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POLICY FRAMEWORK FORSERVICE DELIVERY OF

CHILDREN’S DISABILITY NETWORK TEAMS

MARCH 2020

Policy Framework for CDNTs March 2020 1 |

List of contents

Introduction 3

Abbreviations 4

Context 5

Principles and values 7

Governance 10

Clinical governance and supervision 11

Team structures and responsibilities 14

Policies protocols and guidelines for CDNTs 16

Diagram Access to services 17

Diagram Integrated Children’s Services Forum 18

Joint working with other services 19

Joint working protocol Primary Care, Disability and CAMHS

20

Joint working protocol HSE and Tusla 24

Record keeping and information management 25

Consent 28

Confidentiality 31

Complaints 31

Staff employment policies 32

Bibliography 33

Appendix 1 Self audit tool for CDNTs

34

Appendix 1 Checklist to assist with identifying needs for the development of policies and procedures

50

Introduction


This Policy Framework for Service Delivery outlines the processes involved in the delivery of Children’s Disability Network Team (CDNT) Services. It is not an exhaustive list of all policies required for teams, but provides a guide for teams in developing and reviewing their model of service and PPPGs. (See also Appendix 1 Checklist for Policies and Procedures and Appendix 2 Self Audit Tool for CDNTs)

Diagram 1: The Children’s Disability Network Team within the model of Community Healthcare Network Services

The full text of PDS and CDNT policies referenced in this document can be found on the Progressing Disability Services pages on the HSE website https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/ They can also be found on the PDS pages at The Change Hub on www.hseland.ie. Registration is required to access this site.

AbbreviationsCAMHS - Child Adolescent Mental Health Service


http://www.hseland.ie/

https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/

CDNT - Children’s Disability Network TeamCHN CDNM - Children’s Disability Network Manager

CHN - Community Healthcare Network CHO - Community Healthcare Organisation CNS - Clinical Nurse SpecialistCNA - Cannot attend appointmentCPD - Continuing Professional Development CRO - Central Referrals OfficeDNA - Did not attend appointmentFOI - Freedom of InformationGP - General PractitionerGMS – General Medical Card SchemeHOD - Heads of DisciplineICF - International Classification of Functioning, Disability and HealthICSF - Integrated Children’s Services ForumLIG - Local Implementation Group

OT - Occupational Therapist /Occupational Therapy PC - Primary Care

PCT - Primary Care Team PHN - Public Health Nurse

PNT - Primary Care Paediatric Network TeamPT - Physiotherapist /Physiotherapy

SOP - Standard Operating Procedures SLT - Speech and Language Therapist/Speech and Language Therapy

SW - Social Worker/Social Work


Context

Children’s Disability Network Teams are developed under the Progressing Disability Services for Children and Young People Programme (PDS) in order to:

Provide a clear pathway and fairer access to services for each child with a disability and their family based on their need, not on their diagnosis, where they live or go to school.

Make the best use of available resources for the benefit of children and their families

Work in partnership with families and with education staff to support children with a disability to reach their full potential.

Children’s Disability Network Team Services operate within the legislative context for health services in Ireland and follow the direction of national strategy and policy. The National Standards for Safer Better Healthcare (2012) describes a vision for high quality, safe healthcare. The dimensions of quality are described under eight themes. The first four themes are person centred themes:

Person-centred care and support – how services place the service user at the centre of their delivery of care. This includes the concepts of access, equity and protection of rights.

Effective care and support – how services deliver best achievable outcomes for service users in the context of that service, reflecting best available evidence and information. This includes the concepts of service design and sustainability.

Safe care and support – how services avoid, prevent and minimise harm to service users and learn from when things go wrong.

Better health and wellbeing – how services identify and take opportunities to support service users in increasing control over improving their own health and wellbeing.

The second four themes involves the service providers having capability and capacity to deliver improvements within these quality dimensions:

Leadership, governance and management – the arrangements put in place by a service for clear accountability, decision making, risk management as well as meeting their strategic, statutory and financial obligations.

Workforce – planning, recruiting, managing and organising a workforce with the necessary numbers, skills and competencies.

Use of resources – using resources effectively and efficiently to deliver best possible outcomes for service users for the money and resources used.


Use of information – actively using information as a resource for planning, delivering, monitoring, managing and improving care. All policies for service delivery should be developed in the first instance with the primary goal of achieving best possible outcomes for children and their families. Policies should be within the framework of current legislation and national policies. These include:

UN Convention on the Rights of Persons with Disabilities National Disability Strategy 2004 Education for Persons with Special Education Needs (EPSEN) Act 2004 Disability Act 2005 Department of Health – Statement of Strategy – 2016 – 19 Better Outcomes, Brighter Futures: Report of the National Policy Framework for Children &

Young People 2014-2020. Department of Children and Youth Affairs. 2014 Children First Act 2015

Lead Agency ModelThe Lead Agency Model is the agreed structure for the future service delivery of children’s disability services. Each lead agency will have the responsibility for the provision of services for children 0-18 with complex disability1 in the Children’s Disability Network Team(s) (CDNT) assigned to that agency. The lead agency may be a HSE funded non-statutory organisation or a HSE Community Healthcare Organisation. The National Policy on the Lead Agency Model can be found on the PDS pages on ww.hse.ie https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/

documents/

Principles and Values

The following twelve principles and values provide the bedrock for the model of service delivery for Children’s Disability Network Teams. These principles have been identified and developed through




an iterative process based on national and international best practice evidence1, consideration by the PDS National and Local Implementation Groups, and consultation with stakeholders.

Accessibility

Environment: All service delivery should facilitate the needs of the child and the family including an accessible physical environment where possible. Ability to travel, access to public transport and the geographical location of the family should be taken into account. Information: Families should know how to access information, from whom or where it can be obtained. Information should detail service provision, range and accountability. Information should be presented in a clear and concise manner, jargon-free and in a language that is easily understood. Information should be available in a variety of accessible formats.

AccountabilityAccountability must be embedded in the culture of the team and is the responsibility of all involved in service delivery and can be achieved through:

o Evaluationo Feedbacko Written policies and procedureso Monitoringo Functional, clinical and personal outcome measuremento Evidence based practice and up-skillingo Financialo Compliance with legislation and national policy guidelines

Bio-psychosocial modelThe bio-psychosocial model is a broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behaviour, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.).

Services should be delivered holistically, focusing on all aspects of a child and young person’s and family’s life, particularly in the context of the community and society. The model promotes the idea that society and the environment must recognise and accommodate individual needs, based on dignity and respect, supporting and facilitating children and families to access and be included in their community and society. This involves working in partnership with stakeholders and the wider community to support and develop services and activities that achieve mutually beneficial outcomes. 1 See references in Guidelines for Local Implementation Groups on developing a governance structure for children’s disability services 2011 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/



Clinical governance and evidence based practice Services must be planned and delivered under a system of clinical governance and evidenced best practice. The application of research is part of an evidence based approach to decision making, which incorporates the child and family’s preferences, the use of current best practice and practitioners’ clinical expertise and experience into the support plan. The application of an evidence based approach involves ensuring that services keep up to date with on-going research that informs new practices or techniques and the inclusion of agreed clinical guidelines, policies and protocol with inbuilt audit and review dates. Through clinical governance teams demonstrate that they deliver an evidence based practice. Guidelines, policies and protocols should be locally owned and ensure that research is converted appropriately into practice.

Cultural competenceSensitivity to cultural differences is entwined in the systems of service delivery which should be compatible with family values and goals. Each family’s unique cultural differences and diversity should be recognised. The uniqueness will inform the partnership in service delivery with the family. The culture of each organisation needs to be acknowledged and appropriate aspects integrated within the culture of the new services.

Early identification of needsThe earlier we can identify children with developmental concerns the better, so introducing intervention at the earliest point possible may well achieve maximum developmental benefits. Disability services have a key role in assisting those who come in contact with children and parents in early childhood to recognise risk factors and make appropriate referrals.There should be a clear pathway to services which is easily understood by parents and other referrers. Strong co-ordination is needed between services so that no child/young person/family will fall through a gap in services.

