Disclosure by a 14-year-old girl in January 2019 of four offences of rape by an adult male. Concerns that Child B was at risk of sexual exploitation had arisen a year earlier when Child B had travelled to a hotel to meet a man she had been in contact with over Facebook. Child B had been supported as a Child in Need and was later the subject of a Child Protection Plan, as well as being referred to CAMHS, Catch-22, and Barnardo's. There were concerns at school about bullying and Child B had moved to an Alternative Education placement. Further concerns about disguised compliance from Mother and Father's lack of engagement. Child B made several disclosures of grooming and sexual exploitation which resulted in Section 47 enquiries, and was accommodated under Section 20. Ethnicity and nationality not stated. Findings relate to: the multi-agency sexual exploitation process; child in need/child protection; the significance of neglect as a factor which underlies adolescent vulnerability; bullying; early intervention to prevent child sexual exploitation; information sharing; school nurse involvement; safeguarding roles and responsibilities; public awareness of child exploitation; the voice of Child B. Recommendations include: ensure that children and young people assessed as at high or medium risk of sexual exploitation are immediately flagged on the information systems of all agencies who are in contact with the child or young person; ensure that the support provided to children and young people at risk of sexual exploitation also considers the current and future needs of younger siblings living in the same household.
      
 Title:  Child B. LSCB: St Helens Safeguarding Children Partnership Author: David Mellor Date of publication: 2020  This case review report was deposited by the publishing LSCB(s) with the national SCR repository, a partnership between the Association of Independent LSCB Chairs and the NSPCC.  This report is available online via the NSPCC Library Catalogue. Copyright of this report remains with the publishing LSCB(s) listed above.                              Child B                                                                          Final Version: 9th March 2020                                                         Strictly Confidential    1  St. Helens Safeguarding Children Partnership  Serious Case Review Summary– Child B  Contents  Introduction                                                                                            1  Summary of Case                                                                                  2-3  Child B’s Views                                                                                      3-4                               Findings and Recommendations                                                         5-11                             References                                                                                              11  Glossary                                                                                               11-12   1.0 Introduction  1.1 In January 2019 a 14-year-old young person who will be referred to in this report as Child B disclosed four offences of rape by an adult male. Concerns that Child B was at a high risk of sexual exploitation had first arisen a year earlier and her case had been managed under the local multi-agency child exploitation process. Additionally, she had been supported as a Child in Need and later been the subject of a Child Protection Plan. As a result, a large number of agencies worked together to support Child B and her family in the year prior to her disclosures of rapes.  1.2 The then St. Helens Safeguarding Children Board, since succeeded by the St. Helens Safeguarding Children Partnership, decided to conduct a Serious Case Review (SCR) on the grounds that Child B had suffered significant harm and abuse was suspected.   1.3 St. Helens Safeguarding Children Board appointed Ann Dunne as chair of the SCR Panel established to oversee this review. She is the Senior Assistant Director, Children’s Safeguarding at St. Helens Council. David Mellor was commissioned as the independent reviewer for this SCR. He is a retired chief police officer and former independent chair of safeguarding children’s and adults’ boards who has no connection to any of the agencies involved in this case.  1.4 It is worthy of note that during the period covered by this SCR – January 2018 until January 2019 – there were two focussed visits to Children’s Services in St Helens by Ofsted which highlighted areas for improvement. Several of the findings of this SCR are consistent with the priority areas for improvement identified by Ofsted.                                                     Strictly Confidential    2  2.0 Brief Summary of Key Events and Agency Responses:  January 2018 Concerns arose that Child B may be at risk of child sexual exploitation after she travelled to a hotel to meet an adult male she had been in contact with on Facebook. The hotel staff became suspicious and alerted Cheshire Police, in whose area the hotel was situated. Cheshire Police made a safeguarding referral. On receipt of the safeguarding referral from Cheshire Police, St. Helens Children’s Social Care initiated a Child & Family Assessment (C&FA) but there was a delay in completing the Pan Merseyside Child Exploitation referral form (CE1). February 2018 Child B was seen by Child and Adolescent Mental Health Services (CAMHS) following a referral by her GP. CAMHS referred Child B to Barnardo’s who provide Tier 2 (early help and targeted services) CAMHS support. CAMHS also contacted her school over concerns that Child B was being bullied by other pupils.  