Katy Burch looks at recent research promoting alternative ways toco-ordinate assessments of children with a range of disabilities.
The long-awaited, much-trumpeted and now well-embedded Framework for the Assessment of Children in Need and Their Families reflected, among other things, the national mood for "joined-up" public services.
The assessment framework, it was claimed, would "mark a radical departure in assessment, moving from single agency service-led assessments to assessments of the whole child by a co-ordinated group of professionals".
This was entirely in keeping with more than a decade of user and carer-related research that identified the need to improve the co-ordination of assessments and service delivery, particularly for those children with complex needs.1 Unfortunately, the framework fell short on suggesting exactly how best to ensure that assessments were better co-ordinated for disabled children and their families.
The government's approach includes various ring-fenced funds that are now available to develop individual service areas, such as learning difficulties, on the basis of pooled budgets.
To date, there is still a big question around the extent to which pooled services are best suited to the needs of young people.2 They have been reported as expensive to operate. Neither is it always easy to identify the extent to which these "Rolls Royce" services have had a positive impact on the families concerned.
Other recent research has revealed some alternative approaches to improving the integration and co-ordination of assessment of disabled children. For example:
- A key-worker service. Key workers generally provide families of disabled children with a single point of contact to help clarify expectations and rights, co-ordinate services and provide support. Evaluations of pilot key-worker schemes seem to indicate that they are generally very well received by families, particularly where the professionals involved are well-briefed from the outset, and where they are provided with sufficient time out of their "other" commitments to do this work.3
- Improving methods of consultation with children with communication problems. Recent research has identified that social workers need better training in communicating directly with disabled children. One study in the recent Children Act Now report identified that very few services had found effective ways of consulting directly with children about their wishes and feelings, particularly with children who are unable to speak.4 Other research has suggested that, while disabled children are a high risk group for abuse and neglect, and should be over-represented in our child protection systems, they are in fact significantly under-represented. Their increased vulnerability has been attributed to a variety of factors, including communication difficulties.5
Although governmental inclinations may be towards pooling budgets and services - and indeed many parents caught in a "services shuffle" from one agency to another may welcome such a single point of contact - organisational change in the past has not always delivered the expected elixir of provision. Sometimes reorganisation produces service paralysis while jobs, accommodation and parking spaces are allocated. Instead, many of the goals of a single agency could be achieved in advance of re-organisation, and the key worker and other schemes carried out as a precursor to a single agency.
Katy Burch is senior researcher at the social services research and development unit, Oxford Brookes University.
References
1 Social Services Inspectorate, Removing Barriers for Disabled Children: Inspection of Services to Disabled Children and Their Families, SSI, 1998
2 Joseph Rowntree Foundation, Supporting Disabled Children and Their Families, JRF, 2001, see www.jrf.org.uk
3 S Mukherjee, B Beresford, PSloper, Unlocking Key Working, Joseph Rowntree Foundation, 1999
4 Robinson et al, Making Progress in The Children Act Now: Messages from Research, Stationery Office, 2001
5 R Oosterhoorn, A Kendrick, "No Sign of Harm: Issues for Disabled Children Communicating About Abuse," Child Abuse Review, July-August 2001