Equity of accessOne of the primary objectives in the development of Children’s Disability Network Teams is to have equity of access to services for all children and their families based on need. Access must be based on the child’s needs and not on diagnosis or category of disability or the school he/she attends. The National Policy on Access to Services for Children with Disability or Developmental Delay 2019 provides the framework for services to consider a child’s needs and the most appropriate service to meet those needs. Eligibility criteria and procedures for accessing services will be transparent and user

friendly. Any form of discrimination in relation to access to services must be guarded against by adhering strictly to national policy and to agreed local procedures.


Evaluation of OutcomesTo achieve best possible outcomes for children and families requires:

o Setting explicit goals and objectiveso Regular evaluations and feedback from both team members and familieso A multi-tiered system that encompasses needs assessment, monitoring and accountability

of services and supportso Evaluation of functional, clinical and personal outcomeso Quality reviews and programme clarificationso Responsiveness to each family’s prioritieso Formal and informal evaluation methods

Family Centred PracticeFamily centred practice is an empowering approach that focuses on the whole family and not just the child requiring support. It recognises that the wellbeing and development of the child is dependent on the wellbeing of each of the family members and the family as a whole. Family centred practice ensures that supports provided are determined from family priorities. It requires that there is family involvement in the identification and measurement of achievements. It recognises that each family has its own role, values, structures, beliefs and coping styles. It is important to appropriately assess the varieties of stressors that can adversely affect family patterns of interaction and utilise that information to strengthen families, which may require the selection and implementation of social supports, resource supports, information and services. Individualised plans that are sensitive to family and child issues assist in maximising participation of families.

InclusionChildren’s Disability Network Teams support the inclusion of children in their community and facilitate the maximum development of each child’s independence and participation. This includes offering programmes that support the development of skills for daily living, support for participation in pre-school and school as appropriate and information for families on local activities, social and leisure opportunities.

Interdisciplinary Team ApproachAn interdisciplinary team is a number of professionals from different disciplines who work with the child and family, sharing information, decision-making and goal-setting. They have common procedures and policies and frequent opportunities for communication. They work collaboratively to meet the identified needs of the child with a joint service plan, and see the child separately or together as appropriate. The interdisciplinary team approach is supported by national and


international best practice2. This model of practice aims to enable each child and family to experience and access a holistic, unified continuum of service delivery where a family centred planning approach is central to the process.

Staff are Valued and Respected Effective services for children with a disability and their parents are grounded both in the knowledge and skills of frontline staff and in the relationships formed between staff and families. Staff who are well-motivated and happy in their work provide better care and support better outcomes. Their efforts to provide the best possible service must be acknowledged and valued, and they must be supported by management and encouraged to continuously develop their professional knowledge and skills.

GovernanceThe ‘International Framework: Good Governance in the Public Sector’3 suggests a number of high level governance principles which should underpin the governance arrangements in public sector organisations.

1. Good governance supports a culture and ethos which ensures behaviour with integrity, a strong commitment to ethical values, and respect for the rule of law.

2. Good governance helps to define priorities and outcomes in terms of sustainable economic and societal benefits and to determine the policies and interventions necessary to optimise the achievement of these priorities and outcomes. It means implementing good practices in transparency, reporting, communications, audit and scrutiny to deliver effective accountability.

3. Good governance means developing capacity, including the capability of the leadership team, management and staff.

4. Good governance means managing risks and performance through robust internal control systems and effective performance management practices.

5. Good governance ensures openness, effective public consultation processes and comprehensive engagement with stakeholders.

2 Ten principles of good interdisciplinary team work. Susan A Nancarrow, 1 Andrew Booth,2 Steven Ariss,2 Tony Smith,3 Pam Enderby,2 and Alison Roots4. . Human Resources for Health. 2013

3 International Framework: Good Governance in the Public Sector (IFAC, CIFPA 2014)


Each team’s governance and reporting relationship must be clearly outlined and documented.

Each team is accountable to a Children’s Disability Network Manager. The Children’s Disability Network Manager reports to the designated line manager in the organisational structure.

The Children’s Disability Network Manager is accountable to the Community Healthcare Organisation Head of Social Care (or nominated officer) through the children’s disability services governance group with respect to adherence to the model of service delivery, key objectives and key performance indicators..

The manager has clearly defined roles and responsibilities regarding implementation of service model, clinical management, quality assurance, service planning and accountability. The manager should undertake an annual review of the team structure and associated documentation. The Self-audit tool for Children’s Disability Network Teams is for managers and teams to review the operation of the service on an annual basis, identify areas for improvement and to map progress. (See Appendix)

National policies must be implemented and additional local policies and procedures developed and reviewed by the management/governance group, and teams need to regularly ensure they are operating in compliance with these. In addition to national, organisational and local policies, the team may identify in addition other policies and procedures relevant to the team’s functioning, in line with overall principles of governance and standards. Teams should have a documented process for formulating, approving and reviewing such local policies and procedures. All policies and procedures should record dates of development, date of approval, who it was approved by and proposed review date. Written policies and procedures must be available and accessible to all stakeholders and policies and procedures must be clearly communicated through the induction process.

Clinical Governance and Supervision

“Clinical governance is a framework through which healthcare teams are accountable for the quality, safety and satisfaction of patients in the care they deliver…. A key characteristic of clinical governance is a culture and commitment to agreed service levels and quality of care to be provided.” (Quality and Safety Clinical Governance Development Assurance Check for Health Service Providers HSE & Department of Health 2012)

The service must be able to demonstrate that they deliver an evidence based practice and must implement processes to support continuous improvement which are:

Documented Based on data analysis of self-assessment, consumer assessment and outcomes measurement Informed by other statistical data/events Set priorities, strategies, responsibility and timeframes


Monitor and review

All team members must have a structure for clinical supervision which has protected time and is planned, documented, audited and supported within all disciplines. Team members must have access to evidence based research e.g. journals, online libraries/journals. All team members must have a professional development plan which is reviewed annually and linked to the team development plan.

The Children’s Disability Network Manager must identify through a strengths needs analysis the competencies within the team and those competencies which need to be developed to meet the needs of the children/young people and families within the service. This should be reviewed annually or when team composition changes due to, for example, vacated posts. Team development and training should be scheduled, planned and delivered on an annual basis and training needs identified and incorporated in budget planning. There must be evidence of the completion, evaluation and review of all training programmes.

There should be a regular opportunity for parents/carers and children/young people to express their opinions and experiences of the services they receive and make comments and suggestions on services (e.g. annual focus group) and the service should encourage families to actively engage in general service planning and development.

The service must implement an annual self-assessment process to assess, monitor and improve quality. The Self-audit Tool for Children’s Disability Network Teams provides the format to undertake this review. (See Appendix)

Supervision4

Support and supervision is a process to provide a regular opportunity for the staff member and his/her supervisor to review and reflect on organisational, professional and personal objectives. It is a partnership to establish, maintain and/or elevate the level of an individual’s performance within services. It is the responsibility of all staff and his/her manager/s to actively participate in this process.

A clear reporting relationship will be identified in the supervision agreement for each team member. The Children’s Disability Network Manager must be informed of any practice issues that may arise under supervision, of the competencies of team members and which competencies need to be developed as highlighted through supervision.

Children’s Disability Network Managers will provide clinical assurance for all team members of disciplines

Supervision is provided within the team member’s own discipline

4 Staff Supervision in Social Care. Tony Morrison .2005


Children’s Disability Network Managers may provide direct supervision for team members of their own discipline

Senior grades will provide supervision for staff grades Supervision should take place in a regular, planned and structured manner. Support and supervision is a confidential process, however issues arising may need to be addressed

elsewhere. Supervision may involve clarifying any personal issues that may be affecting work performance but

is not intended as personal counselling and other avenues are available within the employing organization.

