- Serious Case Reviews
- Governance Arrangements
- Deciding Which Panel to Use
- Case Responsibility
- Complex Case Panel Membership
- Roles of Members
- Frequency of Panel Meetings
- Criteria for Complex Case Planning
- Examples of Service-Based Concerns Affecting Outcomes
- Intended Outcomes of the Process
- Appendix 1: Complex Case Pathway Flowchart
A small proportion of young people have multiple needs and present serious ongoing concerns to the education, health, social care and youth support services in their area. It is likely that most of these services will have offered interventions at different times in the young person's history. However, the services may not have been able to commit the necessary resources and expertise in an integrated way that achieves the desired outcomes. Some cases have become 'stuck' and in a small number of cases the consequences have been tragic as risks have spiralled.
The purpose of setting up the complex case panel is to enable managers to realise and share their responsibility for the whole young person, and to avoid taking a reactive stance along specialist divisions.
Where inter-agency planning forums such as Core Groups, Child Protection Conferences, children Looked After Reviews or Teams Around the Child have not made sufficient progress to reduce risk and secure improved outcomes professionals should recourse to independent chairs/reviewing officers to raise their concerns and this should lead to renewed action to address the concerns. In a proportion of cases, the decision may be taken to initiate court proceedings and this sets a path towards the desired outcomes for the child. In some cases this route will not be appropriate or will not have been effective in ensuring the child's safety.
However, when these 'normal' processes have been tried and the risks to the child's safety or outcomes persist, there should be an escalation process that ensures scrutiny, expertise and multi-agency accountability at senior level.
Oxfordshire Safeguarding Children Board has approved the proposal to set up a multi-agency advisory process. The process ensures that senior managers and 'experts' become more involved in overseeing risk management, the resolution of disputes and providing consultation or resources and thereby increase senior accountability for achieving improved outcomes.
2. Serious Case Reviews
The Serious Case Review concerning the death of a 15yr old female in 2008, made a number of recommendations, three of which are addressed by this proposal. They are as follows:
- Ensure the development of an integrated approach to assessment and service delivery for adolescents in complex and high risk cases;
- Ensure that all Trust partner agencies understand, and discharge, fully, their obligations to Looked After Children in respect of partnership working around their care planning, support, education and therapeutic needs;
- Establish a 'virtual panel' of senior representatives from key agencies (Health, Mental Health, Social Care, Education) to advise social workers and inter-agency core groups for Looked After Children when managing the needs of challenging, high-risk adolescents in the Care system.
The Serious Case Review concerning the abuse and neglect of four children made this recommendation:
- Consider a variety of ways in which the delivery of supervision in cases of neglect may be extended (include multi-agency initiatives).
3. Governance Arrangements
It is proposed that the Oxfordshire Safeguarding Children's Board oversees these arrangements by agreeing to:
- Implement and develop the Complex Case panel and process;
- Regularly review, through an annual report to the Board, whether;
- The panel is achieving its intended impact on individual cases;
- Whether the panel is fulfilling the recommendations of the relevant SCRs (above).
- Update guidance as required;
- Identify gaps in commissioning;
- Identify best practice.
The Panel's objective is to improve inter-agency risk management of children and young people.
The Complex Case Panel is a senior level multi-agency advice and consultation group. Its function is operational, but it has the ability to recognise wider service or policy gaps so that strategic work can be taken forward in other forms.
5. Deciding Which Panel to Use
The Panel functions alongside other high level groups which have a particular focus.
Examples of these are:
- Placement & Commissioning Panel: approves placements and packages of care for children with complex needs;
- Multi-Agency Public Protection Arrangements (MAPPA): reviews the risks posed by individual adults and young people in the community;
- Legal Panel (Children, Education & Families): considers whether cases have reached the threshold for s31 care proceedings.
None of these panels preclude the use of the Complex Case Panel. However, professionals/managers considering a referral should have regard to:
- Statutory guidance and local procedures that apply to the case and other panels/processes established to manage them. These should be accessed before the Complex Case Panel;
- The risk management remit of the Complex Case Panel.
6. Case Responsibility
Cases are brought to the Panel for discussion by managers, practitioners and clinicians with case responsibility. The Panel does not supersede or take-over case responsibility, this remains unchanged.
7. Complex Case Panel Membership
Chairperson: Deputy Director, Social Care CEF or in his/her absence: Director of Children's Services, Oxford Health
- Designated Safeguarding Doctor, Oxford University Hospital Trust;
- Designated Safeguarding Lead, Oxfordshire Clinical Commissioning Group;
- Service Manager, Safeguarding and LAC, Oxford Health;
- Clinical Lead, CAMHS, Oxford Health;
- Detective Chief Inspector, Public Protection, Police;
- Safeguarding Manager, CEF
- Disability Manager, CEF;
- Area Social Care Manager, CEF;
- Special Educational Needs Manager, CEF;
- Legal Advisor, CEF;
- Other senior colleagues as required for specific case discussions. Specific invitations should be indicated on the case-referral form.
8. Roles of Members
- Read case referrals in advance of the Panel;
- Research their own agency's involvement with referred cases and bring relevant information to the Panel;
- Take a solution-focussed approach to cases discussed;
- Agree actions with clear timescales and lines of communication, before the next Panel;
- Follow-up and ensure their agency's actions are completed in a timely way;
- Where resources are recommended or committed, the appropriate internal approvals are sought and promises are kept;
- Learning achieved through the Panel is disseminated to relevant teams and individuals;
- Escalate to OSCB any case which meets the criteria for a formal review within the Learning & Improvement Framework.