March 2018 The C&FA was completed and it was agreed that Child B and her family would be supported under a Child in Need (CiN) plan. In late March the delayed CE1 Child Exploitation referral form was considered by a CE2 meeting, which is the meeting at which the CE2 multi-agency assessment tool is completed. Child B was assessed as being at high risk of child sexual exploitation. She was referred to Catch 22, which is a service which works with young people under 18 who are at risk of child sexual exploitation.  April 2018 Child B’s case was discussed at the multi-agency child exploitation meeting (MACE), the purpose of which is to enable information sharing and action planning to tackle child exploitation. It was agreed that her case should be open to the MACE meeting and would be reviewed at the August MACE. May 2018 Catch 22 began working positively with Child B but Barnardo’s had been unable to contact Child B’s mother and wrote to her to say that they would close her daughter’s case unless contact was made. June 2018 A strategy meeting was held after Child B disclosed a sexual assault to the police. It was agreed that current support would continue and a Section 47 enquiry would be initiated. The Section 47 enquiry acknowledged the risks to Child B but concluded that she was not at continuing risk of significant harm and it was decided to continue to support Child B under the CiN plan. After CAMHS received a second GP referral in respect of Child B, Barnardo’s agreed to keep the earlier referral open. July 2018 Child B was referred to the young people’s drug and alcohol team (YPDAAT) who first made contact with her in September 2018. August 2018 Child B was involved in a road traffic accident in a car driven by a male said to be the boyfriend of her adult sister who was arrested for driving under the influence                                                   Strictly Confidential    3 of alcohol. Concern was expressed that Child B was being exposed to risk through her adult sister’s association with the driver of the car and other males. Barnardo’s closed Child B’s case as they had been unable to contact her parents. Child B made a number of disclosures of grooming and sexual exploitation by adult males which resulted in an emergency strategy meeting which led to a further Section 47 enquiry.  September 2018 Child B was judged to be at continuing risk of significant harm and made subject to a child protection plan under the category of sexual abuse. October 2018  Child B’s case was considered at a further CE2 meeting where she continued to be assessed as being at high risk of child sexual exploitation. The action plan was updated and expanded. November 2018 A Legal Gateway Panel meeting was held and pre-proceedings were agreed in respect of Child B. (The aim of pre-proceedings is to try and support the family to address concerns before reaching the stage of legal care proceedings.) Child B had been supported to re-engage with school but was suspended and referred to Alternative Education provision. This provision was unable to manage the risk of child sexual exploitation to which she continued to be exposed. December 2018 A pre-proceedings meeting had to be rearranged when Child B’s mother did not attend. The rearranged meeting did not go ahead later in that month. January 2019 Child B was accommodated by St. Helens children’s social care under Section 20 Children Act 1989 after she disclosed four offences of rape by an adult male.  3.0 Child B’s Views on the Support she received from Agencies  3.1 Child B said she found the work she did with Catch 22 to be helpful, particularly their advice on how perpetrators groom children for sexual exploitation. She seemed to value and benefit from the Catch 22 advice that she should not blame herself for what happened to her. She felt that her self-confidence had increased during the time Catch 22 worked with her.  3.2 Child B was very critical of the High School she attended. She said that she was regularly bullied by female pupils in her year and lower. She said she had been ‘battered, bruised, nearly strangled and dragged around the school’. However, she felt that she was blamed for the incidents because she would ‘shout back’ at the pupils who were bullying her and, as a result, she was perceived by school staff to be the aggressor. She said the school believed those who bullied her.  3.3 She said that she had stayed off school ‘for about a year’ because of the bullying. Child B added that whenever the school contacted mother to discuss the bullying, she (mother) responded by saying that unless the school supported Child B, she would not bring her into school. Child B said that mother’s advice to her was to ‘put her head down and just ignore it’. She described the school as ‘horrible’.                                                    Strictly Confidential    4  3.4 Child B said that the school arranged for her to resume her education by initially attending on a part time basis (10am – noon daily) which she said was ‘alright’ although she said she was still being followed around school by pupils who were intent on being unpleasant to her and so she began missing school again.   3.5 She said her Alternative Education placement was ‘alright’ but she was disturbed to find that pupils from her school who had been involved in bullying her previously were also in the same Alternative Education placement. She added that they did not bully her during the Alternative Education placement.   3.6 Child B felt that YPDAAT had helped her to reduce her alcohol intake when she was out on a Friday and Saturday night. They helped her to appreciate that drinking excessively could increase her vulnerability to abuse.   