National Framework for Children and Young People’s Continuing Care 
Decision Support Tool 

2015/2016

Title: National Framework for Children and Young People’s Continuing Care – Decision Support Tool 	
Author: 
SCLGCP/CMHI/IDC/14100	
Document Purpose: 
Guidance (draft for consultation)	
Publication date: 
Draft for consultation published in September 2015	
Target audience: public, clinical commissioning groups, local authorities, health and wellbeing boards, health and care professionals.	
Contact details: 
Gareth James 
Disabled and Ill Child Services Team 
Social Care, Local Government and Care Partnerships Directorate
2E60, Department of Health, Quarry House, Quarry Hill, 
Leeds, LS2 7UE 

gareth.james@dh.gsi.gov.uk

You may re-use the text of this document (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence/

© Crown copyright 
Published to gov.uk, in PDF format only. 
www.gov.uk/dh 

Children’s decision support tool

1.	The Children’s Decision Support Tool has been developed to bring assessment information together and present it in a concise, consistent way. It is designed to help ensure that all relevant needs are assessed and captured to inform local decisions about the care needed.

2.	Please note that this is a Word® version of the Decision Support Tool, for use in making assessments, and it should be used in conjunction with the Children and Young People’s Continuing Care Framework. The text boxes can be adapted as required.

3.	The nominated children and young people’s health assessor will have worked alongside a multi-agency or multidisciplinary team to compile the information required to complete the Children’s Decision Support Tool, drawing on the three key areas of assessment already mentioned: 

•	the preferences of the child or young person and their family; 
•	holistic assessment of the child or young person and their family, including the carer assessment; 
•	reports and risk assessments from the multidisciplinary team. 

4.	The nominated children and young people’s health assessor should use the Children’s Decision Support Tool to match, as far as possible, the child/young person’s level of need with the relevant description. This approach should build up a detailed analysis of individual needs, in a family context, and provide the evidence to inform the decision on the provision of a package of continuing care.

5.	The tool is not prescriptive, and evidence-based professional judgement should be exercised in all cases to ensure that the child or young person’s overall level of need is correctly assessed.

6.	This process and the information collected will provide the basis for recommendations and costed options to be presented to the multi-agency decision-making forum; this will inform the decision on whether a package of continuing care is needed. The decision on whether continuing care is needed will be taken at the multi-agency decision-making forum, where each party will decide their contribution to the package of continuing care. 

7.	The Children’s Decision Support Tool sets out children’s needs across 11 care domains, divided into different levels of need: 

•	
•	communication
•	mobility
•	nutrition, food and drink (including vomiting) 
•	continence and elimination
•	skin and tissue viability

•	breathing
•	drug therapies and medicines
•	psychological and emotional
•	seizures
•	challenging behaviour
•	other 

8.	The nominated children and young people’s health assessors will use their clinical skill, expertise and evidence-based professional judgement to consider what, for each care domain, is over and above what would be expected for a child or young person of that age. For example, incontinence would only become recognised as an issue when a child or young person has continence needs beyond those expected at his or her age.

9.	The needs described collectively in the care domains and levels of need in the Children’s Decision Support Tool may not always adequately describe every child or young person and their family’s circumstances. Professional judgement and clinical reasoning are paramount in ensuring that a child or young person’s needs are accurately assessed, taken into account and given due weight when making a decision regarding their continuing care needs. All four parts of the assessment process interact in defining the child or young person’s overall need for care. 

10.	Assessors should have evidence to support all assessments, and should avoid simply cutting and pasting the text in a domain. In completing the tool, care should be taken to make sure that needs are not duplicated in different domains. 

11.	There may be circumstances where a child or young person may have particular needs that cannot reasonably be included in the first 10 specific care domains described in the Children’s Decision Support Tool. In this situation, the final ‘Other’ domain may be used to capture high or severe needs. The nominated children and young people’s health assessor, either in conjunction with other members of the multidisciplinary team or by taking into account recent assessments and/or reports, should determine the nature and extent of these needs . 

