2.1.7 Short Term Breaks - Care for Disabled Children

Where it is planned in advance that the child is only to be Looked After on a short term break basis, a different set of criteria to those covering other looked after situations apply. This has been called 'a lighter touch' approach, which means that the approach focuses on the needs of the child and family and is proportionate, so that the level of administration and safeguards increases in line with the levels of need of the family and the levels of services required in meeting these needs.

Short term breaks can be provided by local authorities through the use of their powers under:

• Section 17(6) of the 1989 Children Act, which grants local authorities a power to provide accommodation as part of a range of services in order to discharge their general duty to safeguard and promote the welfare of children in need; and
• Section 20(4) of the 1989 Act which grants local authorities a power to provide accommodation 'for any child in their area (even though the person who has Parental Responsibility for him is able to provide him with accommodation) if they consider that to do so would safeguard and promote his welfare'.

Children and young people may therefore be provided with short term breaks in the following situations and under the following legislation:

Situation 1 - Under Section 17 Children Act 1989, in which case they are not Looked After Children, the 2010 Regulations do not apply and there is no requirement to appoint an Independent Reviewing Officer (IRO). A Child and Family Progress Plan is required in accordance with the Assessment Framework. Reviews should be carried out at least every 6 months and more often if required; or

Situation 2 - Under Section 20 Children Act 1989, with short breaks of not more than 17 days each in the same setting (where the total number of placement days does not exceed 75 in any 12-month period) and/or families have limited resources to support a child whilst the child is away and may not be able to fully exercise their Parental Responsibility. In these circumstances, the child is looked after, an IRO must be appointed, and a Short Break Care Plan drawn up. The 2010 Regulations are modified (Regulation 48), so that Looked After Reviews (see Section 5, Reviews) and Social Worker Visits (see Section 7, Social Worker Visits) are less frequent and the short breaks are treated as a single placement. Or

Situation 3 - Under Section 20 Children Act 1989, where the short breaks exceed a total of 17 days per placement/75 days per 12-month period and/or take place in more than one setting. In these circumstances, the child is Looked After, an IRO must be appointed and a Care Plan drawn up. The 2010 Regulations apply in full, including the provisions on frequency of Looked After Reviews and Social Work Visits.

In situations 1 and 2, the requirements, which usually apply to children in care in respect of health assessments and reports, and notification of placements, do not apply.

There has been an increasing recognition that disabled children and their families have diverse needs and that a greater degree of flexibility is required in both assessment and provision (Aiming High for Disabled Children May 2007).

Good practice would therefore demand that together and in partnership with the children, young people and their parent/carers practitioners should:

• Identify outcomes that are a priority for all family members and that help them to live more ordinary lives;
• Consider the needs that have to be met in their daily lives;
• Plan an individualised package of provision that addresses those needs and achieves those outcomes;
• Agree whether provision will be arranged directly by service providers or whether the family will receive Direct Payments or a Personal Budget to enable them to purchase the provision that they have been assessed as needing, or a mixture of all three;
• Monitor and review how the arrangements are working at agreed intervals, a minimum of six months, and modify them as needs and circumstances change;
• Consider the frequency of reviews in relation to the identified needs of the child/young person and their family.

When a child is not looked after

• If a child receives a short break under s17 (6), which may include accommodation, the child is not looked after within the meaning of the 1989 Children Act;
• Where the Local Authority provides a sitter for overnight care 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.

When a Child is Looked After

There will be some children whose package of short breaks will be such that their welfare will be best safeguarded by being a Looked After child for the period of time for which they are in out of home care i.e. by providing the services under section 20(4) rather than section 17(6). This will include children and young people:

• Who have substantial packages of short breaks sometimes in more than one setting; and
• Whose families have limited resources and may have difficulties providing support to their child while they are away from home or monitoring the quality of care they are receiving.

Deciding which provision is most appropriate for the child

The legal basis on which services are provided should be clear. The decision to provide a short break under Section 17 or under Section 20 should be informed by the assessment of the child's needs and should take account of parenting capacity and wider family and environmental factors, the wishes and feelings of the child and his/her parents and the nature of the service to be provided.

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.

