Continuum of Need

Child's development indicators

Pre-birth

• Ante-natal appointments kept
• Medical advice followed

General Health

• All family members experience good physical health
• Parents or carers respond appropriately to ill health
• Parents or carers register CYP with GP and Dentist
• Developmental checks/Immunisations up to date
• CYP Meeting developmental (physical and sensory) milestones - including speech and language
• Age-appropriate involvement in physical activity

Family and Home

• Positive, attachments between parents or carers and CYP
• Positive relationships with adults and peers within the family and without
• Good family or community network of support
• Age-appropriate relationships
• Good relationships with siblings
• Positive sense of self, sense of identity, and sense of belonging and acceptance
• Positive cultural identity
• Confidence in social settings
• Age-appropriate resilience in the face of challenges
• Age appropriate social and leisure activity
• Positive sense of self and abilities
• Able to express needs

Behaviour

• Demonstrates age- appropriate behavioural development
• Engaging in positive and law-abiding behaviour
• Has age-appropriate ability to selfcare and good personal hygiene, dresses appropriately for different circumstances
• Asks for help appropriately and has age-appropriate understanding of risk and own personal safety
• Demonstrates age-appropriate social behaviour
• Demonstrates age-appropriate sexual development and behaviour
• Gaining confidence and skills in undertaking activities away from family
• Age-appropriate understanding of risk and own personal safety

Learning

• Milestones for cognitive development are met
• Has access to books, toys appropriate stimulation
• Has access to educational provision appropriate to ability
• Regularly attends and enjoys nursery or school, or is in full time employment
• On track to achieve educational potential
• Supported to learn
• Engaged in education, training, or employment if left school
• Well-motivated, self-confident

Parenting capacity indicators

Parents and Carers

• Able to provide care for child's needs and protect from danger in the home and elsewhere
• Providing secure, consistent, and caring parenting and show warmth, praise and encouragement
• Ensuring good family relationships Including where parents are separated
• Providing age and stage-appropriate guidance and boundaries to help child develop appropriate values
• Supporting development through interaction and play or involvement in activity outside the home
• Prioritising the needs of their children
• Protecting their children from crime and anti-social behaviour and from danger and harm in the home and elsewhere
• Physical or mental health difficulties in family not impacting on child - child supported
• Knows how and where to access support and work effectively with services in best interests of child or young person
• Parents or carers have regular income and provide CYP appropriate access to material goods

Risks

None as needs are met within the family environment. All children use universal services which include schools, health care including health visitors, GPs, housing, and other easily accessed services. At this level, children would be expected to do well with minimum intervention from any additional services.

Child's development indicators

Pre-birth

• Some antenatal appointments missed
• Some concerns that medical advice not followed
• Relationship difficulties identified

Health and Wellbeing

• Slow reaching developmental milestones
• Experiencing frequent minor health problems
• Starting to miss health appointments, defaulting on checks or immunisations
• Not registered with GP or Dentist
• Diet a cause for concern - overweight or underweight
• Encopresis or enuresis (soiling and wetting)
• Hygiene or clothing a cause for concern
• Sensory developmental delay
• Reluctant communicator, not understanding age-appropriate instructions, confused by non-verbal communication
• Immature structure of expressive language, speech sounds immature
• Difficulty in listening for an appropriate period of time
• Physical disability

Social, Emotional and Identity

• Emerging concerns for emotional, behavioural mental health - low self-esteem, lack of attachment/bonding with carer, difficulties expressing empathy
• Emerging difficulties in relationships with adults, peers, and siblings
• Over friendly or withdrawn with strangers
• Finds coping with change difficult even with support
• Not always adequate self-care or hygiene, slow to develop age-appropriate self-care skills
• Failing to develop confidence and skills for independence
• Suffering grief through loss of significant adult through bereavement or separation

Behavioural

• Emerging issues with attendance at school or nursery
• Emerging challenging behaviour including in early years and school settings
• Not engaging with constructive leisure activities
• Young carer with limited access to quality education or age-appropriate leisure facilities

Learning and Education

• Limited access to early developmental experiences
• Milestones for cognitive development not met
• Mild to moderate learning difficulties
• Emerging evidence of poor school or early years attendance or punctuality
• Changes of school or early years setting
• Beginning to underachieve in school
• Start of behaviours which may risk exclusion
• Sometimes appears tired in school
• Subject of elective home education
• Family and Social Relationships
• Difficult parent or child relationship - starting to demonstrate difficulties with attachment
• Limited support from family and friends - socially isolated
• Sibling with significant problem (health, disability, behaviour)
• Child living with other family members