12.	The assessment of the level of need must recognise that where a child or young person requires constant supervision or care which is largely provided by family members, there will be a need for professional support to allow the family time off from their caring responsibilities. Respite care is usually the commissioning responsibility of the local authority, but where a clinical professional is needed (for example, to oversee continuous intravenous medication, the CCG should ensure this is provided). 

13.	The Tool provides a framework for a reaching a decision. Information will need to be organised and documented to support that. Some suggested prompts are included where useful. Note that questions may not necessarily be answerable in chronological order (for example, judging the adequacy of the child and their family’s accommodation for their needs), and that more than one section may correspond with a statutory section in an EHC plan. In every section, assessment should seek to identify needs met and unmet. 

Child and family details 

Child / young person	
Child’s name		
Date of birth 		
NHS Number 		
Address		
Telephone number 		
E-mail 		
Mother’s name		
Father’s name 		
First language 		
Family 
•	Does any other member of the family have health or service needs? 		
Communication 
•	Is an interpreter needed?
•	How can professionals best communicate with the child?		
Date referred for assessment
Clock start		
Date of initial needs assessment 		
Referred by
Give referring professional and provider organisation and relevant contact details		
Responsible CCG (CCG of which the child or young person’s GP is a member)		
Siblings 
•	Any issues relating to the child or young person’s brothers or sisters which should be taken into account
•	Are siblings involved in care provision?		
Family circumstances	
Family support 
•	What kind of help is available in the family’s circle of friends and relations?
•	Are there any other organisations or groups that support the family/carer’s family?
•	Summary of parents’/carer’s occupation, employment/shift patterns.
•	Effect of the child/young person’s condition on the parent/carer’s ability to work.
•	Any difficulty meeting bills/financial commitments?
•	Has the child/young person’s condition affected the family/carer’s family’s finances?
•	Is the family/carer’s family in receipt of all benefit entitlements?
•	Do they need extra support from Family Fund or other voluntary organisation?		
Short breaks 
•	Details - including name and address of carer provider, and frequency		
Housing 
•	Owned or rented?
•	Adequacy for the child’s/family’s/carer’s family’s needs?
•	Any adaptations required?		
Transport 
•	Is the family/carer’s family reliant on public transport?
•	Accessing hospital appointments, etc.		
Recreation and leisure
•	Is the child/young person able to choose leisure activities?
•	What is required to enable the child/young person to access leisure activities?
•	What are their interests or hobbies?
•	Are the recreational needs of siblings and other family/carer’s family members being met?		

Education and learning 

Education	
Name of nursery, school or college attending
•	Is the child/young person able to access an appropriate educational setting, either full or part-time?		
Education and learning 
•	What additional support or reasonable adjustments are required in that setting?
•	If the child/young person is too ill to access a setting, what other provision is in place to ensure continuity of learning?		

Medical history 

Health Professionals	
Name, telephone number and location of the following where relevant: 

•	registered GP
•	all consultants
•	Designated Medical or Health Officer for SEND
•	community paediatrician
•	psychologist
•	psychiatrist
•	community children’s nurse
•	specialist nurse (e.g. for epilepsy).
•	Nurse consultant 
•	CAMHS nurse
•	named ward nurse
•	 health visitor
•	school nurse
•	district nurse
•	social worker
•	occupational therapist
•	speech and language therapists
•	physiotherapist
•	other therapists
•	teacher
•	short break services
•	lead professional
•	interpreter.
	
Clinical details	
Medical history
•	Dates of significant health events/current health status.
		
Medication 
•	Current medication; allergies.

		
Equipment – disposable
•	Type, manufacturer/ supplier ; distributor / quantity and frequency etc. Collection method.
		