Before making, and when reviewing, a decision about whether to provide accommodation under Section 17 or Section 20, there should be a careful assessment of the child and family's needs that addresses:

• Particular vulnerabilities of the child, including communication method;
• 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, (See Section 3.2, Carer's Assessment);
• 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;
• 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;
• Potential impact on the child's place in the family and on primary attachments;
• Observation of the child (especially children who do not communicate verbally) during or immediately after the break by a person familiar with the mood and behaviour of the child (e.g. parents or school staff);

• Views of the child and parents - some children and parents may be reassured by and in favour of the status of a child in care, while others may resent the implications and associations of the 'looked after' status. The child may benefit from having an Advocate;

• Extent of contact between short break carers and family and between the child and family during the placement;
• Distance from home; and
• The need for an Independent Reviewing Officer (IRO) to monitor the child's case and to chair reviews;

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.

Looked after children under the age of 16 cannot be placed in 'other arrangements' placements for the purposes of a short break except where the accommodation is provided as part of a residential holiday scheme for disabled children or is one of the other exempted regulated settings under Regulation 27A Care Planning, Placement and Case Review (England) Regulations 2010:

• A care home as defined in section 105(1) Children Act 1989;
• A hospital as defined in section 275(1) of the National Health Service Act 2006;
• A residential family centre as defined in section 4(2) of the Care Standards Act;
• A school within the meaning of section 4 of the Education Act 1996 providing accommodation that is not registered as a children's home as defined in section 105(1) Children Act 1989.

Choosing the type of assessment: all new referrals begin as a Child and Family Assessment.

In cases where the child is viewed to be at risk of possible Significant Harm, and the referral is identified as a section 47 child protection referral the social worker in consultation with their supervisor/manager will implement child protection procedures; this will include a Strategy Discussion and/or appropriate other action.

 Child and Family Assessment

Not all cases will require a full in-depth Assessment where the trigger for the assessment is a request for a short break, therefore in discussion with the Line Manager the case will be reviewed and a decision made by day 15 (i.e. 15 working days from the point at which the assessment was initiated) if it does require a full in-depth Assessment.

In many situations, the child's Assessment maybe a brief assessment where the trigger for assessment is a request for a short break and this is for relatively low levels of short break provision so that it would fall within the Child in Need criteria.

Nevertheless, sufficient information will be required to ensure key information about the child is identified; the reason for the short break; contact and communication details of the person with Parental Responsibility and their ability to monitor the placement whilst the child is there; the child's health and medical details and provision of urgent medical attention (if required); the child's routines, likes, dislikes and current arrangements for the child, (e.g. School) together with behavioural issues and how these are usually dealt with by the family. There should be opportunities for the short break carer and parent and child to meet and discuss the child's personality, routines, etc.

This information and the arrangements should be reflected in a Child and Family Progress Plan together with the child's understanding and views of them going into a Short Break situation and the caring arrangements to be provided by the Short Term Break carer.

Where the child is to be Accommodated under Section 20, the relevant Accommodation papers and 'Consent 'details should be completed. A Care and Placement Plan should reflect the arrangements required. (See Section 4.2, Child in Care Short Break Care Plan).

Where the child's circumstances are more complex because of their social and /or health needs and they are receiving substantial levels of short break support (possibly in different placements), they will be Accommodated under Section 20; a more comprehensive Assessment will be required and should include a multi-agency approach.

Care and Placement Plans should be fully completed and recorded and include Consent, Health, Education and Contact Plans.

Where children become Looked After the Independent Reviewing Unit should be advised and appropriate arrangements made for a review, depending upon whether Regulation 48 applies, (see Section 5, Reviews).

Short breaks will only be used to provide respite care for foster carers when it is in the child’s best interests, including improved stability of the child’s placement with the foster carers. Any respite care provided must take full account of the child’s needs.

Children who receive short breaks should continue to make progress in their development and acquire skills and/or new experiences.

Carer's Assessment

Parent Carer's have a right to have an assessments of their own under the Children and Families Act 2014; section 97 of the Children & Families Act 2014 requires local authorities to undertake a 'parent carers needs assessment':

• On the appearance of need; or
• Where an assessment is requested by the parent.

Where requested, then the local authority must assess whether that parent has needs for support and, if so, what those needs are. The assessment must include an assessment of whether it is appropriate for the parent to provide, or continue to provide, care for the disabled child, in the light of the parent's needs for support, other needs and wishes.