9. Frequency of Panel Meetings
Meetings will take place on an ongoing bi-monthly basis.
10. Criteria for Complex Case Planning
The process seeks to deliver a flexible and holistic, multi-agency response for children and young people who have identified multiple needs, whose planned outcomes are not being achieved despite the best efforts of the inter-agency core group and for whom risks are increasing. For example:
- Neglect: cases with a Child Protection Plan, which have had a plan for more than 18 months and where the area service manager has reviewed the case but remains concerned about the absence of progress due to gaps in provision/lack of a specialist assessment;
- Cases where care proceedings have been instigated but have resulted in a Care Order not being made, against LA advice;
- High Risk Adolescents: cases where adolescents, living in the community, whether in their families, or in care, who are exhibiting behaviours which create a risk of Significant Harm, whether to self or others, through violence, offending, self-harm or serious substance misuse. They may be at risk of a secure order;
- Out of County placements: cases where adolescents have been placed at long distance and are lacking co-ordinated services from a range of professionals to be able to move in-county;
- Multiple Complex Needs at risk of poor outcomes: cases where adolescents have both mental health problems and substance misuse; or mental health problems and learning disability; or where two statutory proceedings are in place at the same time e.g. criminal proceedings and Child Protection Conferencing for a young person with sexually harmful behaviours.
This list is intended to be illustrative, not exhaustive.
11. Examples of Service-based Concerns Affecting Outcomes
Complex Case Planning is not intended to 'escalate' or 'sweep-up' serious cases which are making acceptable progress through normal case-management frameworks. These include support and challenge from panels (e.g. legal, adoption, fostering, placement panels) independent chairs/reviewing officers and casework supervisors/managers.
Rather, it is intended to be used for a small number of cases where improved outcomes are not being achieved and risks are increasing. Features of such cases may include:
- Agencies working in contradiction to one another;
- Agencies' resources diverted towards short-term crises not achieving long term outcomes;
- Gaps in provision - services unavailable;
- Gaps in provision - rigid application of threshold criteria hampering combined inter-agency effort;
- Disputes amongst professionals, unresolved by line-managers;
- Professionals have become 'stuck', run out of ideas, repeating unproductive patterns of service delivery;
- Gaps in specialist knowledge/assessment currently available to planning group.
Child/Young person's increased risk of:
- Self-harm/risky behaviours;
- Harm to others;
- Long-term dislocation from family and community.
12. Intended Outcomes of the Process
Discussion leads to:
- Consensus about levels of risk and management accountability at senior management level;
- A single risk management plan adopted by all agencies involved with child. This should include contingencies to deal with unexpected or short-term crises, increased risks;
- Actions agreed by individual agencies to 'unblock' progress, to reduce risk and improve outcomes within specific timescales;
- In-principle agreements about contributions of resources/shared funding (some of which may be subject to confirmation by agencies);
- Revised Care Plan;
- Communication and monitoring arrangements;
- Progress reporting requirements, including timescale. The panel will decide whether reports should be made in writing or in person to a future panel.
i. Request for Complex Case Discussion at Panel
Any agency can propose that a young person should be discussed at the complex case panel with reference to the agreed criteria, so long as the normal case planning, conferencing or dispute resolution processes have been tried and failed to improve outcomes.
The reason for bringing the case must be presented to the agency's senior manager and authorised within line management structures.
The child's key social worker should be consulted about the referral to ensure the timing is congruent with other processes affecting the case. For example, if the case is about to receive an expert assessment or decision in care proceedings, the referral to the panel may not be timely.
Where possible, the referring agency should bring the case jointly with the child's key social worker. The referring agency should not request that the social worker bring the case to panel and not attend or follow through with their reasons.
Where the child's current plan is being overseen within the child protection or looked after framework, the referral should be discussed with the independent reviewing officer or independent chair.
Once agreement has been obtained, the request should be passed to the administrator at least two weeks in advance of the panel, so that written information is sent out in advance and agencies can check their index systems.
ii. Written Information
The practitioner should ensure that a case referral is completed (see template):
- Basic information and family structure (and wider family/community networks where the connections are important);
- Brief history and overview;
- Any significant assessment information;
- Agencies/professionals involved;
- Analysis of current risks (known and unknown);
- Identified issues or obstacles to effective case planning or provision;
- The anticipated benefits of a complex case plan;
- Outcomes sought.
In addition, the following information should be prepared in advance for circulation to panel members:
- Chronology, current risk assessment, last case review report (e.g. review case conference report).
iii. Conducting the Panel
- This will be chaired by the Deputy Director, Social Care, or in his/her absence, the Director of Children's Service, Oxford Health;
- See panel membership list above for attendees;
- Each case will be presented by the senior manager of the agency which requested the discussion/a representative of the respective core group/inter-agency planning group for the child;
- Case discussions will be minuted (see template) by the administrator and signed by the chairperson;
- Agenda slots will be kept for previous cases on which progress reports have been requested.
iv. Following the Panel
- The administrator will ensure the minutes are received by the key worker or lead professional for the child;
- The senior manager/agency representative who presented the case at panel is responsible for ensuring that the actions approved at the panel are brought back and acted on promptly by the core group/inter-agency planning group;
- The risk management plan should be adopted and implemented by all agencies;
- The care plan should be revised to reflect actions recommended at the panel and reported to the Independent Reviewing Officer/independent chairperson (where appropriate);
- Arrangements for reporting back to the panel to be adhered to.