Equipment – permanent 
•	Type, manufacturer/ supplier; distributor / quantity, maintenance.		
Treatment / care needs 
•	Interventions; who provides and monitors the service; care plans. 
•	Symptom management and pain control.
•	What is the 24-hour daily care routine?
•	How are the child/young person and family/carers supported?
•	Does the family have adequate information on the child/young person’s condition/future?
•	What is the 24-hour daily care routine?
•	Competencies required to care for the child/young person.
•	Is there a lead professional, and is this working well?		

Views and aspirations (section A of EHC plan) 	

This first section should also of course include the views and aspirations of the child or young person and their family – this is the major element of Section A of the EHC plan, and should have a correspondingly prominent position in any continuing care assessment. Chapter 2 provides a more detailed description of the key issues which should be considered in engaging with the child or young person and their family. In particular, this section should consider: 

•	The child/young person’s issues, concerns, anxieties.
•	The child/young person’s preferences about care delivery.
•	The family’s preferences about care delivery.

	

Emotional and support needs  	

Assessment should consider the emotional support needs of a child, young person and their family. 

•	What is the effect of the child/young person’s condition on each member of the family?
•	What times of the day/events are stressful?
•	How does the family cope?
•	Who does the family call on for support at these times?
•	Are there times when the child or young person need particular support?
•	How do they communicate as a family?
•	What is the child/young person’s understanding of his/her condition?
•	What understanding do siblings have of the child/young person’s condition?
•	Is an assessment by the child and adolescent mental health service required?

Outcomes 

14.	The assessment of a child’s continuing care needs must consider the outcomes necessary to enable the child or young person to get the best from life, and outcomes relating to transition (where the child is 14 years or older), identifying unmet need. 

15.	They should be specific, deliverable and linked directly to the child’s wishes. They should include where appropriate, outcomes for transition, through key changes in a child or young person’s life, such as changing schools, moving from children’s to adult care and/or from paediatric services to adult health, or moving on from further education to adulthood. 

16.	Key issues would include: 

•	
•	Maintaining a safe environment.
•	Communicating.
•	Breathing.
•	Eating and drinking.
•	Elimination.
•	Personal cleaning and dressing.
•	Controlling body temperature.
•	Mobilising.
•	Playing.
•	Learning.
•	Expressing individuality.
•	Sleeping.
•	Employment 
•	Independence 
•	Further education 
•	End of life.
•	Pain management

Care domains

17.	Health assessors should consider the needs of the child or young person across the following 11 domains of care. Care has been taken to avoid duplicating needs in two separate domains. However, assessors should consider how different but inter-related needs across more than one domain can complicate the child or young person’s overall care needs and result in sufficient complexity, intensity or risk to demonstrate continuing care needs. Examples of this might include the relationship between skin integrity and continence, or cognitive impairment and behaviour and/or communication. 

18.	It is essential that clear evidence is obtained to support assessments in the relevant domains, and that this evidence is recorded as part of the continuing care assessment, and included in any subsequent care plan. 

19.	As a rule of thumb, a child is likely to have continuing care needs if assessed as having a severe or priority level of need in at least one domain of care, or a high level of need in at least three domains of care. 

20.	The level of need in a single domain may not on its own indicate that a child or young person has a continuing care need, but will contribute to a picture of overall care needs across all domains. Levels of need are relative to each other as well as to those in other care domains. It is not possible to equate a number of incidences of one level with a number of incidences of another level – that needs assessed as ‘moderate’ in two domains are the equivalent of one ‘high’ level of need, for example. In presenting recommendations and costed options to a multi-agency forum, nominated children and young people’s health assessors should consider the level of need identified in all care domains in order to gain the overall picture.

21.	These guidelines should not be used in a restrictive way. Nominated children and young people’s health assessors should be mindful that even if the child or young person is assessed as not having continuing care needs, they may require other healthcare input from universal services or community children/young person’s nursing or other specialist services.

1.	Communication – assessors should indicate the level of need

  Description 	Level of need	
Communicates clearly, verbally or non-verbally, appropriate to developmental needs. Has a good understanding of their primary language. May require translation if English is not their first language. 

