Section 2: Operational requirements for implementing Care and Risk
Management (CARM) Framework
Care and Risk Management (CARM) is proposed as a best practice formal risk management process which must be underpinned by the principles of risk practice through a child-centric lens. Where CARM is not being utilised but a locally devised formal risk management process is in place, this must adhere to the principles of risk practice outlined in this section of the guidance and clearly evidence defensible decision-making. Professionals involved in this work must have the skills and competencies to undertake the complexities inherent within it and where they do not have the appropriate level of competency, appropriate opportunities to develop these must be in place and all professionals should receive robust and meaningful support from their management structures and agencies.
2.1 Aims and Objectives of CARM
- To manage the assessed risk of harm;
- To highlight to appropriate agencies individual children who present a risk of serious harm to others;
- To ensure that a relevant risk assessment is undertaken in relation to a child considered to present a risk of serious harm;
- To share information in a multi-agency forum about the risk of serious harm presented by a child's behaviours;
- To identify risk scenarios which consider the nature of risk, how and when risk might present, and who may be at risk from the harm the child's behaviour may present;
- To identify strengths and protective factors which can support the delivery of individual and effective risk management strategies to reduce harmful behaviours and build capacity within the child;
- To implement risk management measures that are constructive and individualised, bearing in mind the principle of proportionality, the best interests of the individual as well as their physical and mental
wellbeing, and development and circumstances of the case;
- To ensure that the child's social, developmental and psychological needs should be addressed within the context of decisions about risk management strategies; and,
- To ensure that, through the completion of risk assessment(s) and the linked development of risk management strategies, there is an appropriate multi-agency response to the child's behaviour to support effective public protection and victim safety planning.
2.2 CARM Process
A system to co-ordinate referrals to the CARM process needs to be established. Individuals with responsibility for the co-ordination and/or chairing role should have authority to make service provision decisions. Co-ordinators/chairs should be competent in respect of:
- The legislative and policy context of working with children;
- Child development and family functioning;
- Child protection procedures and processes;
- Best practice with children both in relation to offending behaviour and related childhood issues and difficulties;
- Understanding of resilience and strengths-based practice;
- Desistance theory and its application to children's pathways out of offending behaviour;
- Understanding appropriate risk assessment tools for use with children who display harmful behaviour; and,
- Risk formulation and risk management planning.
2.2.1 Referral to CARM
Requirement 1 - Referrals to CARM must be made within one day of the behavior coming to light
Meeting the requirement
Referrals to CARM may be made via a number of channels, including social work, Police, Children's Reporter, education, chair of a multi-agency group etc. Where there is a lead professional, in line with GIRFEC principles any referral to the CARM process should be discussed with them. Any concerns regarding risk of serious harm must be referred to CARM or equivalent formal risk management process within one working day of the behaviour coming to light. Where this is not possible immediate safety measures should be put in place and agency protocols followed with referral to CARM process initiated at the earliest opportunity.
The purpose of the referral discussion is to clarify the nature of the referrer's concerns. Ultimately the individual with responsibility for reviewing referrals will decide whether a CARM meeting or a Child Protection Initial referral discussion (IRD) is triggered. In addition it may be that the outcome of a CP IRD is to progress under CARM procedures. A record of the outcome of this referral discussion should be made on the relevant case management system noting:
- Whether child protection measures are required for either the child alleged to have caused harm or any other child/ person involved;
- Decision whether CARM is required or not and reasons;
- Brief summary of identified risk factors and strengths known at this point;
- Date of agreed CARM meeting (where relevant);
- Allocation of immediate tasks; and,
- Allocation of interim tasks pre-meeting.
Immediate tasks may include:
- Specific action (safety plans) carried out to protect the child alleged to have harmed and any others alleged to have been harmed;
- Review of living arrangements and education, employment or training placement (where necessary);
- Establish legal position in relation to the harmful behaviour i.e. is there a criminal charge in process and the route this is following;
- Link with child and parents/carers as appropriate; this must include advising of their legal rights;
- Measures in place to mediate community response (this may include a Community Impact Assessment by police if deemed appropriate);
- Agreement of communications strategy to manage any media attention; and,
- Agreement of strategies to manage a child's increased risk to self.
Interim tasks may include:
- Development of safety plans in relation to particular settings (e.g. home, school, residential unit) outlining interim risk management measures to be put in place;
- Identify and build on strengths and protective factors;
- The need for a child to be referred to the Children's Reporter;
- The need for a referral to specialist services (e.g. for completion of relevant related assessments such as psychological/ psychiatric/ functional/ offending behavior/ risk); and,
- The allocation of a lead professional (if this has not already occurred).
The outcome of a referral discussion may be that the individual with responsibility for reviewing referrals is of the opinion that no further action is required or that current service provision is sufficient to manage risk without recourse to a CARM meeting. Reasons for this decision must be recorded in detail.
