How commissioners can use short breaks to support the needs of children with complex needs

Written by Lindsey Barron, Luton Borough Council


Luton Borough Councils' Contract Shared Care Service is a short break provision for children and young people (0-18) with complex health needs provided under the Foster Care Regulations 2002.

Contract Carers are employed by the council to provide care in their own homes which have been fully adapted for children with complex needs. Supported by a small team of dedicated social workers and a short breaks nurse, the service sits within Section 75 pooled budget arrangements between the local authority and Luton Clinical Commissioning Group whereby each partner agrees to work together to consider budgets, align activities to deliver agreed aims and outcomes while retaining complete accountability and responsibility for their own resources

The Short Breaks Nurse is commissioned from the Clinical Commissioning Group to support the council in its statutory duties and provides health care assessments and care plans for all children and young people with complex needs. The service is highly valued by professionals and parents and is seen as an essential function to maintain children with disabilities in their homes or placements.


Meeting the needs of the family

Siblings Jane and Lucy are two of 10 children in a large, complex family from a hard to reach minority ethnic community. They have a genetic degenerative condition resulting in profound and complex health needs including limited movement and dexterity, diet and nutrition, speech and language and moderate learning difficulties.

Two of their elder siblings also had the same condition and sadly passed away some years earlier. While the family received paediatric occupational therapy support and were known to social care they did not want any other formal support and were not in receipt of other services.


Emergency support

In November 2013, following their mothers' emergency admission to hospital, an emergency placement request for Jane, 8 and Lucy, 1, was received by the childrens' social work team. With their father absent from the home the 2 older siblings were unable to cope without support.

The emergency placement request was presented at the multi agency care management panel and agreed by the head of the Integrated Disability Service. While a shared care placement was sought for ongoing support, both siblings were placed at Keech, the local childrens' hospice for one week with a planned, phased return home.  


The process of setting up the emergency placement  

  • Emergency placement request agreed at Care Management Panel.
  • Jane and Lucy placed at Keech, local childrens hospice for 1 week.
  • Care Plan agreement meeting for ongoing support and access to Contract Shared Care for short break services.
  • OT risk assessment of the family home, subsequent adaptations for a downstairs extension, two hospital beds, wet room, ceiling track hoist and 24 hour specialist postural seating including moulded wheelchairs.
  • Two Contract Shared Carers identified; one for each child.
  • OT risk assessment and provision of slings for hoisting to each carer.
  • Short break nurse draws up and agrees health care plans with family.
  • Short break nurse delivers and signs off child specific training including delegated clinical tasks to each contract carer.
  • Face to face introductions and meetings with family and Contract Shared Carers to sign and agree care plans.


Implementing the Emergency Placement Plan

  • Social Workers from the Shared Care service worked closely with other professionals including Short Break Nurse, OT, Keech hospice and school to ensure the needs of the children were identified and appropriate risk assessments and care plans were drawn up.
  • Keech hospice supported placement while contract shared care capacity was sorted and enabled the children to continue to access school.
  • Planned phase return home, family involved in planning process.
  • While the family were initially reluctant to accept ongoing support they were willing to work with professionals.


A positive outcome for the family

  • Famiyl engaged with professionals and accepted ongoing support.
  • Family breakdown prevented.
  • Both girls continue to enjoy their short beraks and chose shared care in preference to the hospice as it provided a more family based break.
  • Parent, children and other family members have developed strong bonds with shared carers.
  • Family feels supported.
  • Family feels less stress.


Jane and Lucy's parent:

"Before we got Shared Care things were really hard for me and my daughters, we didn't have spare time and the older girls had to take time off college to help take care of Jane and Lucy."


Jane:

"I like going to Julia, she does nice things with me like cooking and painting my nails. I sometimes ask Julia to take me to places like the library."


Julia, Shared Care:

"One of the most rewarding aspects of Shared Care is being able to give one-to-one care and attention to the children. It's challenging, rewarding and fun."


Family:

"Having the respite has made everybody in the family much happier…Shared Care has taken the stress off us all as a family and now we find that we have more time to do stuff during the day."


Key learning

  • Parent and family feel empowered when they are actively involved in decision making.
  • Face-to-face introductions with the carers reassured parent and family.


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