Able to understand or communicate clearly, verbally or non-verbally, within their primary language, appropriate to their developmental level.
The child/young person’s ability to understand or communicate is appropriate for their age and developmental level within their first language.	No additional needs	
Needs prompting to communicate their needs. The child/young person’s ability to understand and communicate is appropriate for their age and recognised developmental milestones. Special effort may be needed to ensure accurate interpretation of needs, or may need additional support visually – either through touch or with hearing. Family/carers may be able to anticipate needs through non-verbal signs due to familiarity with the individual. Expressive or receptive language.

The child/young person’s ability to understand or communicate is appropriate for their age and developmental level. 

However, special effort may be needed to ensure accurate interpretation of their needs; for example:
•	the child/young person may need prompting to communicate their needs; and/or
•	the child/young person may need additional support – visual support such as symbols, signing or support with hearing, e.g. use of hearing aids.	Low	
Communication about basic needs is difficult to understand or interpret, even when prompted, unless with familiar people, and requires regular support. Family/carers may be able to anticipate and interpret the child/ young person’s needs due to familiarity. 

Support is always required to facilitate communication, for example, the use of choice boards, signing and communication aids. 

Ability to communicate basic needs is variable depending on fluctuating mood; the child/young person demonstrates severe frustration about their communication, for example, through or withdrawal.
	Moderate	
Even with frequent or significant support from family/carers and professionals, the child/young person is rarely able to communicate basic needs, requirements or ideas, even with familiar people.	High	

Communication   

Describe the child or young person’s specific needs relevant to this domain. 	

	

2.	Mobility – assessors should indicate the level of need

  Description 	Level of need	
Independently mobile as appropriate for age and development.	No additional needs	
Able to stand and move with mobility aids. 	Low	
Difficulties in standing or moving even with aids; need support to access curricular or extracurricular activities.
and/or
sleep deprivation due to underlying medically/mobility related needs – occurring three times a night (and at least two nights per week).
	Moderate	
Unable to move in a developmentally appropriate way; cared for in one position (bed or chair) and due to risk of physical harm, loss of muscle tone, tissue viability, or pain on movement; needs careful positioning and is unable to assist or needs more than one carer to reposition or transfer;
or
at a high risk of fracture due to poor bone density, requiring a structured management plan to minimise risk, appropriate to stage of development;
or
involuntary spasms placing themselves and carers at risk;
or
extensive sleep deprivation due to underlying medical/mobility related needs – occurring every one to two hours (and at least four nights a week).	High	
Completely immobile and unstable clinical condition such that on movement or transfer there is a high risk of serious physical harm;
or
where positioning is critical to physiological functioning or life.	Severe	

Mobility 
  
Describe the child or young person’s specific needs relevant to this domain. 	

	

3.	Nutrition, food and drink (including vomiting) – assessors should indicate the level of need

  Description 	Level of need	
Able to take adequate food and drink by mouth, to meet all nutritional requirements. Appropriate to developmental age.	No additional needs	
Some assistance required above what is appropriate for their developmental age;
or
needs supervision, prompting and encouragement with food and drinks above the normal requirement for developmental age;
or
parent/carer and/or child/young person needs support and advice about diet because the underlying condition gives greater chance of non-compliance, including limited understanding of the consequences of food or drink intake;
or
needs feeding when this is not appropriate for developmental age, but is not time consuming.	Low	
Needs feeding to ensure adequate intake of food and takes a long time (including liquidised feed); specialised feeding plan developed by speech and language therapist;
or
unable to take sufficient food and drink by mouth – most nutritional requirements taken by artificial means, for example, via a non-problematic tube feeding device, including nasogastric tubes.	Moderate	
Dysphagia, requiring a management plan with additional skilled intervention to ensure adequate nutrition or hydration and to minimise the risk of choking, aspiration and to maintain a clear airway for example, suction;
or
problems with intake of food and drink, requiring skilled intervention to manage nutritional status; recognised eating disorder, with self-imposed dietary regime or self-neglect, for example, depression leading to intake problems placing the child/young person at risk and needing skilled intervention;
or
problems relating to a feeding device (e.g. nasogastric tube feeding)  which require a risk-assessment and management plan undertaken by a speech and language professional, and requiring regular review and reassessment. Despite the plan, there remains a risk of choking. 	High	
The majority of fluids and nutritional requirements are routinely taken by intravenous means.	Severe	