Reflection and feedback are key components for both participants in the process. Meeting should follow a set framework. Issues raised by either party may need to be addressed

following the meeting and this process should be planned A support supervision record is completed during each meeting which both parties agree, sign, and a

copy of this record is kept. A Support and Supervision file for each individual staff member must be kept in accordance with

confidentiality policyTraining

Team members must have access to relevant training (both internal and external) to develop skills appropriate to the needs of clients and families accessing the service, in line with the professional development needs of the team member and the development plan for the team. This training should be available equally to all team members but must at all times be relevant and should not negatively affect the functioning of the team.

Team Structures and ResponsibilitiesInterdisciplinary TeamA Children’s Disability Network Team works to an interdisciplinary team model. An interdisciplinary team is a number of professionals from different disciplines who work with the child and family, sharing information, decision-making and goal-setting. They have common procedures and policies and frequent opportunities for communication. They work collaboratively to meet the identified needs of the child with a joint service plan, and see the child separately or together as appropriate.5

Responsibilities of the Children’s Disability Network ManagerThe Children’s Disability Network Manager (CDNM) is responsible to the Lead Agency for the development of Children’s Disability Services within a designated area in line with National Policy. The CDNM is the accountable and responsible person for ensuring the delivery of high quality, safe, integrated children’s disability services to the population of the Community Healthcare Network. This

5 Report of the Reference Group on Multi-disciplinary Disability Services for Children aged 5 to 18 years. 2009 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/



will be provided in accordance with legislative and service delivery frameworks and requirements, within the resources allocated. Using the key principles of the Progressing Disability Services for Children and Young People programme as a model of service which is based on family centred practice and interdisciplinary team working, the CDNM will have full responsibility and accountability for managing resources including all the children’s disability staff within the Children’s Disability Network. The CDNM will provide day to day operational line management for children’s disability staff and provide clinical assurance regarding the professional supervision of each clinician working in that team.

Responsibilities of team members

To work within the Model of Service Delivery and Principles To ensure that family members are partners of the team around their child To work collaboratively with other services and agencies involved with the children and families and

share information with parents’ consent as appropriate. To deliver evidence based practice To promote a learning culture within the team sharing good practice with colleagues and others To maintain their competencies through CPD To participate in professional supervision To contribute to the identification of learning and or training needs, both individual professional and

team needs To advise management in relation to the delivery of services and on additional supports families

might need To monitor and evaluate their own standard of service delivery and report on this to their manager To clearly define their roles in relation to clinical and non-clinical core team functions

Teams must have: Clear governance and line management structures Clearly defined remit and service boundaries Clearly outlined working relationships with partners in service delivery – Primary Care, CAMHS,

Education, HSE and voluntary sector and others Clarity in terms of their organisational responsibilities, particularly where team members come from

different agencies Clearly defined team management and line management structure6

6 Guidelines for local implementation groups on developing a governance structure and policies for children’s disability services 2012 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/




Policies, Procedures, Protocols and Guidelines for CDNTs National statutory policies for the safeguarding of service users and staff are mandatory:-

Children First (see www.hse/childrenfirst.ie ) Health and Safety Fire Safety

The following national Children’s Disability Services policies have been agreed by the National Children’s Programme Oversight Group as required in order to provide equity and consistency of services.

National Policy on Access to Services for Children and Young People with Disability or Developmental Delay

National Policy on Prioritisation of Referrals to CDNTs National Policy on Discharge and Transfer from CDNTs National Policy on the management of team interventions/involvement when other services

from private, complementary and alternative therapy are also involved (In development) National policy on the management of attendance and supporting families to engage with

services (In development) Standard Operating Procedure for Assessment of Need

In addition, each team must work with their governance group to support the implementation of the Lead Agency’s policies across interagency teams. All policies must comply with the requirements described in the Service Arrangement.

Prioritisation of policy development

Priority should be given to the development of policies and procedures in the following areas:-


http://www.hse/childrenfirst.ie

1. Pathways for the recording, reporting and management of child protection and welfare concerns, in line with Children First and Safeguarding Vulnerable Adults, so that all staff have clear guidelines of the reporting process and procedure.

2. Processes to ensure compliance with GDPR, record, and data management procedures including reporting, management and recording for data breaches.

3. Consent agreements from parents/carers for interventions from the team for their child, including sharing of information with colleagues on the team and the wider health service pre/schools, management of digital information, student involvement and other relevant activities that may be appropriate to the particular service. This should also include information on the limitations to confidentiality e.g. child protection and welfare issues.

4. Pathways for the recording, reporting and management of comments, compliments and complaints

5. Procedures for support, supervision and performance management of staff

6. Process and pathway for reporting, management and recording of incidents

7. Processes for supporting the implementation of the national Open Disclosure Policy

8. Processes for supporting the implementation of Informing Families Policy

9. The management of behaviours that challenge and the implementation of related polices including restrictive practices.

Access to CDNT Services7

Access to CDNT services is determined in accordance with the National Policy on Access to Services for Children and Young People with Disability or Developmental Delay 2019.

7 National policy on access to services for children with a disability or development delay. HSE. 2019 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/


Children with disability or developmental delay and their families


Diagram 2: Access to Services for Children and Young People

Integrated Children’s Services ForumSee National Policy on Access to Services for Children with Disability or Developmental Delay 2019

Diagram 3: The Integrated Children’s Services Forum


Child with non-complex needs Child with complex needs

Specialist support as needed by Primary Care and Children’s Disability Network Teams

Primary Care Services

Children’s Disability Network Teams

Support and consultation

Transfer between services if and when child’s needs change

Prioritisation of ReferralsPrioritisation of referrals is determined in accordance with the National Policy on Prioritisation of Referrals to CDNTs 2016. https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/

Discharge/closure and TransferDischarge of children from services or closure after a period of intervention, and transfer of services is determined in accordance with the National Policy on Discharge/Closure and Transfer from CDNTs Revised October 2017. https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/

Joint working with other servicesThere is a need to have clear written protocols in place regarding referrals, joint working, transitions and discharge planning with other agencies and services to ensure continuity of care, good communication, sharing of relevant information, lack of duplication and seamless movement across services.

There are three key national joint working protocols: o Joint Working Protocol Primary Care, Disability and Child and Adolescent Mental Health

Services. 2017 o Joint Working Protocol for Interagency Collaboration between the Health Service Executive

and Tusla – the Child and Family Agency to Promote the Best Interests of Children and Families. 2017

o Joint Working Protocol between the HSE and HSE funded service providers, Better Start Early Years Specialists and the Department of Children and Youth Affairs for the provision of health service supports to children with a disability under AIM.

Where national protocols do not exist local protocols must be developed. Other agencies and services which may require a joint working protocol may include:

Acute hospital services Other relevant disability services such as respite services Education (schools/SENOs/NEPS) Specialist supports for CDNTs in areas of high expertise such as motor management Other services as relevant locally






Protocols provide clarity and a joint framework for service provision to children and young people to promote joint and multidisciplinary working across the named services and organisations. They enhance and improve interagency working practices by ensuring clarity in relation to each agency’s referral protocols and operating procedures. The purpose of this is to ensure improved interagency communication and information sharing to enhance service delivery for children, young persons and their families.

Each protocol should outline:1. The aims and principles underpinning the protocol2. A description of the role of the service/team, the services it delivers and criteria for access3. A procedure for consultation and/or joint working which may include regular consultative or review

meetings, shared case work or information sharing4. Procedures for referral across teams5. Process, pathway and responsibility for resolving issues that may arise6. Process for ensuring compliance with protocol7. Responsibility and timeframe for a review of the protocol

8

Joint Working Protocol Primary Care, Disability and CAMHS9 An important aspect of cooperative and joint working is for all services to facilitate children accessing the appropriate service as early as possible to prevent multiple referrals and/or re-referrals in order to facilitate timely access to appropriate support. Accurate initial referral to the most appropriate service facilitates effective joint working by reducing the amount of inter-agency consultation necessary in relation to inappropriate referrals. Primary Care, Children’s Disability and Child and Adolescent Mental Health Services will aim to make the process as seamless and timely as possible by collaborating to provide comprehensive information to families and other referrers and by communicating with all relevant parties effectively and efficiently.