3.7 Child B had only limited contact with CAMHS and Barnardo’s during the period under review and felt that their suggestions for preventing self-harming behaviour ‘didn’t work’. She said that Barnardo’s response to her efforts to access their online counselling service were not helpful. She contrasted the limited benefit she obtained from CAMHS and Barnardo’s with online support she had subsequently received from the ‘7cups’ website which, it is understood, allows users to anonymously connect with trained listeners in order to gain support for issues including mental health. There are different support options including individual listeners, chat rooms and forums. Child B said that this service ‘allowed her to get her feelings out’ and provided her with quite directive advice such as ‘don’t self-harm because the relief from doing so will last for only 2 minutes’, which she said she valued.   3.8 Child B made limited comments about the other agencies she and her family came into contact with. She said that the police had helped her to say what had happened to her and that the sexual health advice service had helped her to an extent. She initially said that she had no comments to make about children’s social care but as the conversation drew to a close she expressed dissatisfaction with the extent to which she was consulted over the decision to take her into care in January 2019. Although she said she was now thankful to mother for consenting to her becoming looked after, she felt that the process was quite abrupt. She said that the social worker visited her at her sister’s address and told her to ‘pack her bags’ and just dropped her off at the children’s home and ‘just left her there’. Child B felt that this process could have been managed more sympathetically.   3.9 Child B was asked if she had any views on how services worked together to support her and her family. She said that she didn’t think they worked together but was unable to enlarge on this view, possibly because she may have been unaware of what to expect from partnership working arrangements.  3.10 It had been hoped to invite Child B’s parents to contribute to this review but, at the time the SCR was being completed, they were facing a number of challenges which precluded contact at that time.                                                     Strictly Confidential    5  4.0 Findings and Recommendations  4.1 Despite the fact that Child B was assessed as at high risk of child sexual exploitation and her case managed through the Pan-Merseyside Multi-Agency Child Exploitation Protocol for twelve months and that, in parallel, she was first supported as a Child in Need and later subject of a Child Protection Plan, the risks to Child B from child sexual exploitation escalated to the point where urgent action was necessary to accommodate her under Section 20 of the Children Act.  4.2 Clearly, the Child Exploitation Protocol cannot eliminate the risk of child sexual exploitation and statutory child protection procedures cannot guarantee a positive outcome for the child concerned, but in this case, it became increasingly clear that despite the individual and collective efforts of a range of agencies, matters were not improving for Child B and the risks to which she was exposed were escalating.  4.3 The multi-agency child exploitation process in St Helens has continued to evolve since the period under review. The process is now led by the Complex Safeguarding Lead from St. Helens Children’s Services who has advised the independent reviewer of the changes including a greater emphasis on timescales in order to prevent drift and delay, although it is not known whether delays have been reduced, and an even stronger focus on reducing the risk of exploitation. Where the child or young person is also subject to Child in Need or Child Protection as well as the multi-agency child exploitation process, creative ways are being explored to better co-ordinate the two processes and manage the impact on practitioners of attending separate meetings for each process.  However, this review focusses on Child B’s journey through the process during the twelve-month period beginning in January 2018.  The Multi-Agency Sexual Exploitation Process  4.4 There were frequent and substantial delays in the progression of Child B’s case which prevented earlier intervention to support her and her family and left the risks to which she was exposed unattended to for a time.   4.5 The plans developed in the CE2 meetings contained an increasing number of actions and eventually became somewhat unwieldy. The plans did not identify, or afford priority to, all of the key issues which could have reduced the risk of child exploitation faced by Child B. In particular, repeated concerns that Child B’s unmet mental health needs may be increasing her vulnerability went largely unaddressed.   4.6 In Child B’s case, being open to the MACE meeting appeared to add little value. MACE did not provide strategic oversight; did not challenge issues such as the delays in progressing Child B’s case; did not ensure that the multi-agency sexual exploitation and the Child in Need/Child Protection plans complemented each other; did not challenge the fact that matters were not improving for Child B; and did not ensure that there was sufficient focus on outcomes for Child B. The latter point was picked up by practitioners involved in the case who attended a learning event to                                                   Strictly Confidential    6 inform this SCR. Many expressed the view that there was too much focus on the child exploitation process and insufficient attention paid to the outcomes for Child B.  4.7 However, the need to focus on outcomes is not solely the responsibility of the MACE meeting. An earlier serious case review into a case involving child sexual exploitation recommended that all practitioners needed to understand their responsibility to relentlessly pursue any concerns that the system was not working for any child (1). The system did not work well enough for Child B.  