Nutrition, food and drink   

Describe the child or young person’s specific needs relevant to this domain. 	

	

4.	Continence or elimination – assessors should indicate the level of need

  Description 	Level of need	
Continent of urine and faeces (appropriate to age and development).	No additional needs	
Continence care is routine on a day-to-day basis and age appropriate;
or
incontinent of urine but managed by other means, for example, medication, regular toileting, pads, use of penile sheaths;
or
is able to maintain full control over bowel movements or has a stable stoma, but may have occasional faecal incontinence;
or
has a stoma requiring routine attention.	Low	
Doubly incontinent but care is routine;
or
self-catheterisation;
or
has a stable stoma but may have occasional faecal incontinence.	Moderate	
Continence care is problematic and requires timely intervention by a
skilled practitioner or trained carer;
or
intermittent catheterisation by a trained carer or care worker;
or
has a stoma that needs extensive attention every day.	High	
Requires peritoneal dialysis or haemodialysis to sustain life.	Priority	

Continence or elimination 

Describe the child or young person’s specific needs relevant to this domain. 	

	

5.	Skin and tissue viability – assessors should indicate the level of need 

(Stomas should be considered under 5. Continence or elimination; tracheostomies under 7. Breathing). 

  Description 	Level of need	
No evidence of pressure damage or condition affecting the skin.	No additional needs	
Evidence of pressure damage and pressure, or a minor wound requiring treatment;
or
skin condition that requires clinical reassessment less than weekly; 
or
well established stoma which requires routine care. 	Low	
Open wound(s), which is (are) responding to treatment;
or
active skin condition requiring a minimum of weekly reassessment and which is responding to treatment;
or
high risk of skin breakdown that requires preventative intervention from a skilled carer or care worker several times each day, without which skin integrity would break down;
or
tracheostomy requiring routine care.	Moderate	
Open wound(s), which is (are) not responding to treatment and require a minimum of daily monitoring/reassessment;
or
active skin condition, which requires a minimum of daily monitoring or reassessment;
or
specialist dressing regime, several times weekly, which is responding to treatment and requires regular supervision.	High 	
Life-threatening skin conditions or burns requiring complex, painful dressing routines over a prolonged period. 	Severe	

Skin and tissue viability  

Describe the child or young person’s specific needs relevant to this domain. 	

	

6.	Breathing – assessors should indicate the level of need

  Description 	Level of need	
Normal breathing (age-appropriate rate). 	No additional needs	
Routine use of inhalers, nebulisers, etc.	Low	
Episodes of acute breathlessness, which do not respond to self-management and need specialist-recommended input;
or
requires the use of intermittent or continuous low-level oxygen therapy to prevent secondary health issues;
or
has profoundly reduced mobility leading to increased susceptibility to chest infection;
or
requires daily physiotherapy to maintain optimal respiratory function;
or
breathing difficulties, which require oral suction.	Moderate	
Requires high flow air / oxygen to maintain respiratory function overnight or for the majority of the day and night (i.e. CPAP / BIPAP). 