See the following three flow charts to show pathways:

Pre-referral pathway Referral pathways for Primary Care, CDNTs and CAMHSConsultation and joint working

8 Guidelines for local implementation groups on developing a governance structure andpolicies for children’s disability services 2012 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/9 Joint Working Protocol Primary Care Disability and Child and Adolescent Mental Health Services. HSE. 2017 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/





Diagram 1: Pre-Referral Pathway


Parent, teacher, or other person has concerns about a child’s social, emotional, behavioural, learning, or other developmental difficulties.

Discusses concerns with others who know the child and/or have understanding of child development (e.g. family members, school, PHN, AMO, GP, etc.) to gather information about the concerns, including nature of concern, onset, severity, frequency, and settings.

Difficulty is judged to be within normal limits for the child’s age based on information available at this time.

Difficulty is causing significant challenges and is considered outside normal limits for the child’s age / developmental level.

Parent level of concern is low.

Parent level of concern is high and/or parent is seeking support .

Parent level of concern is high.

No referral to Health Service is needed.

Identify and provide information about community-based supports, e.g. parenting classes, parent-toddler groups, and other local initiatives.

Provide information on appropriate services. Facilitate referral to appropriate service

(See Diagram 2)

Difficulty is resolved.

Continuing concerns in the context of normal child development.


Light blue = Situation or concernRed = Referrer actionGreen = Referrer judgment/decision

Diagram 2: Referral Pathways for Primary Care Service, Children’s Disability Service (CDNT) and CAMHS


Using the Pre-Referral Pathway (see Diagram 1), referrer determines that a referral for support from Primary Care Service, Children’s Disability Service (CDNT), or CAMHS is indicated. Referrer discusses the reasons for this with the child’s parents or carers, and provides information about available services. Referrer and parents/carers decide which one of the services is most likely to benefit the child based on the child’s difficulties and referral criteria for each service. Referrer obtains consent to refer the child to the most appropriate service.

Family & referrer consider that the child has some difficulties but either a) does not have a disability or b) has a mild level of disability or mental health difficulty.

Family & referrer consider that the child may have a moderate or severe disability or developmental delay with complex needs.

Family & referrer consider that the child may have a moderate/severe mental health disorder.

Referral to Primary Care Service using national referral form with signed parental consent.

Referral to CDNT using national referral form with signed parental consent.

Referral to CAMHS by GP or health professional in consultation with GP using CAMHS referral form with signed parental consent.

Consideration by service receiving referral as to appropriateness of service to meet child’s needs. This determination is based on referral information and the referral criteria of the services. More information is sought if necessary.

Referral information indicates that it is the appropriate service to meet the child’s needs at this time.

Referral information indicates that another service is more appropriate to meet the child’s needs, based on referral criteria of services. If appropriate, this is confirmed with the other service.

Referral information indicates that there is more than one service that could best meet the child’s needs, or the child’s needs cannot solely be met by the receiving service.

Assessment and/or intervention offered.

Service re-directs, or advises referrer and parents to re-direct referral to the appropriate service.

Service consults with another service to determine which service is most appropriate or whether a joint approach is indicated. If agreement is not reached, refer to Integrated Children’s Services Forum for discussion and decision.

Red = Referrer actionGreen = Referrer judgment/decisionDark blue = Service actionOrange = Service judgment/decision

Diagram 3 - Consultation and Joint Working


Child is attending Primary Care Service, CDNT, or CAMHS

Needs are identified which require input from another service e.g., advice, assessment, or intervention in relation to differential/co-morbid diagnosis, complex presentation, or other concerns.

Consultation with other service(s) to understand child’s needs and how they might best be addressed.

Difficulties resolved, child’s needs can be met by existing service.

More than one service is involved and case co-ordination is needed.

Joint assessment or extended joint

assessment is indicated.

Joint intervention is indicated.

Referral to other service with full information on child’s history, assessments & intervention is

indicated.

No decision or agreement reached on pathway for child

Existing service continues.

Shared care plan is agreed.

Following assessment, intervention is provided by existing

service.

Following assessment, referral is made to different or additional service for intervention.

Shared care plan is agreed.

Assessment and/or intervention provided by other service.

Discussion and decision

at Integrated Children’s Services Forum.

Light blue = Situation or concernOrange = Service judgment/decision Dark blue = Service action

Joint Protocol between HSE and Tusla10

The following diagram represents the working protocol as a flow chart. As part of the process there will be quarterly meetings, minutes taken, and shared as appropriate, with a mechanism for addressing emergencies.

CFA = Child and Family Agency

Joint Working Protocols HSE / TUSLA

Where a concern is raised by any Division or Child and Family Agency

Where HSE has a child protection concern

Where children are in care of State with ongoing residential support needs post 18

2. Escalation to Area Joint Working Group following local discussion, if consensus cannot be reached or additional resources are required. Jointly chaired by Area Manager CFA & relevant HSE Head of Service. Attended by relevant managers of Disabilities/Primary Care/Mental Health/CFA). Structured meeting monthly or less per demand

HSE to notify CFA in accordance with Children First National Guidance 2011

3. Escalation to HSE Chief Officer & CFA Service Director Level in exceptional case with business case, identifying options and costing where appropriate and signed by all relevant parties. Quarterly meetings or as required, co-chaired by HSE CO and CFA Service Director and attended by relevant Heads of Service.

1. Joint Working at Local Level: Contact is made with relevant practitioner to agree process of engagement. Meeting can be called by any Division or CFA. Action plan agreed will identify:

- Lead Agency and Professional/Caseworker - required interventions, resources, costs and funding agency/agencies

Contact will be same day where harm has occurred or within 1 week where emergency Child Protection plan or court matters need to be addressed.

4. Escalation to relevant HSE National Director and CFA Chief Operations Officer in exceptional cases only where agreement cannot be reached on a business case at HSE CHO/CFA Regional level e.g. due to lack of resources or other impediment

Where HSE has a child welfare

concern

HSE and CFA to use Meitheal/ Existing Interagency approach

CFA to refer to multiagency Local Aftercare Steering Committee on their 16th birthday to commence Aftercare planning

Record Keeping and Information ManagementRefer to Data Protection Acts 1988 -2003, Freedom of Information Acts 1997-2003 and

10 Joint Protocol for Interagency Collaboration between the Health Service Executive and Tusla Child and Family Agency to Promote the Best Interests of Children and Families. 2017 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/



HSE Standards and Recommended Practices for Healthcare Records Management, V3 2011HSE Record Retention Periods.2013

Definition of Record11

‘A record is defined under the Freedom of Information Acts 1997 and 2003 as "any memorandum, book, plan, map, drawing, diagram, pictorial or graphic work or other document, any photograph, film or recording (whether of sound or images or both), any form in which data (within the meaning of the Data Protection Act, 1988 and 2003) are held, any other form (including machine-readable form) or device in which information is held or stored manually, mechanically or electronically and anything that is a part or a copy, in any form of any of the foregoing or is a combination of two or more of the foregoing" (Freedom of Information Act, 1997, 2003).

Records created by the HSE should be both accurate and complete. They must provide evidence of the function or activity they were created to document. In order to be evidential, records must be authentic, reliable, have integrity and be useable.

2.1 An authentic record is one that can be proven to be what it purports to be. In order to ensure that the records created are authentic then records should be dated, timed and signed. They should be placed into the filing system to form part of the retention schedule so that they are protected against unauthorised addition, deletion or alteration.

2.2 A reliable record is one that can be trusted to be an accurate representation of a function or action taken by the HSE location. Therefore, records should contain all relevant facts and be created at the time of the action or transaction or as soon as possible afterwards by a person authorised to carry out that function, action or transaction.

2.3 The integrity of a record refers to it being complete and unaltered. Once created, additions or annotations to the record can only be carried out by those authorised to do so and any amendment should be explicitly indicated on the record.

