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9.2 Short Breaks (away from home)

SCOPE OF CHAPTER

This chapter details the criteria, assessment and service provision of Short Breaks to children with a disability.

RELEVANT LEGISLATION GUIDANCE AND INFORMATION

RELATED CHAPTERS

Direct Payments Procedure

AMENDMENT

In July 2017, a link was added to Friendship For All (The Children’s Society) in the Relevant Legislation, Guidance and Information section.


Contents

  1. The Legal Basis for Short Breaks
  2. Determining the Nature and Status of the Short Break - Assessment of Needs
  3. Placements
  4. Short Break Settings
  5. Providing Care in the Child's Own Home
  6. Providing Care in the Carer's Own Home or in the Community
  7. Local Implementation and Practice Guidance - Non Disabled Children
  8. Local Implementation and Practice Guidance - Disabled Children

    Appendix 1: Providing Short Break Accommodation under the different Legal Provisions


1. The Legal Basis for Short Breaks

1.1 The Children and Young Persons Act 2008 Section 25 requires that 'Every Local Authority shall provide services designed to assist individuals who provide care for disabled children to continue to do so, or to do so more effectively by providing them with breaks from caring.'
1.2 Further, every Local Authority is required to publish their core offer of short breaks for disabled children by October 2011.
1.3 Short breaks provision in the community for Disabled Children is provided in a variety of ways and local provision is detailed in Pathway to Provision - Multi-Agency Thresholds Guidance
1.4 This Policy and Practice Guidance is primarily aimed at those children who are provided with short breaks overnight (away from home) and applies to both non disabled and Disabled Children.
1.5 The new regulations recognise that parents and not Local Authorities have the main responsibility for looking after their children and that the level of administration and safeguards applied should only increase in line with the level of needs of the family and the level of needs of services provided.
1.6 Short breaks overnight can be provided in three ways:
  1.6.a Section 17 (6) of the Children Act 1989 which grants Local Authorities a power to provide accommodation as part of a range of services in order to discharge their general duty to promote and the welfare of children in need. The 2010 Care Planning Regulations do not apply and there is no requirement to appoint an IRO;
  1.6.b Section 20 (regulation 48) Children Act 1989 where children receive short breaks of not more than 17 consecutive nights in the same setting and where the total number of nights do not exceed 75 in any twelve month period. In these circumstances, the child is deemed to be looked after whilst they are in placement and an IRO must be appointed. The 2010 Care Planning Regulations are modified (Regulation 48) so that Looked After Reviews and frequency of social work visits are less frequent and the short breaks are treated as a single placement;
  1.6.c Section 20 (4) of the Children Act 1989 which grants Local Authorities a power to provide accommodation 'for any child in their area (even though a person who has Parental Responsibility for him is able to provide him with accommodation) if they consider that to do so would safeguard or promote the child's welfare'. The 2010 regulations apply in full, including the provisions on frequency of reviews and social work visits.


2.Determining the Nature and Status of the Short Break - Assessment of Needs

2.1 The legal basis on which services are provided should be clear. The decision to provide a short break overnight under Section 17 (6) or under Section 20 should be informed by an assessment of the child's needs and the analysis will need to consider:
  2.1.a Particular vulnerabilities of the child, including communication method;
  2.1.b Parenting capacity of the parents within their family and environmental context, taking into account any assessments undertaken on family members as carers under the Children and Family Act 2014 and the Care Act 2014;
  2.1.c The length of time away from home and the frequency of such stays - the less time the child spends away from home, the more likely it is to be appropriate to provide the accommodation under Section 17;
  2.1.d Whether short breaks are to be provided in more than one place - where the child has substantial packages of short breaks in different settings, it is more likely to be provided under Section 20;
  2.1.e Potential impact on the child's place in the family and on primary attachments;
  2.1.f Views of the child and parents - some children and parents may be reassured by and in favour of the status of a looked after child, while others may resent the implications and associations of the 'looked after' status. The child may benefit from having an Advocate;
  2.1.g Anticipated extent of contact between short break carers and family and between the child and family during the placement;
  2.1.h Distance from home; and
  2.1.i The need for an Independent Reviewing Officer (IRO) to monitor the child's case and to chair reviews.
2.2 The key question to ask in deciding whether to provide the short break provision under Section 17 or Section 20 is how to Promote and Safeguard the Welfare of the Child most effectively.
2.3 It is more likely that the arrangements come within Section 20 where families have limited resources and may have difficulties providing support to their child while s/he is away from home or monitoring the quality of care.
2.4 A Child and Family Assessment is required for the purpose of providing short breaks away from home.
2.5 Carer's Assessment: Parents of Disabled Children have the right to request an assessment of their own needs. Such a request indicates the need for a possible Child and Family Assessment. The needs of the parents can be recorded under the dimension of family functioning of the Assessment Framework. While there has to be a discrete focus on the needs of the carer the outcome of this assessment should be integrated with the broader assessment of the Disabled Child and family. Carers' assessments should not be conducted in isolation.


