Getting it right for every child Getting it right for every child Children with Exceptional...

Getting it right for every childGetting it right for every child

Children with Exceptional Healthcare Needs

29.09.10

Getting it right for every childGetting it right for every child

Getting it right for every child is the national approach to improving outcomes for children and young people in Scotland, whatever their needs/risks

Based on research and evidence of best practice and proven benefits

It requires agencies to adapt and streamline their practices and systems around the National Practice Model.

GIRFEC PositioningGIRFEC Positioning

Education:

• Curriculum for Excellence

• Support for Learning

Universal

GIRFECAPPROACH:

CoreComponents

*Shared

Principles and Values

*Practice Model

Health:

• Better Health Better Care

• Equally Well

Universal

Special Priorities:

• Early Years Framework

• Achieving our Potential

Strategic

Children, Young People, Families - Needs/Risksand any other relevant issues

Improved Outcomes For All Children And Young People

Building on good practice

*It’s everyone’s job to make sure I’m alright

*For Scotland’s

Children*

The ethos of the Children’s Hearings

System

Culture

Systems

Practice

Specific policies

Policy FrameworkPolicy Framework

• Early Years Framework

• Equally Well

• Achieving our Potential Support for Learning More Choices More Chances Youth justice LAC Better Health Better Care Hall 4 Towards a Mentally Flourishing

Scotland Curriculum for Excellence Road to Recovery

GIRFEC

= TRANSFORMATIONAL

CHANGE

WHAT HOW

Development to implementation Development to implementation

Children's Summit -The Pledge

Guide to Implementing Getting it right

CEL 29 2010: Met NHS Chiefs

National engagement - aligning GIRFEC with Early Years and other Social frameworks

Child Protection Consultation

Future Scrutiny

Benefits

More details?More details?

Marj.stewart@scotland.gsi.gov.uk

0131 244 0277

www.scotland.gov.uk/gettingitright

The Highland practitioners view

Presented by Fiona Shevill

(Social Worker Complex Needs)

Practitioners ConsultedPractitioners Consulted

Children and Families

Community Children’s Nurses/Specialist Nursing Staff.

Community Paediatricians

Health Visitors

Paediatric Physiotherapists, OT, SALT

SW staff in Community Disability Team and Respite unit in Inverness.

Colleagues in CHAS

Colleagues in Education Services

GIRFEC PrinciplesGIRFEC Principles

MA working is not new especially in relation to this group of children.

Key Working/Care Coordination already well established in several areas pre GIRFEC.

Integrated practice well embedded in many settings using the ‘Team around the Child’ approach.

Important to remember we already have the skills/practice base to bring to the GIRFEC model!

Positive Outcomes following ImplementationPositive Outcomes following Implementation

Single assessment framework across agencies.

One MA Child’s Plan with all identified partners around the table and contributing to the plan.

Child and families views central to the plan.

Interactive electronic Child’s Plan being piloted with Child friendly format for children to input their views directly via pc.

Clearly defined professional roles via named person and Lead Professional role.

Shared language across agencies and different professional disciplines. Reduction in agency specific terminology.

Clear action plan with defined timescales for review.

Strengthened MA working through compilation and review of the plan.

Appreciation of different skills within the MA team.

Feedback from FamiliesFeedback from Families

Everyone involved in their child’s care, working and communicating as a team.

Key information about their child now in one document/no longer multiple assessments with the need to repeat their story over and over. Difficulty however in making sense of plans when too long.

Action plan feels realistic with clear outcomes, responsibilities and timescales.

Meetings more efficient where assessment and plan is updated in advance by Lead Professional in collaboration with family.

Challenges of GIRFEC for Children with Challenges of GIRFEC for Children with Complex Health NeedsComplex Health Needs

Children with Complex needs do not follow a predictable developmental path. In practice the GIRFEC model appears to fit better for those children who do.

Pressures outweigh strengths which can compound an already daunting situation for families.