Parenting capacity indicators

• Parents requesting help
• Parents requiring advice or support on parenting issues for example, appropriate childcare arrangements, home conditions, basic routines and boundaries, low-level behaviour management (rewards or sanctions)
• Parents or carers have learning disability impacting on parenting capacity
• Parents or carers are 'care leavers' and/or very young with insufficient support
• Parents or carers have poor social skills
• Parents or carers are isolated/lack support from family or friends
• Inconsistent responses to child by parents or carers, including where parents or carers are separated and/or where care is delivered by multiple people
• Parents or carers have relationship difficulties or there is conflict which may affect the child
• Behaviour problems not recognised and addressed by parents or carers - lack of response to concerns raised about child
• Parents or carers offer inconsistent boundaries and lack of appropriate guidance and boundaries for child's stage of development and maturity
• Parents or carers over controlling, overprotective CYP unable to develop independence

Environmental indicators

• Family are socially isolated refugees or asylum-seeking migrants
• Unemployment, low income, poor housing conditions
• Insufficient facilities to meet social integration needs for example, advice/support needed to access services for disabled child where parent is coping otherwise

Risks

Unmet needs compromises life chances of children and families.

In some cases, a child or young person supported by the universal services may have unmet needs which can be met by additional services usually from a single agency but which do not require a Team Around the Family Approach. Examples of this could include:

• A referral to the Speech and Language Team where language delay is considered to stem from a health-related issue rather than an environmental or parenting issue
• A referral to Portage where a child's special educational needs are otherwise well met by the parents
• A referral to Smoking Cessation services where there are no other identified needs
• A referral to a parenting programme

Child's development indicators

Pre-birth

• Several antenatal appointments missed, poor ante-natal care
• Medical advice not followed
• Relationship difficulties

Health and Wellbeing

• Slow in reaching developmental milestones, including persistence of poor or delayed speech and persistence of sensory developmental delay
• Experiencing frequent significant illness or infections
• Frequent A&E attendance
• Frequently missing health appointments, checks or immunisations adversely impacting on health of CYP
• Unnecessary accessing of health services
• Not accessing health related equipment or using it
• Not registered with GP or Dentist
• Poor diet, overweight or underweight
• Poor hygiene and clothing
• Disability which is challenging for parent

Social Emotional and identity

• Persisting emotional and mental health difficulties - low self-esteem, poor attachments, poor impulse control
• Difficulties expressing empathy
• Difficulties building or sustaining relationships with peers or adults
• Victim of bullying including cyber bullying - or perpetrator of bullying others
• Inappropriate use of social media
• Struggling to meet age-appropriate expectations in respect of hygiene or self-care
• Emerging signs of self-harming behaviour
• Emerging signs of eating disorder

Behavioural

• Issues with attendance at school or nursery
• Disruptive challenging behaviour including in early years and school settings
• Risk of short-term exclusions
• Starting to engage in low level offending or anti-social behaviour - parents or school finding behaviours difficult to manage behaviours
• Emerging evidence of low-level misuse of substances
• Emerging concerns re: inappropriate relationships with adult and peers
• Non engagement with constructive leisure activities
• Increasing difficulty coping with anger

Learning and Education

• Limited access to early developmental experiences
• Milestones for cognitive development not met
• Poor school or early years attendance or punctuality
• Multiple changes of school or early years setting
• Not making expected educational progress despite support/ underachieving in school
• Often appears tired in school
• Not accessing work appropriate skills
• Emotionally based school refusal
• Electively home educated - emerging concerns about suitability appropriateness of curriculum
• Young carer not supported to access education or age-appropriate leisure facilities
• Emerging concerns of unnecessary accessing of health services and/or unusual or perplexing presentation in school which might impact on learning (consider FII)

Family and Social Relationships

• Family demonstrating low level anti-social behaviour towards others
• Parents or carers have relationship difficulties or there is conflict which may affect the child
• Sibling with significant problem (health, disability, behaviour)
• Limited support from wider family and/or friends
• Family are migrants/asylum seekers or refugees at risk of social isolation, discrimination and/or harassment