2.4 A useable record is one that can be located, retrieved, presented and interpreted or read whenever or wherever there is a justified need for that information. It should be traceable within a records management system. Record schedules and filing indices that capture the records are essential in ensuring records are useable. In electronic records, metadata or contextual information is required in addition to the physical transfer of records to ensure their continued usability.

11 HSE Record Retention Periods 2013 https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/ulh/staff/resources/pppgs/rm/recret.html


https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/ulh/staff/resources/pppgs/rm/recret.html


2.5 Records retained should be original (or an electronic copy, transferred using the appropriate and verifiable system), unique or of continuing importance to the HSE. They should have care delivery, legal, fiscal, administrative or historical purpose.’

Reasons for Keeping Records12

If there is no record, it did not happen!

To document the history of service intervention: this information is important for all providers who may be involved with the service user currently or in the future.

As a professional tool: the records provide information that enables employees to properly undertake their professional tasks and/or discharge the service’s legal duties towards a service user – for example, to gain sufficient information to carry out an assessment, identify needs, develop a plan of service intervention, monitor and review the outcome of intervention.

To map out the pathways of intervention for each service user, both historically and for the future.

To help ensure best practice: service users have access to a single, lifelong, team record which demonstrates that intervention in their case is outcome-focused and follows evidence-based guidance, and which describes best practice. The record documents timely reviews and outcomes.

To account for actions taken: records help to enable professional and administrative accountability to the service users and, in some instances, to a court, the HSE and other state agencies.

To provide evidence of intervention, past and present, and of due care, should there be a claim of malpractice, injury or another claim concerning a service user.

To comply with legal obligations: under the Data Protection Acts 1998 and 2003, there may be a legal requirement that certain records are made and kept by the service (for example, records of actions taken in response to particular legal duties).

To enable supervision and professional development: the auditing of records is a vital way in which managers/supervisors can monitor whether services are being provided in a professional manner. They can also guide and support the actions of the people providing services. For example,

12 Information Management Guidelines. Enable Ireland.2008


records (which do not reveal identities) can assist with training and the professional development of staff and managers.

To assist with service evaluation: for example, records will be used to assist in the evaluation and improvement of the effectiveness of the service.

Good record-keeping ensures that: You can work with maximum efficiency without having to waste time hunting for information. There is an ‘audit trail’ which enables any record entry to be traced to a named individual at a given

date/time, with the secure knowledge that alterations can be similarly traced. New employees can see what has been done, or not done, and why. Any decision made can be justified or reconsidered at a later date. We can provide a historic record of events for an individual. Records can be important, for example,

in providing a service user with details of their past (e.g., where an adult seeks information about his or her childhood while availing of services).

There must be a clear written policy and procedures for record-keeping for the team which every member adheres to and which is regularly audited:

A record must be maintained on each service user Records must be held securely in line with service protocol Criteria for maintenance of records forms part of the team’s PPPG and is adhered to by all team

members The record must be retained on all children referred, transferred, discharged in line with HSE/service

provider guidelines Up to date informed written consent form in line with consent policy needs to be on file

Retention of RecordsA child’s records must be retained until their 25th birthday or 26th if young person was 17 at the conclusion of treatment, or 8 years after death. If the illness or death could have potential relevance to adult conditions or have genetic implications, the advice of clinicians should be sought as to whether to retain the records for a longer period. Records created under the Child Care Acts must be kept in perpetuity.13

ConsentIt is essential that all referrals to any CDNT include written consent for the child by the parent(s) or legal guardian(s). The national Children’s Services Referral Form (see National Policy on Access to Services for Children with Disability or Developmental Delay 2019) includes a consent form which

13 HSE Record Retention Periods 2013 https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/ulh/staff/resources/pppgs/rm/recret.html




must be completed before a referral can be accepted. Refer to HSE Consent Policy 2014 Part Two - Children and Minors and consent policies of service providers.

Excerpts from HSE Consent Policy a Guide for health and social care professionals HSE 2014 Part Two– Children and Minors P.26-3314

General guidelines regarding consent In any matter relating to children, the child’s best interests are of paramount importance. In providing health and social care services to children, it is important that their autonomy is respected. This means that the child’s own voice should be heard and respected as far as possible in decision‐making about their care. Involving children in decision‐making may be different from seeking consent from adults due to the age or ability of the child to understand the relevant information and decision to be made.

The role of the parents and/or legal guardians to make decisions for the child is of course also very important. Even where children are not able to give a valid consent for themselves, they still have the right to be involved in the decision‐making process as even young children may have opinions about their healthcare and they have the right to have their views taken into consideration. It is always important to give children information about their care in a form and language that they can understand.

Who can give consent for a child?Parents and legal guardians are generally considered best placed to safeguard the health and wellbeing of their children. Reference to ‘parent’ in this Policy is intended to mean a parent as defined by Section 2 of the Guardianship of Infants Act 1964 as amended by the Status of Children Act 1987. These provisions mean that only a person who is a legal guardian may give consent in respect of his/her child. Legal guardianship is described as follows:

Where the parents are married, both mother and father are legal guardians Where the child has been jointly adopted by a couple, the adoptive parents are both legal guardians After separation or divorce, both parents remain legal guardians If the parents are not married, the child’s mother is the only automatic legal guardian but the child’s

father may also be legal guardian by agreement with the mother effected by way of a statutory declaration or by virtue of a court order.

Where a child accesses a health or social care service with an adult, the adult should be asked to confirm that they are the parent or legal guardian. This should be documented in the child’s record. If they are not the parent/legal guardian, contact must be made with the appropriate person to seek consent.

14 Consent: A Guide for Health and Social Care Professionals. HSE Quality and Patient Safety Division.2014 https://www.hse.ie/eng/about/who/qid/other-quality-improvement-programmes/consent/


https://www.hse.ie/eng/about/who/qid/other-quality-improvement-programmes/consent/

If the child’s parent is a minor, he or she is nonetheless presumed to be the best decision‐maker for their child. If their decision is not considered to be in the best interests of the child, then you should engage in dialogue with them about their decision, including an assessment of their maturity as outlined below. If appropriate, another person such as the child’s grandparents might be involved in this process with the consent of the minor parent. If agreement cannot be reached, legal advice should be sought.

Do I need to get consent from both parents?Seeking the consent of one parent is widely recognised as sufficient in health and social care practice both in Ireland and elsewhere and is considered more practical for safe, timely and effective service provision in the interests of the child. If both parents have indicated a wish to participate in decision‐making for the child, you should accommodate this as far as possible. It is the parent’s responsibility to make sure they are contactable at the time when decisions have to be made for the child. In circumstances where the decision to be made for the child will have profound and irreversible consequences, both parents should be consulted if possible. However, if urgent care is required and the second parent cannot be contacted, you must act in the best interests of the child.: A guide for health and social care professionals QPSD‐GL‐054‐1. 1 What if neither parent is contactable?In emergency circumstances where neither parent is contactable, you may provide care if this is necessary in the best interests of the child. If urgent care is not required, you should postpone treatment until a parent is in attendance to give consent.

Age of consentIrish law generally defines a child as a person under the age of 18 years, other than someone who is or has been married. However, section 23 of the Non‐Fatal Offences against the Person Act 1997 provides that a person over the age of 16 years can give consent to surgical, medical or dental treatment and it is not necessary to seek consent from the parents. For those under 16, it is good practice to involve them in decision‐making and to seek their assent to the proposed intervention or care.

Refusal of services by children, minors or their parents: If a young child refuses treatment despite parental consent, they should always be given the

opportunity to explain the reasons for their refusal. You may be able to provide sufficient explanation and reassurances to the child to allay any fears or worries they may have.

If a mature minor under 16, acting in the absence of a parent, refuses a health or social care service, you should encourage them to involve their parent in the decision. If they do not want to involve the parent and you are of the view that the service is in the minor’s best interests, you should inform the parent despite the minor’s refusal.