Important for strengths not to feel tokenistic…we should not be making children fit the plan.

Integrating all of the complex assessment information on a child can be difficult.

Plans quickly become too cumbersome to be useful.

Impossible to review all of the above in one MA meeting.

Issues as other processes running in parallel, e.g. IEP/CSP meetings/specialist medical reviews.

Ensuring the value of chronologies is not overlooked as not an integral part of the Child’s Plan.

Recognising the specialist expertise of the lead agency, most often ‘health’, whilst ensuring a holistic approach to assessment of the child and their family.

Lead Professional role can seem overwhelming in light of the large professional team around these children, and the responsibility for coordinating input to and updating the Child’s Plan.

Inter-agency ChallengesInter-agency Challenges

Different pace of implementation of e-GIRFEC tools.

Incompatibility of e-systems meaning assessment information and Child’s Plan’s not easily shared.

Debate about which agency should take on LP role, where all three agencies inputting to a child’s care.

Maintaining good communication at a time of rapidly changing circumstances or sudden deterioration in a child’s health.

Meeting the ChallengesMeeting the Challenges

Adapting the My World Triangle to address the very specific and specialist needs of this group of children. i.e.

•Complex health needs/palliative care/end of life planning.

•Quality of life issues/helping children communicate their wishes

•Support during hospital admissions

•Domiciliary nursing

•Respite/daycare

•Support to siblings

•Access to equipment/mobility issues/M&H

•Access to education

•Adapted Housing

• Income maximisation

•Bereavement support

My World TriangleMy World Triangle

Certain protocols and guidance held as separate specialist assessments, referenced within the MA plan.

Regular core groups to address particular areas for discussion/review e.g. respite care. Responding flexibly to families when requesting smaller/less formal reviews.

Sensitive approach to end of life planning which must be done separately with relevant professionals/family, and should inform the Child’s Plan, but not be recorded in any detail within the plan.

Identification of the Lead Agency to identify LP role.

Key person within each agency to collate relevant information and pass to LP to integrate within Child’s Plan.

In the most complex cases, consideration to be given to the LP responsibilities being shared.

Ongoing MA training crucial to moving forward together and commitment to the integrated approach.

Case Example. Baby A.Case Example. Baby A.

Born at 39 weeks immediately transferred to Aberdeen children’s hospital for surgery to small bowel.

Cystic Fibrosis diagnosed at 2 weeks.

Noted by CF physio to have significant head lag, floppy when prone. Duchene Muscular Dystrophy diagnosed at 5 mths.

Possible third diagnosis ? Underlying neurological condition/CP.

Prognosis given two chronic conditions, very poor, although hard to accurately predict as extremely rare.

Underweight, necessitating gastrostomy/NG feeding.

MH difficulties ; both parents.

Placed on CP register due to acrimonious parental relationship/physical neglect.

LP role moved from health to SW then back to health when CP concerns reduced/de-registered.

Absolute need for LP responsibilities to be shared in cases like these.

Case ExampleCase Example

Baby ABoy 1

½ Years

Mum

Maternal Gran

Half Brother

Dad

3 Half Siblings

3 Aunts

Paternal Gran

Police

Woman’s Aid CAB

Housing

Adapting Housing

App

HP Procedure

CF Medical Team

Neuromuscular Medical

Team

Social Work

Services

GP/HV

Specialist CF Nurse

CF Physio

Specialist Dietician

Consultant Hosp

Paed

Consultant Com Paed

Paed Physio

Specialist Neurologist

FSW Transport

Respite Crossroad

s

Specialist SW

Assess

CP Procedures

Com Nursery Nurse

Useful resourcesUseful resources

Act Family Companion/care pathway for children with life limiting and life threatening conditions.

SWIA/CHAS End of Life Planning, practice guide. For publication end Oct 2010 and launch at national conference Friday 10th Dec 2010.

Thanks for ListeningThanks for Listening

Fiona Shevill

Fiona.shevill@highland.gsx.gov.uk

01463 701376