions which have placed her at risk of significant harm. However maternal grandmother has agreed to care for Mary short term and is perceived as a significant protective factor. Protective factors Nursery placement Good relationship with nursery teacher Maternal grandmother Vulnerability History of physical and emotional neglect Young age of child 136 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment

43 H.II.c EXEMPLAR Nhsl Public Health Conclusions and recommendations: Mary Smith What is the analysis of the child/young person s well-being? (summary analysis using information from well-being) Mary is a very vulnerable child who has been exposed to significant adversities as a result of her parents addictions which have placed her at risk of significant harm. However maternal grandmother has agreed to care for Mary short term and is perceived as a significant protective factor. What are the desired outcomes for this child/young person? (consider short term and long term outcomes) Short term. Mary needs a safe and loving environment where she is secure and able to thrive Long term. Mary s parents need to demonstrate that they are able to recognise, prioritise and meet Mary s needs in a sustained way. What are you as a public health nurse doing to help develop this child/young person s well-being? (please refer to any support or specific support or service you are providing) Complete single agency assessment part II. Develop care plan which specifies outcomes and actions required to deliver the child protection plan. Continue to liaise with all agencies Do you have all the information you need to help this child/young person s well-being? What additional help or advice might you or the child need from within the health service to develop the child/young person s well-being? To communicate with addiction worker and G.P. What additional help, if any, may be needed from professionals in another agency? Extended nursery placement hours Children and families social work to carry out child protection investigation If additional support is identified, do you believe an Integrated Assessment and Child s Plan might help to bring all available information and relevant professionals together to develop the child/young person s well-being? What are the parent/carer s views about the child/young person s well-being? (please summarise using their own words wherever possible) Both parents agree they cannot look after Mary at present and are happy for grandmother to provide alternative care whilst they access addictions services and bring their substance use under control What are the child/young person s views about their own well-being? (based on the child s age, stage and capacity to communicate) Mary says she misses her parents but feels happy and safe in the care of her grandmother Health Plan Indicator: (circle as appropriate) Core Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment Additional 137

44 Practice Guide 138 Section 7. Core Component 3b. Public Health Nurses Single Agency Assessment