If a person between 16 and 18 refuses a treatment or service, in general you should respect this refusal. However, if it relates to life‐sustaining treatment or other serious decisions, you should make reasonable efforts to discuss the decision with all relevant parties. You may seek the assistance of the HSE advocacy services or a mediator in order to try to reach consensus. Failing agreement, an application should be made to the High Court to adjudicate on the refusal.

If parents refuse on behalf of the child or minor, you should recognise the right of the parents to participate in decisions about what is best for the child. It may be advisable to call a case conference involving the parents and all relevant care providers to try to reach consensus. If the parents seek a second opinion, this should be facilitated wherever possible. In exceptional circumstances where consensus cannot be reached, you may consider applying to the court for an adjudication of the matter.Consent: A guide for health and social care professionals QPSD‐GL‐054‐1. 1 Children in the care of the Child and Family Agency Tusla - refer to HSE Consent Policy 2014 Part Two Children and Minors P. 57-58.

See also www.treoir.ie/information-guardianship.php for rules of Guardianship.

Assisted Decision MakingSee https://www.hse.ie/eng/about/who/qid/other-quality-improvement-programmes/assisteddecisionmaking/

ConfidentialityThe team must have a written policy on confidentiality developed in accordance with organisational guidelines and relevant legislation, including the Data Protection Acts (1988-2003) and the Freedom of Information Acts (1997-2003).

There should be evidence that each team member understands the team’s policy on confidentiality and their duties to keep and maintain child and family information in confidence and that each team member receives FOI and Data Protection training.

All collected data must apply legislative and professional best practices in terms of client consent and information sharing. Records should be audited for compliance with the Acts and parents/carers and children/young people as appropriate to their age must be informed about their rights under the Acts.

Complaints


https://www.hse.ie/eng/about/who/qid/other-quality-improvement-programmes/assisteddecisionmaking/

http://www.treoir.ie/information-guardianship.php

The team must have a written procedure in relation to complaints which is accessible to service users and their families. There must be one complaints procedure for a team as agreed by the organisations involved. A complaint may be made about something not done correctly or omitted, or may concern an employee. Each complaint should be viewed as an opportunity to review a service or an aspect of the service and where indicated support development or change.

Complaints should be resolved as quickly as possible firstly through an informal response by front line employees or through subsequent investigation and resolution by the person(s) nominated to

deal with complaints as they arise.

Staff and Employment Policies15

Members of multi-agency teams will each have their own terms and conditions according to their contract and their employer’s policies and procedures. Recognition of the differences between the terms and conditions of the agencies involved in delivering the team service needs to be noted and acknowledged. Where these involve variations which will affect how and when services will be delivered, appropriate accommodation to these variations must be negotiated.

Terms and conditions include, but are not restricted to: Leave After hours attendance Incremental credits Induction for new employees Disciplinary Procedures Grievance Procedure Human Resource Issues Role of Occupational Health Model Policy Statement Sick Leave Procedures

15 Guidelines for local implementation groups on developing a governance structure and policies for children’s disability services 2012 https://www.hse.ie/eng/services/list/4/disability/progressing-disability/pds-programme/documents/



Working Alone with Children Infection Prevention & Control Lone working Management of allegations of abuse against staff members IT Acceptable Usage Policy

BibliographyInternational Framework: Good Governance in the Public Sector (IFAC, CIFPA 2014)

HSE Achieving Excellence in Clinical Governance 2010

HSE Quality and Patient Safety Clinical Governance Development An assurance check for health service providers 2012

Guidelines for local implementation groups on developing a governance structure andpolicies for children’s disability services 2012

National policy on access to health services for children with disability or developmental delay 2016

National policy on discharge/closure and transfer from Children’s Disability Network Teams 2016

National policy on prioritisation of referrals to Children’s Disability Network Teams 2016

National Consent Policy HSE 2014

Consent: A Guide for Health and Social Care Professionals. HSE Quality and Patient Safety Division.2014

Outcomes for Children and Their Families Report of an outcomes focussed performance management and accountability framework for Early Intervention and School Age Disability Network Teams. 2013

Interim Standards for Children’s Disability Network Teams 2014

Checklist of policies and procedures for children’s disability services 2010


Disability Act 2005 Guidelines to Assist Assessors 16.6.09

Your Service, Your Say. HSE Complaints Policy 2015

Outcomes for Children and Their Families. Report on an Outcomes-Focused Performance Management and Accountability Framework for Early Intervention and School Age Disability Network Teams.2013

Staff Supervision in Social Care. Tony Morrison. 2005

Assisted Decision Making Capacity Act 2015: A Guide for Health Professionals (Draft for consultation). HSE. March 2017


Appendix 1 Self-audit tool for Children’s Disability Network Teams

Self-audit tool for Children’s Disability Network

TeamsThis self-audit tool should be completed collectively by the whole team on an annual basis. It is not for use as a score-card, but rather as a means for teams to acknowledge their achievements, assess and monitor quality, promote continuous improvement and identify and prioritise development opportunities. The criteria are grouped under the twelve Progressing Disability Services for Children and Young People (PDS) Principles.

Approved by Head of Operations – HSE Disability Services 30.5.19

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1. Accessibility

Criteria Yes/No Evidence/Comment Action1.1 Environment : All service delivery should facilitate the needs of the child and the family including an accessible physical environment.

1.1.1 The service is delivered in a building which is accessible to children and families. See NDA Guidelines on Access Auditing of the Built Environment

1.1.2 The service is delivered in a variety of spaces which can be adapted for different uses.

1.1.3 There is access to confidential space for meetings of families and team members

1.2 Information: Families should know how to access information, from whom or where it can be obtained. Information should detail service provision, range and accountability, presented in a clear and concise manner, jargon-free and in a language that is easily understood. Information should be available in a variety of accessible formats.

1.2.1 Information is available in a range of accessible formats (See Make your information more accessible www.nda.ie)

1.2.2 Children and young people receive information as appropriate to their age and understanding throughout their involvement with the service.1.2.3 The team responds to families’ requests for information including signposting to relevant sources.

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http://www.nda.ie/

1.2.4 All written material is in clear, concise and easy to understand language and is accompanied by pictures and diagrams where appropriate.

1.2.5 Professional approved interpreters are provided when appropriate and there is a clear policy in relation to provision of interpretation and translation.

1.2.6 Information leaflets and reports are translated into other languages, based on the cultural diversity of the team’s service users

2. Accountability

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Accountability requires a documented governance structure with clear lines of responsibility and reporting relationships. Mechanisms for collection of data and compliance with legislation and national guidelines must be in place. Accountability needs to be embedded in the culture of the team and is the responsibility of all involved in service delivery, supported by written policies and procedures.

Criteria Yes/No Evidence/Comment Action2.1 Governance

2.1.1 There is a document available to the team detailing the governance structure for Children’s Disability Network Teams within the CHO

2.1.2 The team member’s governance and reporting relationships are clearly outlined and documented.

2.1.3 There is a Family Forum established and supported by the service

2.1.4 The team provides opportunities for families to express their opinions, concerns and experiences of the service such as through the Family Forum, compliments and complaints procedures

2.2 Policies and procedures

2.2.1 The team has written policies and procedures which are agreed by the governance group, available and accessible to all stakeholders.2.2.2 There is a documented process for formulating, approving and reviewing policies

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and their implementation, and for identifying associated risks.

2.2.3 Induction for all team members includes an introduction to the key PPPGs and how to access hard and soft copies of the most up to date versions.

2.3 Legislative and data return requirements

2.3.1 The team has a standardised mechanism in place for collation and return of data in line with governance arrangements at national and local levels.

2.3.2 Each team member receives mandatory training. 2.3.3 Records are audited in line with legislation

2.3.4 Team members are familiar with all relevant legislation, national and local policies and can access information about them:

Safety statement Data protection and GDPR Children First Record keeping Incident management Compliments and complaints Safeguarding vulnerable adults

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3. Bio-psychosocial model

The bio-psychosocial model is a broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical etc.), psychological factors (mood, personality, behaviour, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.). Services should be delivered holistically, focusing on all aspects of a child and young person’s and family’s life, particularly in the context of the community and society. This involves working in partnership with stakeholders and the wider community to support and develop services and activities that achieve mutually beneficial outcomes.