3. Placements

3.1

Children placed under Section 17(6): Children placed under this section will be those that have an allocation of overnights in a single setting and who have stable family lives where the short breaks provision is intended to provide additional periodic family support.

All children receiving short breaks under Section 17, irrespective of whether accommodation is provided under subsection (6), must have a multi-agency short breaks CIN plan. For children receiving short breaks within the community, the CIN plan will include the full range of family support services provided on a multi-agency basis and will show how the short break will meet the needs of the child and family identified in the assessment. It will:
  3.1.a Have clear and realistic objectives;
  3.1.b Include the ascertainable wishes and feelings of the child and views of the family;
  3.1.c Follow consideration of options, including but not limited to direct payments;
  3.1.d State the nature and frequency of services, as far as is practicable, including health and social care in the same plan, especially if short breaks are provided from different agencies;
  3.1.e State the child's health, emotional and behavioural development including full details about any disabilities and clinical needs the child may have and medications they may require;
  3.1.f State the child's specific communication needs, especially for children who communicate non-verbally, and include the child's likes and dislikes with particular regard to leisure activities;
  3.1.g Include the results of all necessary risk assessments which could include, depending on the child's impairment, moving and handling, invasive procedures, and behaviour;
  3.1.h State contact arrangements for emergencies;
  3.1.i State commitments of professionals involved;
  3.1.j Refer to or summarise any other important documents about the child's development;
  3.1.k Confirm those caring for the child have been selected following the advice set out in Government guidance on direct payments; and
  3.1.l Outline arrangements to review the plan.
  For those children receiving short breaks overnight, additional information is required which includes;
  3.1.m Promoting contact with parents/anyone with Parental Responsibility;
  3.1.n Arrangements for contacting parents as necessary, in particular an emergency contact number;
  3.1.o How the carers, as appropriate, promote the child's educational achievement;
  3.1.p The name and address of the registered medical practitioner;
  3.1.q The type of accommodation, address, name of person responsible;
  3.1.r The child's personal history, religious persuasion, cultural and linguistic background and racial origin;
  3.1.s The respective responsibilities of the Local Authority and parents/anyone with Parental Responsibility; any delegation of responsibility from parents to the Local Authority; the respective roles and responsibilities of the placement provider, social worker, Independent Reviewing Officer (IRO) and other staff employed or commissioned by the Local Authority to contribute to the plan for the child's care; the respective safeguarding responsibilities of the provider and the Local Authority;
  3.1.t The expected duration of the arrangements and the steps to end them; arrangements for giving notice of intention to terminate the placement along with the Local Authority's responsibilities for convening a review of the child's Care and Pathway Plan where there is a risk of the placement being terminated;
  3.1.u Frequency of visits;
  3.1.v Financial arrangements for the placement;
  3.1.w When the child is placed with a Local Authority-approved foster carer, confirmation of the foster carer's agreement;
  3.1.x The provider's responsibilities for notifying the child's social worker of any significant change in the child's circumstances
  3.1.y

As far as practicable, the child should be involved in agreeing the Plan.

The parents must be fully involved in all aspects of agreeing the Short Break Care Plan.
 

The plan should be signed by the parents, the Local Authority, those providing the care/ the provider agency and, where appropriate, the child.