Recommendation 1:  That St. Helens Safeguarding Children Partnership obtains assurance that the MACE meeting provides strategic oversight of the multi-agency child exploitation process including  • an overriding focus on outcomes for children and young people assessed as at high risk of exploitation,  • challenging plans where the situation is not improving for a child or young person, • challenging delay and drift, • ensuring CE plans prioritise key issues essential to reducing risk and  • ensuring CE plans and child in need/child protection plans are complementary.   Child in Need/Child Protection  4.8 Child B’s case should have been escalated to child protection earlier than it was. Assessments were insufficiently informed by earlier children’s social care and early help involvement with the family and there was insufficient challenge to father’s complete lack of engagement or to the gap between mother’s words and deeds and the evidence of disguised compliance on her part. (Disguised compliance is a concept derived from learning from serious case reviews and consists of parents giving the appearance of co-operating with child welfare agencies to avoid raising suspicions and to allay concerns (2)).  The vital parenting assessment should have been commenced earlier and, having been identified as a key task, was repeatedly delayed. Many of these issues were highlighted in focussed visits to St Helens Children’s Services by Ofsted in July and November 2018. The full Ofsted inspection which took place in September 2019 acknowledged progress made whilst highlighting the further developments required (3).  4.9 St. Helens Safeguarding Children Partnership may be able to obtain assurance in respect of the learning from this case about the manner in which Child B was supported, initially as a Child in Need and subsequently under a Child Protection Plan, from reports received in respect of the improvement programme established following the first of the Ofsted focussed visits in 2018. The specific issues on which the Partnership may wish to obtain assurance are:                                                     Strictly Confidential    7 • the extent to which child in need plans provide challenge and focus on change, capacity for change and the outcomes for the child or young person, • the extent to which section 47 enquiries fully consider historical information, parental capacity to safeguard and the possibility of disguised compliance, • that decisions to escalate to child protection are informed by escalating risks and fully consider relevant historical information, • that key elements of the Child Protection Plan, such as the parenting assessment in this case, are progressed expeditiously and • that timescales for key elements are monitored to avoid drift.  Recommendation 2  That St. Helens Safeguarding Children Partnership obtains assurance in respect of:   • the extent to which child in need plans provide challenge and focus on change, capacity for change and the outcomes for the child or young person, • the extent to which section 47 enquiries fully consider historical information, parental capacity to safeguard and the possibility of disguised compliance, • that decisions to escalate to child protection are informed by escalating risks and fully consider relevant historical information, • that key elements of the Child Protection Plan, such as the parenting assessment in this case, are progressed expeditiously and • that timescales for key elements are monitored to avoid drift.  The significance of neglect as a factor which underlies adolescent vulnerability  4.10 The recurring concerns documented throughout Child B’s childhood, which included parental alcohol misuse; poor home conditions; lack of food in cupboards; lack of supervision; inconsistent school attendance; and lack of parental co-operation with agencies, makes painful reading. The inability of agencies to which Child B and her siblings were referred to intervene effectively because of a lack of challenge, lack of professional curiosity and a tendency to downplay concerns is equally disturbing. The picture is consistent with what was observed during the Ofsted focussed visit to children’s services in July 2018, when a high proportion of cases seen featured issues of long-standing neglect where too many children had been left in home circumstances where their health and well-being were compromised. Ofsted also observed that the cumulative impact on children was not sufficiently recognised by all workers or their managers, and the high tolerance to familial neglect was neither questioned nor challenged by effective management oversight or reflective supervision (4).  4.11 The long-term parental neglect both Child B and her elder sibling suffered left them both extremely vulnerable to exploitation as they entered their adolescent years. It is therefore recommended that St. Helens Safeguarding Children Partnership disseminate the learning from this case, including the long history of largely unaddressed parental neglect and the likely impact on the risk of sexual exploitation to which both Child B and her elder sibling were exposed. Dissemination                                                   Strictly Confidential    8 of learning from the review will provide an opportunity to emphasise the importance of the 2019-2024 St. Helens Neglect Strategy (5). It is also recommended that the 2019-2024 St. Helens Neglect strategy is amended to include child exploitation (sexual and criminal) as a contextual risk factor alongside domestic abuse, substance misuse, adult mental health, child poverty and youth homelessness.    