Requires continuous high level oxygen dependency, determined by clinical need. 
or
has a need for regular oral pharyngeal and/or nasopharyngeal suction (e.g. more than weekly), with a management plan undertaken by a a respiratory practitioner. 	High 	
Has frequent, hard-to-predict apnoea;
and/or
continuous airway monitoring and positioning of head and neck to maintain airway; 
and/or
severe, life-threatening breathing difficulties, which may require essential oral pharyngeal and/or nasopharyngeal suction, day or night;
or
a tracheostomy tube that requires essential suction by a fully trained carer, to maintain a patent airway;
and/or
requires ventilation at night for very poor respiratory function; has respiratory drive and would survive accidental disconnection, but would be unwell and may require hospital support.	Severe	
Unable to breath independently and requires permanent mechanical ventilation;
or
has no respiratory drive when asleep or unconscious and requires ventilation and one-to-one support while asleep, as disconnection would be fatal;
or
a highly unstable tracheostomy, frequent occlusions and difficult to change tubes.	Priority	

 Breathing 

Describe the child or young person’s specific needs relevant to this domain. 	

	

7.	Drug therapies and medication – assessors should indicate the level of need 

  Description 	Level of need	
Parent, informal carer or self-administered medicine as age appropriate.	No additional needs	
Requires a suitably trained family member, formal carer, teaching assistant, nurse or appropriately trained other to administer medicine due to:
•	age
•	non-compliance
•	type of medicine;
•	route of medicine; and/or
•	site of medication administration	Low	
Requires administration of medicine regime by a registered nurse, formal employed carer, teaching assistant or family member specifically trained for this task, or appropriately trained others;
and 
monitoring because of potential fluctuation of the medical condition that can be non-problematic to manage;
or
sleep deprivation due to essential medication management – occurring more than once a night (and at least twice a week).	Moderate	
Has a drug regime that requires management by a registered nurse (within prescription) at least weekly, due to a fluctuating and/or unstable condition or symptom management;
or
sleep deprivation caused by severe distress due to pain requiring medication management – occurring four times a night (and four times a week).	High 	
Has a medicine regime that requires daily management by a registered nurse and reference to a medical practitioner to ensure effective symptom management associated with a rapidly changing/deteriorating condition;
and/or
extensive sleep deprivation caused by severe intractable pain requiring essential pain medication management – occurring every one to two hours
and/or 
requires continuous intravenous medication, which if stopped would have a detrimental effect to underlying medical condition (e.g. Epoprostenol (Flolan) Infusion). 	Severe	
Has a medicine regime that requires at least daily management by a registered nurse and reference to a medical practitioner to ensure effective symptom and pain management associated with a rapidly changing/deteriorating condition, where one-to-one monitoring of symptoms and their management is required. 	Priority	

 Drug therapies and medication

 Describe the child or young person’s specific needs relevant to this domain. 	

	

8.	Psychological and emotional needs (beyond what would normally be expected from a child or young person of their age) – assessors should indicate the level of need 
(Note that Domain 1 separately considers Challenging Behaviour). 

  Description 	Level of need	
Psychological or emotional needs are apparent but age appropriate and similar to those of peer group.	No additional needs	
Periods of emotional distress (anxiety, mildly lowered mood) not dissimilar to those of age-appropriate peer group, which subside and are self-regulated by the child/young person, with prompts/ reassurance from peers, family members, carers and/or staff within the workforce.	Low	
Requires prompts or significant support to remain within existing infrastructure; periods of variable attendance in school/college; noticeably fluctuating levels of concentration. Self-care is notably lacking (and falls outside of cultural/peer group norms and trends), which may demand prolonged intervention from additional key staff; intentional self-harm, but not generally high risk;
or
evidence of low moods, depression, anxiety or periods of distress; reduced social functioning and increasingly solitary, with a marked withdrawal from social situations; limited response to prompts to remain within existing infrastructure (marked deterioration in attendance/concentration within lessons and deterioration in self-care outside of cultural/peer group norms and trends).	Moderate	
Rapidly fluctuating moods of depression, necessitating specialist support and intervention, which have a severe impact on the child/young person’s health and well-being to such an extent that the individual cannot engage with daily activities such as eating, drinking, sleeping or which place the individual at risk;
or
acute and/or prolonged presentation of emotional/psychological deregulation, poor impulse control placing the young person or others at serious risk, and/or symptoms of serious mental illness that places the young person at risk to his/her self and others; this will include high-risk, intentional self-harming behaviour.	High 	

Psychological and emotional needs

Describe the child or young person’s specific needs relevant to this domain. 	