For this purpose, a Short Breaks Care Plan template is provided within the CIN episode which is compliant with the detail described above for those children receiving overnight care.
3.2 Reviews of children placed under Section 17 (6)
  A case review for a child who is not looked after should:
  3.2.a Ensure the service(s) provided meet the needs identified in the Short Breaks Care Plan and safeguard and promote the welfare of the child;
  3.2.b Focus on outcomes for the child and family;
  3.2.c Be a multi-agency review whenever possible. Different elements of a child's care package should not require a separate review;
  3.2.d Include the ascertainable wishes and feelings of the child and the views of the family;
  3.2.e Take place at least six monthly. The needs of the child and family may indicate that a review should take place before the statutory minimum, for example if the child's condition is changing quickly, or there are changed family circumstances, or where there is a complex package of services including direct payments.
  3.2.f An IRO is not required to chair these reviews. The review should consider whether the legal basis for the child's short break remains appropriate and no significant change to the Plan should be made unless it has been considered at the review.
  A review will usually include a face to face meeting but in some cases, regular review meetings may not be necessary. Generally it should be possible to include a review of short breaks with a review of other aspects of a child's health, education or development, where some of the same people will already be together.
  Reviews should take the form of a meeting when requested by the family. In all circumstances a face to face meeting should take place at least once a year.
  Depending on the level of service for the child and family and the vulnerability of the child, Local Authorities may wish to consider including an element in the review which is independent of the service provider and those with Parental Responsibility, for example arranging for an 'independent' chair with a role similar to the role of the IRO in the case of a Looked After Child.
  Having an advocate may be particularly useful for disabled young people moving towards adulthood.
  The CIN review / Chair's report must be completed and a copy provided to the child and parents / carers.
  Local agreement: The first CIN short break review will take place as a formal meeting within 3 months of the first overnight stay so that parents / carers can feedback their 'monitoring' of the placement and the legal basis on which the break is reviewed to ensure it is both appropriate and proportionate. It is particularly important that parent's involvement / contact with the placement is considered as part of this review and that the child is safeguarded adequately. Where parents are not able to maintain a reasonable level of contact with the placement, then the review should consider whether the placement should be provided under s.20. Following the initial three month review, the annual review should be linked with the annual review of the child's SEN statement (where applicable).
  A review can be brought forward at any time and can also be brought forward at the request of a parent / child.
3.3

Visiting requirements under Section 17(6)

There is no statutory requirement to visit children accommodated under Section 17 (6) on the basis that these children will spend only a short period of time away from home, and the expectation is that parents /carers will visit the placement / support their child in placement / and monitor the quality of care the child receives.

Local Agreement: Team Managers are required to set the frequency of visiting which should include at least one visit to the child in placement during a defined period. This should be recorded in the Short Breaks Care Plan and in case notes.
3.4 Children placed under Section 20 (4)
  Children placed under this section will include those who;
  3.4.a Have substantial short breaks packages sometimes in more than one setting; this would include those who have stays within educational and health establishments;
  3.4.b Whose families have limited resources and may have difficulties supporting their child while she / he is away from home or monitoring the quality of care he / she is receiving.
 

There are 2 distinct ways in which children fall under this section:

In the following cases, regulation 48 applies;
  3.4.c They are provided with accommodation under Section 20 ( 4) for a continuous period of more than 24 hours;
  3.4.d They receive pre-planned short breaks overnight in one setting;
  3.4.e Their allocation is no more than 75 days in a year;
  3.4.f They are not accommodated for a single episode of 17 days or more;
  3.4.g Regulation 48 allows for a series of pre-planned short breaks for a child in the same placement to be treated as a single placement for the purposes of applying the LAC regulations. These children will have a short break care plan linked to the CIN episode as described above;
  3.4.h Visiting arrangements under s.20 (4) where regulation 48 applies are;
  3.4.i The first visit must take place within three months of the first overnight stay or as soon as practicable thereafter;
  3.4.j  Subsequent visits must be at intervals of no more than 6 months;
  3.4.k The IRO has a role in agreeing the frequency of visits and may state whether visits should be more than the statutory minimum required;
  3.4.l The statutory guidance states that 'usually a qualified social worker will be the visitor and in every case should be a person with the skills and experience to communicate effectively with the child and fulfil functions of the visit'
  Reviewing arrangements under s.20 (4) where regulation 48 applies;
  3.4.m All reviews must be chaired by an IRO. The first review takes place within three months of the first overnight stay and thereafter at intervals of no less than 6 months;
  3.4.n Significant changes to the short breaks care plan should not take place unless agreed at a review;
  3.4.o Every review should consider whether the legal provisions on which the short break is provided is the most appropriate to safeguard and promote the welfare of the child (this can be a 'step down' approach to CIN status).
  The full care planning regulations for LAC will apply to those children where;
  3.4.p They are provided with accommodation under Section 20 (4) for a continuous period of more than 24 hours; and /or
  3.4.q They receive overnight breaks from more than one provider; and / or
  3.4.r They receive more than 75 nights in a year (previously more than 120 nights per year);
  3.4.s In these cases, these children will be subject to the full raft of the Care Planning regulations including a PEP, Health Plan and Pathway Plan. The Pathway Plan will only apply if they have been looked after for a consecutive period of 13 weeks and they do not require a Placement Plan;
  3.4.t A qualified social worker would have to be the case worker for these children;
  3.4.u Visiting arrangements are as for a fully Looked After Child (Regulation 28) which is;
  3.4.v First visit within one week of placement starting (and would mean a visit to the placement when the child is present)
  3.4.w Thereafter, minimum of 6 weekly visits for the first year then
  3.4.x If the placement is a permanent one, visits should take place at a minimum of 3 monthly intervals
  3.4.y Reviews chaired by an IRO must take place within 20 days of the first overnight stay, the second within 3 months of the first review and thereafter every 6 months. The review should consider whether the legal basis for the provision of short breaks remains appropriate, all services provided to the child and family should be reviewed and no change should be made to the care plan unless first considered at the review.


4. Short Break Settings

Outline Requirements on Settings Where Short Breaks Might Take Place

Hospices Regulated by the Care Quality Commission (CQC) under the Care Quality Commission (Registration) Requirements 2009 Hospices are regulated and inspected by the Care Quality Commission (CQC)
Local Authority foster care Fostering services are registered with and inspected by Ofsted. National Minimum Standards which came into force in April 2011
Children's homes Children's homes are registered with and inspected by Ofsted. Quality Standards (March 2015)
Residential special schools Different regimes apply depending on whether the residential special school is maintained, non-maintained or independent. The National Minimum Standards for residential special schools which came into force from 1st April 2015


5. Providing Care in the Child's Own Home

The key to providing safe care to children in their own homes is the same as to the provision of safe care elsewhere. It is essential that safe recruitment practices are followed and staff are properly trained and supervised and that the requirements of the Disclosure and Barring Service are complied with.

Where the Local Authority provides a sitter or overnight carer in the child's own home, the child is not being provided with accommodation by the Local Authority and the authority is therefore providing the short break service under Section 17 Children Act 1989.

However, care that is provided under arrangements made by the Local Authority and which is provided on a frequent, intensive or overnight basis comes within the definition of 'Regulated Activity' under the Safeguarding Vulnerable Groups Act 2006 Act, whether or not it takes place in the child's own home and the requirements of the DBS in relation to regulated activities will apply.

Best practice is that the child should be cared for by an approved Local Authority foster carer. Childminders with whom the Local Authority places or wishes to place children overnight (or childminders wishing to take on such work) should be asked to apply for approval as Local Authority foster carers. It is not appropriate for the Local Authority to provide overnight accommodation with childminders who are not also approved foster carers.


6. Providing Care in the Carer's Own Home or in the Community

It is essential that individuals providing care in their own homes are subject to full employment and personal checks, as well as safe recruitment methods, and that they are provided with induction and training.

There are no requirements for agencies to register with Ofsted or the Care Quality Commission if they provide services to support disabled children in the community or in their own homes, unless they provide personal care. If personal care is provided, services must register with the Care Quality Commission and comply with the relevant standards.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Regulation 2 defines personal care as follows:

Physical assistance given to a person in connection with: eating or drinking, toileting, washing or bathing, dressing, oral care or the care of skin, hair and nails (with the exception of nail care provided by a chiropodist or podiatrist); or

The prompting, together with supervision, of a person, in relation to the performance of any of the activities listed above, where that person is unable to make a decision for themselves in relation to performing such an activity without such prompting and supervision.