Recommendation 3:  That St. Helens Safeguarding Children Partnership disseminates the learning from this case, including the long history of largely unaddressed parental neglect and the likely impact on the risk of sexual exploitation to which both Child B and her elder sibling were exposed. Dissemination of learning from the review will provide an opportunity to emphasise the importance of the 2019-2024 St. Helens Neglect Strategy.  Recommendation 4:  That the 2019-2024 St. Helens Neglect Strategy is amended to include child exploitation (sexual and criminal) as a contextual risk factor alongside domestic abuse, substance misuse, adult mental health, child poverty and youth homelessness.    Bullying  4.12 Child B’s school generally perceived her to be the instigator of bullying whereas Child B strongly felt that she was often the victim. It is difficult to reconcile these opposing views although the long-term parental neglect suffered by Child B meant that she often presented as unkempt and later began caring for her younger sibling, factors which may have affected her ability to make friends amongst her peers. This case suggests that schools may need to look at bullying more holistically and consider the impact of neglect, particularly chronic long-term neglect, on pupils involved in bullying incidents whether perceived as instigators and/or victims.  Recommendation 5:  That St. Helens Safeguarding Children Partnership share the learning from this SCR with local schools and invite them to review their approach to bullying to ensure that the potential impact of neglect on those involved in bullying incidents is considered.  Early intervention to prevent child sexual exploitation  4.13 Child B’s exposure to the risk of child sexual exploitation mirrored the experience of her elder sister five years earlier. Although it is understood that no interventions were put in place to support Child B’s sister at the time she may have been at risk of sexual exploitation, it may have been possible at the time that concerns arose in respect of her elder sibling to anticipate that Child B may also go on to be at risk of sexual exploitation. The common denominator in both of their lives was serious enduring parental neglect.                                                    Strictly Confidential    9  4.14 Therefore it is recommended that St. Helens Safeguarding Children Partnership obtain assurance that the support provided to children and young people at risk of sexual exploitation also considers the current and future needs of younger siblings living in the same household.  Recommendation 6:  That St. Helens Safeguarding Children Partnership obtain assurance that the support provided to children and young people at risk of sexual exploitation also considers the current and future needs of younger siblings living in the same household.  Information sharing   4.15 Child B’s GP, CAMHS and Barnardo’s do not appear to have become aware that Child B was at high risk of sexual exploitation until after she was accommodated by the local authority in January 2019. The system by which partner agencies involved in the CE2 and MACE meetings flag their records in respect of children and young people at high or medium risk of sexual exploitation was insufficiently robust in this case and may therefore need to be strengthened.  Recommendation 7:  That St. Helens Safeguarding Children Partnership obtains assurance that children and young people assessed as at high or medium risk of sexual exploitation are immediately flagged on the information systems of all agencies who are in contact, or likely to come into contact with the child or young person.  School nurse involvement  4.16 The school nurse service played a largely passive role in this case until Child B became subject to a Child Protection Plan in late August 2018. The school nurse service had been a repository of information shared in respect of the growing concerns relating to Child B but did not appear to consider whether there was a role for the service in safeguarding Child B prior to August 2018. Capacity issues may well have been a factor and so the Safeguarding Children Partnership may wish to seek assurance from North West Boroughs Healthcare NHS Foundation Trust (NWBH) as provider, over the steps they have taken to recruit and retain sufficient staff to deliver the four levels of school nurse service at community, universal, universal plus and universal partnership plus.  Recommendation 8  That the St. Helens Safeguarding Children Partnership seeks assurance from North West Boroughs Healthcare NHS Foundation Trust (NWBH) as provider of school nursing services over the steps they have taken to recruit and retain sufficient staff to deliver the four levels of school nurse service at community, universal, universal plus and universal partnership plus.                                                   Strictly Confidential    10  Safeguarding roles and responsibilities  4.17 When this report was presented to the St. Helens Safeguarding Children Partnership Board, members observed that there were occasions when practitioners made assumptions that Child B’s needs were being met, when this was not the case. For example, agencies took comfort from Child B being ‘under CAMHS’ as she had been referred to that service, despite the fact that neither CAMHS nor Barnardo’s were able to provide a service to her. Members also observed that once a lead had been assigned, for example a social worker to lead on Child in Need support, there was sometimes a tendency for other partners to become less engaged in the process. In this case not all Child in Need meetings were well attended.   4.18 Members felt that it would be useful for partner agencies to be reminded of their responsibility to maintain their focus on safeguarding a child or young person and that this should not diminish simply because the child or young person had been referred to a partner agency or a partner agency had taken on a lead role.  