Parenting capacity indicators

• Parents requesting help and continuing to require advice or support on parenting issues - struggling to provide adequate basic care, care is erratic and inconsistent despite support
• Parents or carers have significant learning disability and poor social skills impacting on parenting capacity
• Parents or carers unable to provide age-appropriate stimulation
• Parent or carer suffering physical or mental ill health, or terminal illness impacting on their ability to parent without support.
• Child's health needs not adequately met for example, delaying health care, failing to follow health advice
• Poor supervision and attention to safety issues in and outside the home
• Parents or carers are 'care leavers' and/or very young with insufficient support
• Parent previously 'looked after' child
• Parents or carers inconsistent in their responses to child including where parents/carers are separated and/or where care is delivered by multiple people
• Parents or carers have relationship difficulties or there is conflict which may affect the child
• Behaviour problems not recognised or addressed by parents/carers - lack of response to concerns raised about child
• Parents or carers offer inconsistent boundaries or lack of appropriate guidance and boundaries for child's stage of development and maturity or are over controlling or protective
• Child(ren) criticised by parent; parent speaks negatively to professionals -about one or more of their children, persistent inability of parent or carer to be warm and affectionate - low warmth, high criticism environment

Environmental indicators

• Adverse childhood experiences (ACE's)
• History of involvement with statutory services, history of neglectful parenting or history of domestic abuse
• Parent/Carer In prison/involved in criminal activity
• Family are migrants, asylum seekers or refugees at risk of social isolation, discrimination and/or harassment
• Family isolated with absence of support from family or friends
• Family affected by low income, debt or poverty affecting access to appropriate services to meet child's needs, impacting on quality of housing and ability to meet basic care needs of children
• No recourse to public funds
• Large number of children under 5 years

Risks

Without a multi-agency response to share information and formulate a plan to address the unmet needs of all family members, there is a risk that outcomes for the child(ren) will be adversely affected, and the child(ren) will fail to meet their potential. Ultimately there is a risk that the unmet needs will escalate and require a higher level of intervention.

Child's development indicators

Pre-birth factors

• Majority of antenatal appointments missed
• Medical advice not followed
• Issues of domestic abuse
• Lack of preparation for the birth
• Previous history of serious mental ill health
• Persistent excessive alcohol consumption, smoking or other substance misuse

Health and Wellbeing

• Complex medical needs and/or disability, needs being met via a variety of health professionals
• Severe disorder and impairment in understanding spoken language or communication difficulties having a severe impact on everyday life, requiring alternative or augmented means of communication
• Serious developmental delay
• Not registered with GP and/or Dentist
• Multiple A&E attendances causing concern
• Frequent significant illnesses, infections or injuries
• Delays in seeking medical/dental attention
• Non-attendance at health appointments impacting on child's health and wellbeing
• Clinically obese or malnourished (failure to thrive)
• Evidence of significant substance/alcohol misuse
• Pregnancy and/or Sexually Transmitted Infection in young person (under 16)

Social, Emotional and Identity

• Mental ill health or severe bouts of depression or threats of suicide deterioration over time - impulsivity or lack self-control
• Persistence of low self-esteem, lack of attachment or bonding with carer
• Inability to sustain relationships with peers/adults
• Escalating self-harming behaviour
• Complex identity issues impacting on day-to-day functioning
• Seriously affected by persistent discrimination for example, based on ethnicity, sexual orientation or disability
• Evidence that bullying including cyber bullying having adverse impact on wellbeing
• Poor self-care for age, including hygiene
• Eating disorder adversely impacting on health and development
• Inappropriate use of social media - emerging evidence of age-inappropriate relationships, 'grooming' and vulnerability to CSE or abuse
• Evidence that witnessing domestic abuse is having an adverse impact on health and wellbeing
• Evidence of unnecessary accessing of health services
• Concerns of unusual or perplexing presentation in school which may impact on learning (consider FII)

Behavioural

• Regularly missing from early years, education or employment or training
• 'Missing from home' episodes
• Disruptive or challenging behaviour in the community, early years settings, school and home
• Increasing difficulty coping with anger
• Involved in criminal, anti-social, violent or risk taking behaviour
• Subject to antisocial behaviour disorder (ASBO) or acceptable behaviour contract (ABC) i.e., out of control in the community
• Enters Criminal Justice System at pre-conviction stage for example, has received an Out of Court Disposal
• Prosecution for adult offences
• Evidence of inappropriate relationships with adult and peers - at risk of 'grooming' and also of 'grooming' others (consideration of both as victims)
• Displaying elements of harmful sexual behaviours
• Increasing evidence of vulnerability to CSE, sexual activity, teenage pregnancy, or risk of radicalisation or modern slavery and criminal exploitation for example, County Lines, Gangs or Criminal Exploitation
• Regular heavy use of substances, drugs or alcohol
• Non engagement with constructive leisure activities