The assessment must also have regard to:

• The well-being of the parent carer; and
• The need to safeguard and promote the welfare of the child and any other child for whom the parent carer has parental responsibility.

Following assessment, the local authority must then decide;

• Whether the parent has needs for support;
• Whether the child has need for support;
• And if so whether those needs could be met (wholly or partly) by services under Children Act 1989, s17.

Services to be provided for parent carers of disabled children should be included in the Child and Family Progress Plan and can be included in the Education, Health and Care Plan, if the child has one.

There should be effective relationships with parents/carers so that they feel confident leaving their child for their stay and they understand what the placement can offer. Parents should feel involved in the planning of the short break placement and that they are able to raise concerns and complaints. Short break staff should be accessible and keep parents informed about their child’s short break experiences.

(See also: Children and Young People Aged 0-25 with Special Educational Needs and Disabilities)

The Child and Family Assessment should therefore consider the following under each of the headings:

Click here to view The Assessment Framework.

Child/ Young Persons Developmental Needs

The 'All About Me Booklet' is an ideal document for the child to talk through and identify their needs.

The child's developmental needs are affected not only by their impairment or condition, but also by the life they lead including their experience of disabling barriers and social exclusion. When a child has complex needs, understanding concerns about their development can be particularly challenging. Disabled children including children with sensory loss or learning disability may have different rates of progress across the various developmental dimensions.

Health:

Child's needs:

• What is the young person's diagnosis;
• Medical conditions / allergies;
• Refer to seizure management medication (including strength);
• Dose times and how medication is taken;
• Any allergies to medication;
• Childhood illnesses (i.e. measles, chicken pox etc.);
• Immunisations;
• Allergies;
• Visual / hearing impairment.

Education:

Child's needs:

• School attended;
• Who 1:1 is;
• Favourite subjects;
• What targets are set on the statement?
• Is the school residential / non-residential?

Identity:

Child's needs:

• What do I like to eat?
• What don't I like to eat?
• What do I drink / don't drink?
• What activities do I like?
• What are my favourite toys?
• Can I take turns?
• Do I need help to move from one activity to the next?
• How do I communicate?
• What systems (if needed) are used at school / home?
• How do I respond to praise / attention?
• How do I like to be responded to when attempting to communicate?
• What is my religion?
• Do I practice my religion and celebrate festivals?

Family and Social Relationships:

Child's needs:

• How well can I make relationships, siblings/ friends?
• Can I distinguish between girl/boy/man/woman?
• Can I accept physical contact/ do I keep eye contact?

Social Presentation:

Child's needs:

• How do I show happy/sad/frustrated feelings?
• How confident/ shy am I in social settings?

Parenting Capacity

It is important to record the strengths of all parents/careers as well as any areas of difficulty they are experiencing. In relation to the issues affecting parent's capacity to respond to the child's needs, research has shown that problems with mental health, domestic abuse, drug and alcohol misuse, a history of childhood abuse or being a child abuser are likely to affect parenting. It is important to record not simply that an issue is present but to whom it refers and its effect on parenting capacity. For example:

Assessment of parents generally relies on verbal communication, so if parents are inarticulate, passive, have learning disabilities, communication impairments or there are cultural misunderstandings, cooperation and engagement might be misinterpreted, and they and their children risk being disadvantaged. Improving the assessment of parenting capacity therefore requires a combination of approaches to the collection of information.

What are their personal, social and community resources that help them to parent a child who is disabled, which depending on the complexity of the disability, is likely to be more complicated, more time consuming, less familiar, more anxiety provoking, physically harder and emotionally more difficult.

Basic Care

Providing for the child's physical needs, and appropriate medical and dental care. Includes provision of food, drink, warmth, shelter, clean and appropriate clothing and adequate personal hygiene appropriate to their ability. How do parents promote good health and what do they do to help their child have a positive identity.

Ensuring Safety

Ensuring the child is adequately protected from harm or danger, in particular given their age, ability and understanding. Includes protection from significant harm or danger and from contact with unsafe adults/other children and from self-harm. Recognition of hazards and danger both in the home and elsewhere relevant to their ability.

Emotional Warmth

Ensuring the child's emotional needs are met giving the child a sense of being specially valued and a positive sense of own racial and cultural identity. Includes ensuring the child's requirements for secure, stable and affectionate relationships with significant adults, with appropriate sensitivity and responsiveness to the child's needs. Appropriate physical contact, comfort and cuddling sufficient to demonstrate warm regard, praise and encouragement, particularly recognizing the importance of achievements where a child is disabled and/or has a sensory impairment.