The principles of the bio-psychosocial model run throughout this audit tool.

Criteria Yes/No Evidence/Comment Action3.1 To facilitate implementation of the bio-psychosocial model, each child’s individual strengths and needs are recognised, identified and responded to, along with those of their family, to facilitate maximising their potential.

3.2 The bio-psychosocial model of service delivery is documented and communicated to all team members and line managers, through induction and a regular team review process

3.3 Service delivery is reviewed annually by the manager with the team to ensure it continues to meet the needs of stakeholders.

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4. Clinical Governance and Evidence Based Practice

Clinical governance is described as the system through which healthcare teams are accountable for the quality, safety and satisfaction of service users in the care they have delivered. It is recognised that clinical governance is everyone’s responsibility. There must be clear lines of accountability and a performance management structure for all members of the CDNT. An evidence based approach involves ensuring that services keep up to date with on-going research that informs new practices and the inclusion of agreed clinical guidelines, policies and protocols with inbuilt audit and review dates.

Criteria Yes/No Evidence/Comment Action4.1 All team members have a structure for supervision and clinical supervision which has protected time and is planned, documented, audited and supported within all disciplines.

4.2 The CDNM identifies on an annual basis the competencies within the team and those competencies which need to be developed to meet the needs of the children/young people and families within the service, in collaboration with clinical supervisors.

4.3 The team’s training needs identified are incorporated in budget planning

4.4 There is evidence of the completion, evaluation and review of all training programmes for staff and for families.

4.5 Team members have access to evidence based research e.g. journals, online libraries

4.6 Team members are facilitated to conduct

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research.

5. Cultural Competence

Sensitivity to cultural differences is entwined in the systems of service delivery which should be compatible with family values and goals. Each family’s unique cultural differences and diversity should be recognised to inform the partnership in service delivery with the family. The team should work in a manner that is sensitive to culture, ethnicity, socio-economic diversity, values and priorities.

Criteria Yes/No Evidence/Comment Action5.1 The team members have training in cultural competence and regularly review their competence and knowledge to respond appropriately to cultural diversity.

5.2 The team recognises and explores cultural context with every family to inform all interactions.

6. Early Identification of Needs

Introducing intervention at the earliest point possible may well achieve maximum developmental benefits for the child or young person. Disability services have a key role in assisting those who come in contact with children of all ages to recognise risk factors and make appropriate referrals. There should be a clear pathway to services which is easily understood by parents and other referrers.

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Criteria Yes/No Evidence/Comment Action6.1 There is an open referral system in place, including referral by parents as specified in the National Policy on Access to Services for Children with Disability or Developmental Delay 2016.

6.2 The team has an up to date information leaflet as advised in the National Access Policy, giving local details of how and where to make a referral.

6.3 Parents/carers are given access to appropriate universal supports as soon as their child’s referral has been accepted.

7. Equity of access

One of the primary objectives in the development of Children’s Disability Network Teams (CDNTs) is to have equity of access to services for all children and their families based on need. Access to services must be based on the child’s needs and not on diagnosis or category of disability or the school he/she attends.

The National Policy on Access to Services for Children with Disability or Developmental Delay 2016 provides the framework for services to consider a child’s needs and the most appropriate service to meet those needs. Eligibility criteria and procedures for accessing services will be transparent and user friendly. Any form of discrimination in relation to access to services must be guarded against by adhering strictly to national policy and to agreed local procedures.

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Criteria Yes/No Evidence/Comment Action7.1 The team complies with national audit and monitoring of the operation of the National Policy on Access to Services for Children with Disability or Developmental Delay 2016.

7.2 An Integrated Children’s Services Forum (ICSF) is established in the area to include representatives of CDNTs, Primary Care, CAMHS and other services as relevant. Functions of the ICSF include:

To act as a decision making forum on referrals where pathways or level of service are not clear within a defined timeframe.

To make recommendations for shared care provision and joint working across Primary Care, Children’s Disability Network Teams and CAMHS.

8. Evaluation of outcomes

The implementation of the Outcomes for Children and their Families Framework - a Report on an Outcomes-Focused Performance Management and Accountability Framework for Early Intervention and School Age Disability Network Teams 2013 will apply to all staff in Children’s Disability Network Teams in terms of what they can be held accountable for:

To maintain a focus on desired outcomes for the individual child and the family To ensure a standardised outcomes-focused approach to the delivery of services and supports for each child and

their family in accordance with their needs and priorities

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Criteria Yes/No Evidence/Comment Action8.1 The team receives support to ensure the outcomes accountability framework is implemented and embedded in the team culture and practice.

8.2 The team’s IT system captures relevant information to measure and review outcomes.

9. Family Centred Practice

Family centred practice focuses on the whole family and not just the child requiring support. It recognises that the wellbeing and development of the child is dependent on the wellbeing of each of the family members and the family as a whole. Family centred practice ensures that supports provided are determined from family priorities. It recognises that each family has its own role, values, structures, beliefs and coping styles. Each child’s and their family’s unique experience of disability is acknowledged and responded to in a dynamic, holistic, and child- and family-centred manner.

Criteria Yes/No Evidence/Comment Action9.1 The service supports families as appropriate

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in their role to help their children and young people in their development. This may be evidenced through the completion of Measure of Processes of Care (MPOC) by families and MPOC-SP by the team members.

9.2 The team has practices and protocols for ensuring that families, children and young people are encouraged to express their opinions, concerns and experience and take part in decision-making as appropriate to their age and understanding.

9.3 The team complies with national policy and procedure on the implementation and review of the individualised family centred plan.

9.4 All children/young people have a current Individual Family Service Plan (IFSP).9.5 Parents/carers and children/young people as appropriate to their age are encouraged / and supported to be actively involved as partners in the development and delivery of their IFSP, including expressing their priorities for intervention.

9.6 The team has documented evidence of agreed role and responsibilities of key worker/contact person.

9.7 Parents/carers are assigned a designated key worker/contact person.

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10. Inclusion

Children’s Disability Network Teams support the inclusion of children in their community and facilitate the maximum development of each child’s independence and participation in home, school and community.

Criteria Yes/No Evidence/Comment Action10.1 The team uses mainstream facilities where appropriate and possible.

10.2 The team supports children’s and families’ access and meaningful participation in local activities, social and leisure opportunities.

11. Interdisciplinary Team Approach

An interdisciplinary team is a number of professionals from different disciplines who work with the child and family, sharing information, decision-making and goal-setting. They have common procedures and policies and frequent opportunities for communication. There is an understanding amongst all members of the team of interdisciplinary team working and respect for different roles and responsibilities.

Criteria Yes/No Evidence/Comment Action11.1 All new staff are given information on inter-disciplinary team working on induction.

11.2 Where resources are insufficient to meet the needs of children and their families/carers, there are agreed pathways for the identification, management

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and escalation of risk in the provision of service in line with national policy.

11.3 The team has a documented policy on the process of conducting team meetings encompassing operational and clinical discussion and planning.

11.4 The agenda and minutes of team meetings are recorded and circulated. Agreed decisions and actions are identified, documented and followed through.

11.5 The team members all work to a common set of policies and procedures

11.6 The team all work to a common set of individual child and family goals as agreed and prioritised by the family.

11.7 Each child has an integrated file within the service that is used by all members of the team to share and records the child’s clinical information, assessments, reports, correspondence, referrals, consents etc.

11.8 Administrative support is an integral part of the team and provided for all team members.

11.9 All team members including administrative support are based in the same building

11.10 Team members have access to an integrated IT system

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11.11 Communication facilities are adequate to meet the needs of all team members.