However any form of care or supervision provided for children on a frequent, intensive, or overnight basis comes within the definition of 'Regulated Activity' under the Safeguarding Vulnerable Groups Act 2006 and the requirements of the Disclosure and Barring Service in relation to regulated activities will apply, unless it is a family arrangement or a personal arrangement for no commercial consideration.

Where families arrange care themselves by employing carers in a private capacity, funded by direct payments, this comes within the definition of 'Regulated Activity' under the 2006 Act if it is frequent, intensive or overnight. However, the requirements of the Disclosure and Barring Service in relation to regulated activities will not apply, although Local Authorities are under a duty to inform the parents who are using direct payments to employ carers in a private capacity that they are entitled to use the Disclosure and Barring Service to check the status of the carers they employ in this way.


7. Local Implementation and Practice Guidance - Non Disabled Children

See Part 6, Looked After Children

In the case of non disabled children the process for offering a short break away from home under Section 17 (6) needs to be designed as part of an on-going support package to a family. It is envisaged that these support needs will be agreed as part of a post Adoption Support Plan, rehabilitation plan or support to avoid a child becoming accommodated under Section 20, provided the length of stay is not in excess of either 75 days over a 12 month period and does not exceed 17 consecutive days.

In order to facilitate a short break away from home, the social worker will be required to complete a Child/Young Person's Care Plan (Short Breaks) which is available in the CIN episode. If the short break away from home is part of a support package for a non adopted child, the short break Care Plan is the only plan that should be required to offer these services. If the short break is part of the Post Adoption Support Plan - the Short Break Care Plan will need to be completed alongside the Post Adoption Support Plan.

The process for approving a short break away from home, as with any accommodation, needs to be approved by a CSM/Group Manager. At the point at which the short break away from home is agreed, the 'Short Breaks Services Agreed' pro forma must be completed (available within CIN / LAC episode). The legal basis for the short break must also be completed on framework.

Commissioning this resource will be done through the placement team.

In the event that a child does not return home as planned at the end of a short break an accommodation panel must be arranged immediately. If the decision is for the child to remain accommodated, the child then becomes accommodated under Section 20 (1) and the IRO admin must be informed with the first LAC review taking place within 20 days of this date.

For the purpose of determining whether the young person is entitled to a Pathway Plan, the 13 week timescale is calculated from the first day of accommodation under s.20 (1) and NOT from the date they became accommodated under S17 (6).

Visiting / review requirements are covered in section 3 of this guidance.


8. Local Implementation and Practice Guidance - Disabled Children

 

Allocation of short breaks away from home will be based on an assessment of need (Child and Family Assessment). This applies to both non disabled and Disabled Children. It should also be remembered that this Local Authority has a policy of not placing children under the age of 10 years in a residential setting. This equally applies to short breaks placements. There may be occasions when there is no capacity within family based short breaks placements to provide a placement to a child under the age of 10. In these circumstances, a residential placement may be considered as a last resort but with the understanding that this would be kept under regular review to ensure the placement meets the needs of the child and reassessing the placement when a vacancy become available in a family setting.

It should also be noted that children who have over 75 nights per year provided by the Children's Centre are also now classed as being accommodated under s.20 (4).

Children who have short breaks within hospices will only be accommodated by the Local Authority if the Local Authority has arranged for and /or funded this placement.

8.1

Child and Family Assessments

  Child and Family Assessments will be multi-agency and include contributions from paediatricians / education / other agencies involved with the family. They will include detailed reference to current services provided for the child. The analysis should inform the decision regarding the suggested level and type of service required to meet the needs of the child, but should not name the placement.
  The assessment should also include reference to any current service provision and whether this will reduce / cease when short breaks overnights are introduced.
  The Child and Family Assessment will be completed in no longer than 45 working days at which point the Team Manager will discuss with the social worker the legal basis on which the services are to be provided. The legal basis is recorded within the core and authorised by the Team Manager by day 35.
  Following authorisation, the Team Manager will notify the Children's Service Managers of the authorised assessment on Framework via case note alert.
  Where the Child and Family Assessment identifies the provision of short breaks overnight via a direct payment, the social worker will alert the direct payments team to the Child and Family Assessment on framework via email. Team Managers may authorise up to £2000.
 

