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Vulnerable Families

The following pathway should not be read as stand-alone and MUST be read in conjunction with Section 3: Pathways.

  • This pathway captures families with higher levels of vulnerability. This pathway interlinks with the Safeguarding pathway and some families will cross between both.

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Antenatal

28 weeks +

Core Purpose 1, 2, 3

Delivery of (targeted) additional support.

Childrens Centres & EYFS

Vulnerable families who need multi-agency support. TAF/C.

Targeted services initiated via a CAF with a lead professional/ agency.

Support for vulnerable /targeted families as part of a multi- disciplinary/agency team.

Reduce risk of/actual child abuse/neglect.

Birth - 5 years

Birth - 5 years

Care of the vulnerable child with physical disability.

Primary Care & GP

Case management HV, Community Nursing/Pediatric Team, specialist services. Information sharing, support for parents, workload planning.

Contribution to CAF.

Birth - 5 years

Core Purpose 1, 2,3

Care of the vulnerable child.

Childrens Centres & EYFS

Targeted services initiated via a CAF with a lead professional/ agency.

Support for vulnerable /targeted families as part of a multi-disciplinary/agency team.

Reduce risk of/actual child abuse/neglect.

Birth - 5 years

Information sharing, safety, support for families, workload planning.

Contribution to CAF.

Primary Care & GP

Referral/Liaison with other health, social care and support services for example:

  • Peadiatric services
  • Community Nursing Team (CNT)
  • Social worker
  • RM
  • HV
  • Teenage pregnancy services/FNP

Birth - 5 years

Management of LAC with Social Services

Primary Care & GP

Registration of LAC.

Ongoing management of child’s needs.

Birth - 5 years

Support for family and Child with long term complex additional needs or disability.

Primary Care & GP

Practitioners contribute to a CAF to access Early Support approach to coordinate family led framework to deliver services and support to children with complex additional needs or disabilities and their family. Contribute as appropriate to 6monthly Family Service Plan meetings by attendance/information sharing.

Information sharing, safety, support for families, workload planning.

Birth - 5 years

Contribute to TAF/TAC.

Primary Care & GP

Information sharing, safety, support for families, workload planning.

Birth - 5 years

Care and provision of additional specialist support and treatment of vulnerable mothers/ families.

Referral to appropriate services for example:

  • Peadiatric services
  • Community Nursing Team (CNT)
  • Social worker
  • RM
  • HV
  • Teenage pregnancy services /FNP

Primary Care & GP

Practitioners would contribute to a CAF and form part of the team of relevant professionals/agencies needed to support the mother/family e.g:

  • Specialist Teen Services - FNP & voluntary organisations.
  • Safeguarding services - social services Mental Health Team
  • DAT
  • LA - housing
  • Children’s Centre/LA parenting teams MARAC
  • SARAC - sexual exploitation

Birth - 5 years

Core Purpose 1, 2, 3

Targeted support to reflect local demographic data and need e.g. teenage parents/travellers/ BME programme.

Childrens Centres & EYFS

Targeted groups sessions to reflect local demographic need with a focus on:

  • Promoting parenting skills
  • Promoting health, wellbeing and positive mental health of mother.
  • Access for hard to reach families

Birth - 5 years

Additional visits

Tailored Package (This package may be repeated a number of times to deal with the individual needs of the parent at any given time in the child’s development.)

Health Visiting

Promote partnership working with the family. Undertake additional visits in conjunction with other agencies e.g. CAMHS.

Work with Mental Health Services to support either parent already receiving services (and contribute to care package lead by Specialist Team Action).

Liaison / communication with other agencies / services / GP’s.

  • Consider referral to parenting support groups:


    • Mellow parents/bumps/babies
    • Incredible babies
    • Infant Massage
  • Consider offering referral to Video Interactive Guidance (VIG) or locally commissioned attachment therapeutic groups via local Primary Infant Mental Health Services.
  • Delivery of parent health education sessions in the home which include: 


    • Support to bring about behaviour change
    • Stop Smoking
    • Diet and nutrition
    • Safety issues in house and car

Delivery of tailored packages that will address the individual needs of the family e.g.

  • Management of sleep issues
  • Intensive support on understanding infant behaviour.
  • Support regarding routine and coping with tiredness 
  • Support with planning and cooking meals.

Birth - 5 years

Safeguarding

In cases where there are identified concerns regarding Safeguarding at a Universal Partnership Pus level targeted support should be provided as specified in the Safeguarding Pathway.