Stimulation

Promoting child's learning and intellectual development through encouragement and cognitive stimulation and promoting social opportunities. This also includes facilitating the child's development and potential through interaction, communication appropriate to the child's ability, talking and responding to the child's language and questions, encouraging and joining the child's play, and promoting educational opportunities. Enabling the child to experience success and ensuring school attendance or equivalent opportunity. Facilitating the child to meet challenges of life, particularly where there are the additional difficulties for disabled and/or sensory impaired children and young people.

Guidance and Boundaries

Helping and enabling the child to regulate their own emotions and behaviour. Understanding the impact of the child's disability and how it may affect their behaviour, and using appropriate techniques to manage this. Ensuring others understand the child's needs and that consistent responses are given to the child or young person.

Stability

Providing a sufficiently stable family environment to enable a child to develop and maintain a secure attachment to the primary caregiver(s) in order to ensure optimal development. Includes: ensuring secure attachments are not disrupted, providing consistency of emotional warmth over time and responding in a similar manner to the same behaviour. Parental responses change and develop according to child's developmental progress, allowing space for the child's development, for them to take some risks appropriate to their ability. In addition, ensuring children keep in contact with important family members and significant others.

Environmental Factors

Family History and Functioning

Family history includes both genetic and psycho-social factors. Family functioning is influenced by who is living in the household and how they are related to the child; significant changes in family/household composition; history of childhood experiences of parents; chronology of significant life events and their meaning to family members; nature of family functioning, including sibling relationships and its impact on the child; parental strengths and difficulties, including those of an absent parent; the relationship between separated parents. The impact of the child's impairment on other family members is recorded in this section. When recording the impact of the child's impairment on siblings, practitioners should consider whether siblings are themselves 'children in need' and require a Child and Family Assessment. Consideration will also have to be given to whether a separate 'Carer's assessment' should be carried out in respect of parents or carers.

Wider Family

Who are considered to be members of the wider family by the child and the parents? This includes related and non-related persons and absent wider family. What is their role and importance to the child and parents and in precisely what way do they offer support and / or practical help.

Housing

Does the accommodation have basic amenities and facilities appropriate to the age and development of the child and other resident members? Is the housing accessible and suitable to the needs of disabled family members? Includes the interior and exterior of the accommodation and immediate surroundings. Basic amenities include water, heating, sanitation, cooking facilities, sleeping arrangements and cleanliness, hygiene and safety and their impact on the child's upbringing.

Employment

Who is working in the household, their pattern of work and any changes? What impact does this have on the child? How is work or absence of work viewed by family members? How does it affect their relationship with the child? Includes children's experience of work and its impact on them.

Income

Income available over a sustained period of time. Is the family in receipt of all its benefit entitlements? Sufficiency of income to meet the family's needs. The way resources available to the family are used. Are there financial difficulties, which affect the child?

Family's Social Integration

Exploration of the wider context of the local neighbourhood and community and its impact on the child and parents. Includes the degree of the family's integration or isolation, their peer groups, friendship and social networks and the importance attached to them.

This is often a major issue for families with a disabled child. Any discrimination experienced by the family as a consequence of the child's impairment should be recorded. Support to the family through membership of support groups for disabled children should also be noted.

Community Resources

Describes all facilities and services in a neighbourhood, including universal services of primary health care, day care and schools, places of worship, transport, shops and leisure activities. Includes availability, accessibility and standard of resources and impact on the family, including disabled members.

Short term break placement options in Lincolnshire are:

1. Haven Cottage and Strut House: short term residential units providing care for children and young people age 6-18;
2. Family Links: a family based scheme providing overnight care to children living throughout the county;
3. Direct Payments: this allows the family to purchase respite care in a manner which may be more flexible to meet their needs;
4. School based accommodation as part of the child's Specialist Education Needs, see Section 1.5, Legal Basis for Short Breaks.

Requests for Placements

Social Care Child in Need Short Break Plan

This is applicable where short breaks are provided under Section 17(6) and Section 20(4) of the Children Act 1989.