Where the Child and Family Assessment identifies the provision of short breaks overnight from in house services, the social worker will alert provider services to the Child and Family Assessment on framework via the following email addresses:

The Big House: TBHMT@nottscc.gov.uk

Minster View: MVMT@nottscc.gov.uk

Caudwell House: caudwell.house@nottscc.gov.uk

Short Breaks Team: shortbreaks@nottscc.gov.uk

Children's Centre: linda.connolly@nottshc-chp.nhs.uk

For the purpose of alerting the Children's Centre, a copy of the assessment should be sent via email with a request for confirmation of receipt.

8.2

Health Assessments

  The social worker will also commission a health assessment (where appropriate) as follows;
  For those children who attend Caudwell / Children's centre, their health assessments will be commissioned from Caudwell / Children's Centre nursing staff.
  For those children with high level health needs that are placed with contract carers / foster carers, these will be commissioned from the Short Breaks Team nurse.
  For Minster View and the Big House, the child's health records ('red book') should be used in conjunction with discussion with parents / school nurse (where appropriate.) This is on the basis that children attending Big House / Minster View do not have high level health needs and for those who do have medication for epilepsy / sleeping etc, their medication is clearly labelled. Where there is any doubt, GPs can be consulted.
  For those children who do not have complex health needs and are placed with contract carers / health carers, their medication regime will be noted as for those attending BH / MV as above.
8.3 These meetings will take place at Caudwell house on Tuesday mornings and bookings will be made via the receptionist at Caudwell House. Provider services will ensure that a nominated representative is available on these dates.
  All appropriate provider services who can potentially meet the needs of the child must be invited to this service planning meeting. This will ensure that placement mix, capacity and appropriateness of placement choice are fully discussed.
  This meeting should take place within 2 / 3 weeks of the Child and Family Assessment being completed and will be chaired by the Team Manager. The meeting will be attended by providers / parents / young person / SW /TM. Ideally, the health assessment (where required) will be available at this meeting.
  The decision as to where the child will be placed is made at this meeting, although there may be exceptions when parents wish to view placements such as the Children's Centre / Caudwell House before making an informed choice.
  Consideration on how the agreed allocation is introduced will be based on the child's needs and subject to further discussion at this meeting. The service providing the short break will also inform parents / carers of details regarding their booking / allocation system and advise how their allocation will apply on a year by year basis.
  In cases where the decision is made regarding the child's placement at the service planning meeting and the necessary health information is available, the drawing up of the short breaks Care Plan should be completed within this meeting. The Short Break Care Plan pro forma is available within both CIN and LAC episodes and thus avoids the duplication of plans.
  The date of the first CIN / LAC review will be confirmed at this meeting. For those children who are provided with short breaks under s.20 (4), the social worker will inform the IRO admin immediately after this meeting has taken place and a date obtained for the first LAC review which must be held within 20 days of the first over night stay.
  There will be rare occasions when in house providers will not be able to provide a service to a child, for example, due to inappropriate placement matching. When this occurs, this should be discussed with the Service Managers and a decision will be made whether to refer the application to the Placements Team to procure an external short breaks placement.
  This outcome of this meeting will be recorded on the 'Short Breaks Services Agreed' pro forma by the social worker / Team Manager and a copy forwarded to the CSMs (Children's Disability Services).
8.4 Applications for an increase in short breaks allocation
  These will require an updated Child and Family Assessment with contributions from the relevant agencies. The updated assessment should be completed within 30 days of the decision to update and presented at a LAC or CIN review and the CSM's (Children's Disability Service) informed. Reviews can be brought forward for this purpose where appropriate.
  The exception to this would be an unexpected crisis situation which warrants an immediate uplift in allocation and must be agreed by a Service Manager.
  Any changes to the legal basis for short breaks will be via a review decision (unless an unexpected crisis necessitates a change in legal status and is agreed by a Service Manager). The review should be brought forward in these circumstances.
  Following a decision to increase / decrease the short breaks allocation the Short Breaks Care Plan and Short Breaks Decisions pro forma will be updated and sent to the CSM's (Children's Disability Service).

End