Recommendation 9  That St. Helens Safeguarding Children Partnership remind partner agencies of their responsibility to maintain a focus on safeguarding a child or young person, and that this should not diminish simply because a referral had been made to a partner agency or a partner agency had taken on a lead role.  Public awareness of child exploitation  4.19 When Child B travelled to a hotel to meet an adult male in January 2018, staff became suspicious and contacted the police. This was an excellent piece of work by the hotel staff which helped to safeguard Child B and demonstrates the contribution that people in a wide variety of roles can play in preventing the sexual exploitation of children and young people.   Recommendation 10  That St. Helens Safeguarding Children Partnership initiates a renewed public awareness campaign in respect of child sexual exploitation, with particular focus on key groups such as taxi drivers, hotels, after school clubs, youth groups, park wardens and sports clubs. Given the likelihood of turnover of personnel in some of these sectors, it may be of value to provide guidance on how to embed messages on child sexual exploitation in staff training and development.  Recommendation 11  That St. Helens Safeguarding Children Partnership acknowledges the positive intervention of the hotel chain who helped to safeguard Child B in this case by writing a letter of thanks.                                                    Strictly Confidential    11 The ‘voice’ of Child B  4.20 During the period under review Child B repeatedly sought help from agencies by visiting a local pharmacy to obtain antidepressants saying she wanted to ‘fall asleep and not wake up’, sitting down in the road so that traffic had to slow down to pass her, attending hospital ED on several occasions and twice attempting to access online counselling services from Barnardo’s after her parents did not take her to appointments with the latter service. What Child B appeared to be communicating to agencies through these behaviours was that her life was very difficult and she needed help. Despite the range of agencies in contact with her and her family she was unable to access help for her low mood and agencies did not appear to understand the significance of the help-seeking behaviours described above.  Recommendation 12  When St. Helens Safeguarding Children Partnership disseminates the learning from this SCR, practitioners are encouraged to reflect on how Child B’s efforts to seek help for herself could have been responded to more effectively and what she was attempting to communicate noticed, and acted upon.   References:  (1) Retrieved from https://library.nspcc.org.uk/HeritageScripts/Hapi.dll/filetransfer/2019AnonymousKatieOverview.pdf?filename=AA58F75CEDE68892A73FB681FE246B8371684F102152F0AA780A14959D3BCE5767137B3B2A935011CBAEC3068664FF681AA6D2524E357BAB96C006752CCD756759AD77BD1E389823A55CFAAE74B2EE64F46C611AD1724BE1AC50776135EAAAAFFECACF7BE0247BFC24B132894BF737ED6D2EE77EC0A82BFD51F9CB13BB656A5AEEB274B0D202E7F27F792337D2997A5F7B4930A36B46ED&DataSetName=LIVEDATA  (2) Retrieved from https://learning.nspcc.org.uk/media/1334/learning-from-case-reviews_disguised-compliance.pdf  (3) Retrieved from https://files.ofsted.gov.uk/v1/file/50010873  (4) Ibid  (5) Retrieved from https://sthelenssafeguarding.org.uk/assets/1/neglect_strategyfinal.pdf  Glossary  Child and Adolescent Mental Health Services (CAMHS) Tiers:                                                   Strictly Confidential    12 Tier 1 provide early intervention and prevention services and are provided through schools and children’s centres; health visitors; school nurses; GPs; helplines; and websites. Tier 2 provides early help and targeted services. In St. Helens, these services are provided by Barnardo’s. Tier 3 provides specialist CAMHS, including eating disorder services.  Tier 4 means specialised day and inpatient units, where people with more severe mental health problems can be assessed and treated. (CAMHS are moving from the Tiers approach to the THRIVE framework which is an integrated, person centred, and needs led approach to delivering mental health services for children, young people and their families. It conceptualises need in five categories; Thriving, Getting Advice and Signposting, Getting Help, Getting More Help and Getting Risk Support).   A Child in Need (CiN) is defined under the Children Act 1989 as a child who is unlikely to achieve or maintain a reasonable level of health or development, or whose health and development is likely to be significantly or further impaired, without the provision of services; or a child who is disabled.  Child and Family Assessment The purpose of the assessment is to determine if there is identifiable evidence of risk or identifiable significant harm to the child or whether they are unlikely to achieve or maintain a reasonable standard of health or development or they have a disability.  The Early Help Assessment Tool (EHAT) is a process for gathering and recording information about a child in respect of whom practitioners have concerns in which the needs of the child and how those needs can be met are identified.  The term Early Help describes the process of taking action early and as soon as possible to tackle problems and issues emerging for children, young people and their families. Effective help may be needed for at any point in a child or young person's life.  Section 47 Enquiry is required when children’s social care have reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm. The enquiry will involve an assessment of the child’s needs and the ability of those caring for the child to meet them. The aim is to decide whether any action should be taken to safeguard the child.            