	

9.	Seizures – assessors should indicate the level of need 

  Description 	Level of need	
No evidence of seizures.	No additional needs	
History of seizures but none in the last three months; medication (if any) is stable; 
or
occasional absent seizures. 	Low	
Occasional seizures or periods of unconsciousness that have occurred within the last three months which require the supervision of a carer or care worker to minimise the risk of self-harm;
or
sleep deprivation due to essential seizure management – occurring three times a night.	Moderate	
Seizures that result in unconsciousness and that may require frequent (more than monthly) skilled intervention to reduce the risk of harm and may require the administration of medication by a registered nurse or specially trained carer;
or
sleep deprivation due to essential seizure management – occurring four times a night; 
or
Requires monitoring and intervention for autonomic storming episodes (e.g. using infusion pumps). 	High 	
Severe uncontrolled seizures, daily or more, resulting in unconsciousness that does not respond to treatment outlined in an established protocol, and results in a high probability of risk to his/her self or others.	Severe	
Requires daily intervention by a registered nurse who will use clinical judgement to select and implement from a range of appropriate interventions to manage seizures and treat any related risks.	Priority	

Seizures
 
Describe the child or young person’s specific needs relevant to this domain. 	

	

10.	Challenging behaviour – assessors should indicate the level of need

  Description 	Level of need	
Functioning within current environment without further specific specialist training of carers/professionals.	No additional needs	
Some incidents of behaviour that do not pose a significant risk or barrier to intervention but require some additional direct/indirect input from identified resources/professionals within frontline services.	Low	
Challenging behaviour that follows a predictable pattern and that does not pose a risk to self or others;
or
behaviours that indicate a marked difficulty in self-regulating his/ her behaviours. This may include impulsive behaviours and/or self-neglect (self-neglect differs from parental neglect and is more applicable to adolescents). This is also separate from peer or cultural trends/uniform or identity.	Moderate	
Demonstrates a fluctuating poor ability to self-regulate behaviours in maintaining personal safety and development, despite specialist health intervention. Likely to require intense multi-agency involvement to maintain existing infrastructure, and additional high-level support from several agencies.	High 	
Demonstrates a consistent poor ability to self-regulate behaviours in maintaining personal safety and development, despite specialist health intervention. Likely to require ongoing, intense multi-agency involvement to maintain any infrastructure, and additional high-level support from several agencies. Usually requires direct specialist clinical assessment, treatment and review from specialist healthcare professionals in addition to those of frontline service.	Severe	
Demonstrates a consistent poor ability to self-regulate behaviours in maintaining personal safety and development, despite specialist health intervention, whereby the physical health and safety of the person or others is likely to be placed in serious jeopardy;
and
behaviours that create a barrier to intervention, requiring direct, urgent and intensive specialist clinical assessment, treatment and review from specialist healthcare professionals in addition to those of frontline services;
and
sustained behaviours that demonstrate the impairment of a child/young person’s personal growth and development through an inability to access necessary resources.	Priority	

 Challenging behaviour 

Describe the child or young person’s specific needs relevant to this domain. 	

	

11.	Other significant care needs

This final section is intended for particular needs which do not easily fall within the preceding domains, or which are not adequately reflected. Assessors should endeavour to include here any relevant high or severe levels of need, using their professional judgement and evidence presented by relevant contributors to inform a decision as to the level of need, and its impact on the individual’s wellbeing. Only high or severe needs should be considered under this domain. 

It is essential that this domain is used with discretion and judgement, to ensure consistency with the levels of need in the other domains. CCGs will want to ensure that this domain is not used as a means to circumvent low levels of need in the other domains. 

  Description 	Level of need	

	High 	

	Severe