Learning and Education

• Persisting lack access to early developmental experiences despite support
• Cognitive development milestones not met despite support
• Significant impact on not engaging with speech and language support
• Persistent school/early years poor attendance or punctuality despite support
• Persistent condoned absence from school
• Unexplained absences from school leading to exploitation concerns
• Lack of support for education/social interaction
• Parent/child subject of statutory intervention for poor attendance
• Excluded from school
• No school place and meets hard to place criteria (Fair Access Criteria)
• Emotionally based school refuser or unable to cope with everyday life (including employment)
• Complex learning difficulties leading to safeguarding vulnerabilities
• Additional special educational needs support required including EHCP
• Not making progress in spite of interventions
• Always tired in school
• Totally disengaged from learning
• NEET (for more than 6 weeks) - and experiencing barriers to progress
• Electively home educated evidence of ineffective curriculum
• Unusual or perplexing presentation actually impacting on learning (consider FII)
• Educational (or social or mental health needs) which may lead to educational placement out of school or away from home

Family and social relationships

• Siblings of looked after children and young people with mental ill health, wellbeing issues or severe disabilities
• Suspicion child or young person engaging in child exploitation activity such as:
  • CSE
  • County lines
  • Trafficking or modern day slavery
• Risk of Radicalisation
• Young Carer
• Privately fostered
• Living with other family members or 'friends
• Family at risk of breakdown related to child's behavioural difficulties or child/parent relationship at risk of breaking down
• Emerging evidence of chaotic lifestyle for example, homelessness, sofa surfing
• Suspicions of potential female genital mutilation within the family, or significant others
• Child or Young Person at risk of forced marriage
• Child or Young Person at risk of honour-based violence
• Destructive involvement from extended family
• Family socially isolated refugees or asylum seekers and/or subject to frequent harassment or hostility
• Family are isolated, or lack of support from family or friends

Parenting capacity indicators

• Significant Learning Disability impacting on parenting capacity
• Poor social skills
• Parents unable to recognise child's needs to the extent child's development is being impaired
• Poor mental health
• Young inexperienced parents with no support for example, 'Care leavers
• Parent previously a 'looked after' child
• Absence of commitment to parenting or prioritises own needs over needs of child or young person
• Refusal to register CYP with a GP or take medical advice causing avoidable harm to health and well-being
• Insufficiently protective for example, allows exposure to inappropriate or harmful material and people (for example, via internet) or overprotective
• Low warmth, high criticism environment or inappropriate use of punishment and sanctions
• Absence of guidance or boundaries
• Significant substance and/or alcohol misuse impacting adversely on child and is detrimental to their development
• Parental conflict adversely impacting on child or young person. Repeated incidents of domestic abuse having an emotional impact on children
• Parents in conflict with statutory services
• Parent in prison

Environmental indicators

• Adverse childhood experiences (ACE's)
• History of involvement with statutory services/history of neglectful parenting/ history of domestic abuse
• Moderate mental or physical health difficulties within the immediate family
• Parent involved in criminal activity
• Family are migrants or asylum seekers/refugees at risk of social isolation, discrimination and/or harassment
• Family affected by low income/debt/ poverty affecting access to appropriate services to meet child's needs, impacting on quality of housing and ability to meet basic care needs of children and risk of breakdown of family for example, imminent risk of eviction through non-payment of rent
• No recourse to public funds
• Large number of children under 5 years
• Moderate mental or physical health difficulties within the immediate family
• Family socially isolated refugees or asylum seekers and/or subject to frequent harassment/hostility
• Family are isolated or lack of support from family or friends
• Displaced families or women (illegal immigrant, asylum seeker, refugee, living in a women's refuge or hostel)

Risks

Without a Child in Need Assessment to explore the needs and capacity of all family members, which results in a robust multi-agency plan to address the unmet needs of the children, there is a risk that the identified issues will have a significant detrimental impact on the children's life-chances. The children will already be underachieving and failing to meet their potential and urgent remedial action is required. Without this Assessment, it is highly likely that the issues will escalate to a level where a statutory Child Protection response will become necessary.