The Child and Family Progress Plan should be in writing and set out clearly all the services that are to be provided to meet the child's needs. Many families with disabled children receive a range of services to meet their child's needs. Wherever possible there should be a single plan, which includes the full range of family support services on a multi-agency basis. The plan will show how the short break will meet the needs of the child and family identified in the assessment. It will:

• Have clear and realistic objectives;
• Include the ascertainable wishes and feelings of the child and views of the family. The child may benefit from having an Advocate;
• Follow consideration of options, including but not limited to Direct Payments;
• 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;
• 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;
• 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;
• Include the results of all necessary risk assessments which could include, depending on the child's impairment, moving and handling, invasive procedures, and behaviour;
• State contact arrangements for emergencies;
• State commitments of professionals involved;
• Refer to or summarise any other important documents about the child's development;
• Confirm those caring for the child have been selected following the advice set out in Government guidance on Direct Payments (see GOV.UK Applying for direct payments); and
• Outline arrangements to review the plan.

Child in Care Short Break Care Plan

The Short Break Care Plan is maintained by Short Breaks Provider.

This is applicable where short breaks are provided under Section 17(6) and Section 20(4) of the Children Act 1989.

• The child's health and emotional and behavioural development, any disability, medical needs and medications;
• The child's specific communication needs;
• Promoting contact with parents/anyone with Parental Responsibility;
• Arrangements for contacting parents as necessary, in particular an emergency contact number;
• The child's likes and dislikes regarding stimulation and leisure interests;
• How the carers, as appropriate, promote the child's educational achievement
• The name and address of the registered medical practitioner
• The type of accommodation, address, name of person responsible;
• The child's personal history, religious persuasion, cultural and linguistic background and racial origin;
• 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;
• 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;
• Frequency of visits;
• Financial arrangements for the placement;
• When the child is placed with a local authority-approved foster carer, confirmation of the foster carer's agreement;
• The provider's responsibilities for notifying the child's social worker of any significant change in the child's circumstances.

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. The Plan should also be reviewed on a regular basis to ensure that is remains current.

There is not a requirement for a separate Placement Plan for short breaks.

(Where required and appropriate please note 'Ceasing to look after a child', Children Act 1989 Guidance and Regulations - Volume 2: Care Planning, Placement and Case Review).

The chair of the review will depend on the status of the child/young person's short break provision. If a child is in short break provision as part of their Section 17 Child and Family Progress Plan then the chair will be the Practice Supervisor or social worker. However, if the child is in short break accommodation and their circumstances involve a high level of complexity they will be subject to section 20 and it is therefore appropriate for the Independent Reviewing Officer (IRO) to chair their review.

The Practice supervisors should discuss each new referral where a short break is an identified need with the practitioner and the IRO to agree the status of the short break (Section 17 or 20) and agree on the Care Planning and Review chair.

Reviews - All Cases

No significant change to a Child and Family Progress Plan or a Short Break Care Plan should be made unless it has first been considered at a review.

In each case, whether children are provided with accommodation under Section 17 or under Section 20, the review should consider whether this continues to be the most appropriate legislative basis for the service provided.

Children in Receipt of Short Breaks under Section 17 Children Act 1989 (Situation 1)

A case review for a child who is not looked after should:

• Ensure the service(s) provided meet the needs identified in the Child and Family Progress Plan and that they safeguard and promote the welfare of the child;
• Focus on outcomes for the child and family;
• Be a multi-agency review whenever possible. Different elements of a child's care package should not require a separate review;
• Include the ascertainable wishes and feelings of the child and the views of the family;
• 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.

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.

Children in receipt of Short Breaks under Section 20 Children Act 1989 (Situation 2)

Reviews are less frequent than for children in care in Situation 3.

• The first review must take place within 3 months of the start of the first placement;
• Second and subsequent reviews must take place at intervals of not more than 6 months;
• Reviews may be convened earlier, e.g. at the request of the child, parents or carer; or in cases where the child is particularly vulnerable; or where the child is provided with a high level of short breaks.

Children in receipt of Short Breaks under Section 20 Children Act 1989 (Situation 3)

The 2010 Regulations in relation to Looked After Reviews apply in full, and reviews will take place as follows:

• The first review must take place within 20 working days of the first placement;
• The second review must take place not more than 3 months after the first;
• Subsequent reviews must take place at intervals of not more than 6 months.