If a CARM meeting is necessary, the lead professional must have the following information - detail of the concerns, potential harm or actual harm, including relevant supplementary information pertinent to the concerns where available. Initial information for CARM meeting should encompass:
- A copy of single/multi-agency assessments of wellbeing or equivalent and Child's Plan for the relevant child where this is available;
- Copies of any completed risk assessments;
- Copies of any specialist assessments or assessments from other practitioners/agencies e.g. Child and Adolescent Mental Health Service (CAMHS) or Education;
- All available information which can be gathered within the timescale;
- Chronology of offending/harmful behaviour;
- Understanding of strengths or protective factors.
2.2.2 Initial CARM meeting
Requirement 2 - The initial CARM meeting should take place as soon as possible and no later than 21 calendar days after the referral discussion.
Meeting the requirement
A risk assessment may not have been undertaken prior to the initial CARM meeting. However, appropriate actions and strategies should have been put in place immediately as required to promote the safe management of potential harm based on available information and initial assessment of need and risk of harm pending the CARM meeting.
The child and their parent(s)/carer(s) need to be informed that a CARM meeting is being convened, invited to attend and the objective and CARM process clearly explained to them. Prior to any meeting taking place the child and their parents'/ carers' views must be sought and expressed on their behalf should they decline to attend. The individual with responsibility for reviewing referrals to the CARM process will decide whether it is appropriate to include the child and their parents/ carers for the whole meeting or part of the meeting and record the reasons why.
Although participation of the child and/or his parent(s)/carer(s) can assist with information sharing, as well as sharing of specific tasks in relation to risk management, this needs to be weighed against the stress and impact the meeting can have on participants. In addition, they may wish to bring others to support them such as practitioners from advocacy or children's rights services or other support or legal representative.
In some situations, restricted access information will need to be shared at a CARM meeting though all information sharing must be in accordance with existing legislation. This includes information that by its nature cannot be shared with the child and/or his parent(s)/carer(s). Such information may not be shared with any other person without the explicit permission of the provider.
Restricted information includes:
- Sub-judice information that forms part of legal proceedings and which could compromise those proceedings;
- Information from a third party that could identify them if shared;
- Information about an individual that may not be known to others, even close family members, such as medical history and intelligence reports; and
- Information that, if shared, could place an individual(s) at risk.
If a child is subject to Police investigation this should not delay the convening of a CARM meeting with high level of care and attention to ensure no compromise of any legal process which may have been triggered or is being considered. Assessment and intervention processes will need to be proportionate to the legal status of the case, balancing the child's rights against identified issues in relation to public safety.
2.2.3 CARM Group Membership
Requirement 3 - CARM chair must identify appropriate practitioner to complete necessary risk assessments.
Requirement 4 - Where a risk assessment has been completed in advance this should be provided five working days in advance to the chair.
Requirement 5 - Lead professional is responsible for updating the Child's Plan to incorporate the risk management strategies.
Requirement 6 - The CARM chair will establish attendees' views as to whether the child requires ongoing risk management through the CARM process or not and the reasons why.
Requirement 7 - Decision of CARM meeting should be reached by consensus, where this is not, it should be recorded and the chair will make final decision whether CARM process is required or not.
Requirement 8 - A full minute approved by the chair of the CARM meeting must be circulated to attendees within 15 calendar days.
Requirement 9 - The lead professional must communicate key decisions of the CARM meeting to the child and their parent/carer the same day.
Meeting the requirements
While the standing membership of a CARM meeting will vary according to circumstances it is anticipated that the following agencies (in addition to the referrer, Chair and minute-taker) will be represented:
- Parents/ carers
- Support for child and/ or parent
- Social Work
- Health (e.g. CAMHS);
- Residential staff (this would reflect any establishment where a child is placed)
In some situations, it may be appropriate for additional agencies to be included. However, the reasons for their inclusion must be recorded and it must be appropriate in relation to the specifics of the child involved or their parents/carers.
At the outset, the CARM meeting must consider whether a child is subject to any form of statutory order(s) (e.g. through the CHS and any related conditions or any court imposed order or license). Where there are outstanding charges, this may limit the interventions and information available or what can be discussed with the child to prevent prejudicing a prosecution.
In situations where criminal charges are not concluded CARM can still be effective, as interventions and strategies can be implemented (CYCJ, 2020). In these situations, discussions with solicitors and the family may assist to agree parameters of intervention and restrictions to ensure legal right to due process is not impeded.
CARM meeting attendees will need to consider all the circumstances of the referred child in order to be clear about current or potential protection issues. Specifically, the meeting should consider:
- What further action (if any) needs to be taken to keep the referred child safe?
- What further action (if any) needs to be taken to keep the referred child's family member(s)/carer(s) safe?
- What further action (if any) needs to be taken to keep other members of the community safe (e.g. peers, teaching staff, victim(s), residential care staff etc)?
- What existing strengths or protective factors can be built upon?
- What would enhance the safe management of risk in that child's environment?
It is the responsibility of the practitioner charged with completion of the risk assessment and their line manager to ensure that they are appropriately trained to do so.
The content of the assessment should be scrutinised by attendees to identify whether it is sufficient and whether any further information is required. The content of risk assessments is detailed in Section 1 and these are always incomplete without a formulation of risk.