Child's development indicators

Pre-birth factors

• All or most antenatal appointments missed
• Concealed, Denial or Unwanted pregnancy
• Evidence of incidents of domestic abuse during pregnancy
• Lack of preparation for the birth
• Lack of understanding of the needs of new-born, unrealistic expectations of new-born, inability to prioritise needs of baby
• Previous parental history of serious mental ill health
• Persistent excessive alcohol consumption, smoking or other substance misuse by mother or parents
• Pre-birth assessment identifies child unborn child at risk of significant harm

Health

• Profound or severe and/or multiple disabilities with significant unmet needs
• Life threatening and severe chronic physical and/or mental health problems for which appropriate treatment is not being sought
• Delays in seeking medical or dental attention
• Regularly unfed or signs of malnutrition evident
• Complete rejection by parents
• CYP whose basic needs are persistently neglected
• Not registered with GP and/or Dentist
• Sexually inappropriate language or behaviour for age
• Pregnancy and/or Sexually Transmitted Infection in young person
• Multiple A&E attendances
• Frequent significant illnesses, infections or injuries
• Bruising or any other injury in a non-mobile infant
• Suspected non-accidental or actual non-accidental Injury
• Substance misuse which has chronic health implications for the child and is detrimental to their development
• Unnecessary accessing of health services
• Suspected or actual Fabricated or Induced illness

Social Emotional and Identity

• Subject to a CP Plan or suffering or at risk of suffering physical or sexual or emotional abuse or neglect
• Additional special educational needs support required including EHCP
• Cognitive developmental milestones not met despite support, or not making progress in learning in spite of interventions
• Fabricated Induced Illness impacting on learning (consider FII)
• Always tired in school
• Totally disengaged from learning
• NEET (for more than 6 weeks) - and experiencing barriers to progress plus other risk factors
• Electively home educated but ineffective curriculum plus other risk factors
• Unable to cope with everyday life (including employment)
• Educational (or social or mental health needs) which may lead to educational placement out of school or away from home

Family and Social Relationships

• Previously removed from parents and/or subject of CLA processes
• Person identified as posing a risk to children living in the home - parents not protecting. This includes former partners who have re-instated contact
• Child left alone or unsupervised based on age, development, and maturity
• CYP assessed as high risk either to themselves or others - abuses other children
• Abandoned child or unaccompanied asylum seeking minor
• Family at risk of breakdown related to child's behavioural difficulties
• Chaotic lifestyle 'sofa surfing' - homeless and not eligible for temporary housing
• At risk or suspected risk of Trafficking or Modern Day Slavery
• At risk or suspected of Radicalisation
• Involved in criminal activity and/or with Gangs
• Young Carer plus other risks
• Privately fostered plus other risks
• Risk of female genital mutilation within family or significant others
• CYP at risk of forced marriage or Honour Based Abuse or Crime committed to protect or defend the honour of the family or community (honour-based violence)
• Family experiencing social exclusion
• Teenage pregnancy
• Domestic abuse within family having adverse impact on health and development of CYP
• Destructive involvement from extended family

Parenting capacity indicators

• Absence of guidance and boundaries - not protecting from significant harm including from unsafe adults and inappropriate or harmful material for example, via internet
• Parent or carer a risk to children
• Physical or mental ill health or terminal illness impacting on ability to parent CYP even with support. Parent struggling to address own emotional needs impacting adversely on CYP even with support
• Significant learning disability which impacts on parenting ability. Unable to meet CYP care needs consistently - even with support
• Inability to recognise child's needs to the extent child's development is being impaired
• Chaotic substance or alcohol use impacts on ability to provide basic care of child
• Absence of commitment to parenting or prioritises own needs over needs of child or young person
• Persistent refusal to register CYP with a GP or seek medical advice causing avoidable harm to health and well-being of CYP
• Low warmth, high criticism environment undermining CYP sense of self- worth, or Inappropriate use of punishment and sanctions
• Extreme continuous domestic abuse. having an adverse emotional impact on children
• Young inexperienced parents with no support for example, 'Care leavers' or Parent previously a 'looked after' child
• Parents in conflict with statutory services
• Parent in prison

Environmental indicators

• Own childhood experiences (ACE's)
• History of involvement with statutory services/history of neglectful parenting
• Moderate mental or physical health difficulties within the immediate family
• Family affected by low income, debt or poverty affecting access to appropriate services to meet child's needs, impacting on quality of housing and ability to meet basic care needs of children, and creating risk of breakdown of family for example, risk of eviction through non-payment of rent or a dangerous house or accommodation - placing child in danger
• Family not entitled to benefits/no recourse to public funds with no means of other support

Risks

It is known that the child has already been harmed and that parents have either been involved or have been neglectful in protecting their child. There is an identified, significant risk of harm and without an immediate and urgent response, the child or children are likely to suffer that harm either now or in the future. Without this urgent action, it is highly likely that the issues will escalate to a level where the child(ren) will need to be accommodated.