12. Staff are valued and respected

Effective services for children with a disability and their parents are grounded both in the knowledge and skills of frontline staff and in the relationships formed between staff and families. Staff who are well-motivated and happy in their work provide better care and support better outcomes. Their efforts to provide the best possible service must be acknowledged and valued, and they must be supported by management and encouraged to continuously develop their professional knowledge and skills.

Criteria Yes/No Evidence/Comment Action12.1 Each member of the team has a performance appraisal and professional development plan which is regularly reviewed.

12.2 Staff are made aware of and know how to access the relevant independent Employee

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Assistance and Counselling Service available through their employer and existing policies and procedures.

12.3 There is a process in place for identifying risks including inadequate resources.

12.4 There is a process in place for identifying needs for training in line with priorities established by the team.

Appendix 2 Checklist to assist with identifying needs for the development of policies and procedures

Heading Policies and procedures Suggested scopeMission statement

Objectives and vision for service

What is the overall ethos? What is the service aiming to achieve? Who is it for? ‘We are on a mission to…’

Organisational structure

Model of service delivery Refer to PDS Principles - Interdisciplinary team model, family centred practice etc.

Governance structure Who is responsible to whom? Reporting structure. Management or steering groups etc.

Roles and responsibilities of all staff

Clarity around roles, recognising professional boundaries and autonomy. What are the expectations of each member of staff?

Service user/parent input How is service user or parent input to planning of services going to be achieved?

Induction A checklist of all the necessary information about the service to be given to the

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new member of staff, and training that is completed during induction.

Health and safety policy

Health and safety in line with corporate policy and with responsibility for health and safety assigned

The HSE has a corporate health and safety policy and most other organisations will have one. One member of the team or a committee should be assigned the responsibility for health and safety and should be given training if necessary.

Services provided by team

Range of services A broad outline of services offered, which can be reviewed to reflect new developments as necessary. This should be available to stakeholders

Access to services

Inclusion/exclusion criteria for access

Refer to National policy on access to services for children with disability or developmental delay 2019

Referral Referral process What happens when a referral is received? Acknowledgment letters. Who makes the decision on accepting a referral? Who is informed of the decision?

Referral form National Referral and Additional Information Forms

Assessment of Need procedure

Are there ways in which this differs from a direct referral?How are AON referrals to be tracked and a record kept of the timeframe?

Appeals process Procedure for parents and referrers to appeal decisions on referrals. How are they to be informed about this procedure?

Prioritisation Waiting list Refer to National Policy on Prioritisation of Referrals to CDNTs 2016.The waiting list and prioritisation process must be transparent to avoid any suggestion of bias. Therefore it should be explained in any leaflets or letters about referral and acceptance into service.How is it ensured that the waiting list is kept up-to-date?

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Prioritisation criteria There must be clear criteria for prioritisation which have been tested for any ambiguity.Are all team members aware of the order by which children should be taken on for intervention?

Discharges, transitions and transfers

Transitions and transfers (including links with other agencies)

Refer to National Policy on discharge and Transfer from CDNTs 2017.Is there an interagency forum in the area or regular formal meetings with other agencies where transfers are discussed?If not who flags the transfer to the other service?How transitions or transfers to other services are planned and discussed with service users and their families.A procedure for the transfer including passing on information and files.

Discharge process Discharge planning process and tracking: o informing family with plenty of notice, meetings offered, who should be notified?

(e.g. GP, referrer), database changes, storing of records following discharge. Is there a process whereby parents can look for a review for their child after discharge if new concerns arise?

Assessment Assessment process Information for family prior to assessmentAssessment procedure Contact person for familyCollection and sharing of information from family- they should not be asked for the same information more than once, so is there a common history form? Sharing of results and discussion among teamJoint team assessment report template (goals and outcomes focussed)Sharing of results of assessment with family

Assessment tools and methods

Validation and appropriateness of assessment tools used. Informal assessments must be backed by evidence.

Intervention Individual Family Service Plan How often should there be an IFSP meeting? This may vary according to the child’s

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needs but there must be guidelines on offering IFSP meetings.Inclusion of family at meetings, by questionnaires or discussion with key workerInformation gathering for IFSP from family and other relevant agenciesConducting meeting Template for IFSP Signing of IFSP by team (or on behalf of team) and family.

Framework for measuring intervention outcomes

Gathering regular feedback from families on progress in key areas of their child’s development.

Review of child’s plan and programmes

How often is the child’s plan reviewed by the team? Are there regular clinical team meetings for this purpose? How is the review recorded? How are families included and informed?

Intervention outside centre Are interventions in the home, school or other setting facilitated and seen as a core part of the child’s care pathway?

Identification by parents of their own skill development needs

Is there a means of ensuring that parents have the opportunity to talk about any furthering of skills or training programmes they would like? E.g. Key worker regularly asks them or it is a standard question at IFSP meetings

Report-writing protocols Guidelines on how the service would like reports formatted, especially for newly qualified staff.

Templates for reports and standard letters

Templates save time, ensure a consistent approach and a team/service identity.

Translation for non-English speaking families

Guidelines on when translation will be available e.g. for assessment and IFSP meetings

Transport for families If the team has access to a bus or can provide taxi vouchers, what are the criteria

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for offering transport to families?

Managing attendance Guidelines for all team members on how to address non-attendance including letters to be written, warnings to parents followed by discharge/return to waiting-list.

Intimate care Guidelines for relevant staff. These may be available at organisation level

Infection control Guidelines for all staff which may be available at organisation level

Team working

Model of team working What are the guidelines for how the team is going to work together? Is it an interdisciplinary team and if so how is this organised. Any new member of the team should have a clear understanding of how the team works and what is expected of them.

Team meetings and case discussions

How often will meetings be held?Do all team members attend?How is the agenda decided on?How is the meeting conducted? E.g. Who chairs it? how are decisions made?.

Clinical governance and decision making

How is quality in care achieved, maintained and improved? What are the lines of responsibility and accountability for clinical decision-making? Is there a clinical audit process?

Key working with defined role and responsibilities

What are the parameters for the key work role? There needs to be a job description which is clarified with parents so that they also know the extent of the key worker’s responsibility.

Information and

Information management How is information about service users managed? What information is on the database, who has access to it and who maintains it?

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Communication Record-keeping Where is information including day-to-day intervention, telephone calls etc.

recorded? Where are records kept? Central files, individual discipline files, confidential files. Filing system, safety. Tracking of files when removed from cabinet.

Retention of records How long are records retained following the service user’s discharge?

Collection and return of data Who should service statistics be returned to?

FOI and access to individual files by service user

Information on FOI for staff and service users and policy on giving access to files

Information sharing with external agencies

Guidelines on when consent is specifically needed

Information leaflets for families

On a range of relevant topics, but most importantly on how the service operates

Information leaflet for referrers

A leaflet should be available for and circulated to potential referrers giving them guidelines on criteria for access and referral procedure.

Confidentiality Policy on confidentiality for staff and information on this policy for families

Consent When must consent be sought, whom from and what is the extent of that consent? Information on guardianship, consent on behalf of a child in care. How is consent explained to families?Consent forms (including specific occasion consent and consent for student to work with child)

Complaints Procedures for making a complaint, responding to a complaint, appeals

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Training and CPD

Clinical supervision Who provides supervision to whom? Protected time allowed

Training How needs for training are identified and prioritised, including mandatory training Allocation of training budget Evaluation of training completed

Review of staff competencies and job performance

Performance appraisal process

Child protection

Implementation of Children First guidelines

Refer to Children First

Safe working Home visitsWhat to do when it is found that the child is alone at home, or no adult is there when delivering a child back to their home Parent/carer observed as reduced in capability to care for the child due to drink/drugs/mental health

Procedure in event of allegation against staff member

Dual responsibility to the child and to the member of staff until the matter is resolved.

Child protection training This should be delivered regularly (minimum of annually) as mandatory for all staff.

Organisational staff policies

ExpensesTravelAnnual leaveTime in lieuSick leave

These should be issued from the employer’s HR section to all staff

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Context - Ireland's Health Services - HSE.ie · Web viewThe Children’s Disability Network Manager...

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