The CARM chair must ensure that consideration is then given to the risk management strategies - monitoring, supervision, intervention, and victim safety planning (as per s. 1.4.3 Risk management measures).
Chairs must also give specific consideration to the contingency plans in place which clearly outline the steps and actions where an urgent response is required to early warning signs or signature risk factors, that are evidenced by what is known specifically in relation to that child, and that may indicate risk of serious harm is escalating or imminent. There will also be less concerning factors indicating initial instability, disinhibition or movement towards harmful behaviour, which will require an appropriate, but less urgent response. Those involved in the case, including where appropriate the individual, their parent(s)/carer(s) and potential victim(s), should know what the key factors are to look out for, and what the response to them should be. There should be a clear plan as to what action should be taken by whom, and how quickly should any of these factors be identified. Emergency contacts should be identified both within and out with office hours.
Where a referred child already has a Child's Plan in place it is the responsibility of the lead professional to amend and update this to reflect the risk management strategies agreed at the CARM meeting. When a Child's Plan has not yet been completed or is in the process of being completed, it remains the responsibility of the lead professional to incorporate and implement the risk management strategies agreed.
In drawing the CARM meeting to a conclusion, the chair should seek to establish attendees' views as to whether the child should remain subject to the CARM risk management process or whether existing child planning processes are sufficient to manage and respond to the likelihood of serious harm/or harm occurring.
If the view of the CARM meeting is that not continuing with the CARM process is a defensible position to take in relation to ongoing risk management, a further meeting will not be required.
If the view of the CARM meeting is that the child should continue in the CARM process, the chair will instruct the establishment of a CARM core group which should meet at least monthly (see below). It will be the responsibility of the lead professional and the other members of the CARM meeting to identify the members of the CARM core group. The relevant child and their parent(s)/carer(s) should be included within the core group. However, where they decline to attend, their views must be gathered and expressed at the core group meetings to be incorporated within any decision being made. They must be fully informed in a manner appropriate to their understanding of the discussion and outcomes from these meetings.
A date for the first CARM core group should be agreed at the initial CARM meeting and a review CARM meeting should be arranged to take place within three months.
It is intended that decision-making at a CARM meeting will be consensual and follow scrutiny of the available information. Practitioners will reach a mutual agreement about risk classification and risk management arrangements. However, provision should be made for any dissenting views to be recorded when agreement cannot be reached. In such cases it will be the responsibility of the chair to take a final decision about inclusion in the CARM process and risk management arrangements.
A minute of every CARM meeting should be taken which captures discussion, as well as key decisions and actions. If the child and their parent(s)/carer(s) are not present at the meeting, reasons for this should be recorded. A full minute should be verified and signed by the chair and circulated to all attendees within fifteen calendar days of the CARM meeting and any action plan should be circulated within five calendar days of the meeting. In exceptional circumstances, a note of action points may need to be circulated after a meeting if immediate risk management decisions need to be implemented.
While provision of a full CARM meeting minute to the child referred for discussion may not be appropriate, it is imperative that the key decisions are communicated to the child and their parent(s)/carer(s) by the lead professional on the same day. While verbal feedback is a necessary minimum, it may be beneficial for local authorities to give some consideration to creating child-friendly paper-based resources that can distil the content of complex discussions held at CARM management meetings into a more accessible format.
2.2.4 CARM review
The role of the chair at any CARM review meeting will be to direct attendees:
- To review the risk management plan;
- To consider any reported/referred further incidents of harm involving the child since the previous care and risk management meeting;
- To consider whether any form of further assessment is required to inform risk management strategies;
- To review the risk management elements of the Child's Plan and to identify what progress has been made, if any, as regards the implementation of risk management strategies;
- To consider whether modifications or additions to the existing risk management strategies as encompassed in the Child's Plan are necessary and to ensure that the lead professional records any such changes;
- To evaluate progress in relation to risk reduction; and,
- To consider the views of the child and their parent(s)/carer(s) and to assess their level of co-operation with risk management strategies.
The final task of the chair at any CARM review meeting will be to re-assess the need for the child to remain subject to CARM.
2.2.5 CARM Core Group
The functions of a CARM core group include:
- To review the contingency plan and early warning signs/triggers;
- To ensure that the child and their parent(s)/carer(s) are active participants in the process of risk management and risk reduction;
- To ensure ongoing assessment of the needs of, and risks to, a child subject to the CARM process;
- Implementing, monitoring and reviewing risk management strategies so that the focus remains on improving outcomes for the child. This will include evaluating the impact of work done and/or changes within the family in order to decide whether risks have increased or decreased;
- Activating contingency plans promptly when progress is not made or circumstances deteriorate;
- Reporting to CARM review meetings on progress;
- Referring any significant changes to risk management strategies, including non-engagement of the family, to the chair of the CARM meetings;
- To determine whether meeting more frequently than monthly is both necessary and proportionate;
- Ensuring appropriate representation and engagement of key partners;
- Ensuring the minute is recorded and circulated; and
- Ensuring decisions are taken to address any obstacles to the delivery of the plan.
2.2.6 CARM links to multi-agency public protection arrangements (MAPPA)
When risk management strategies are in place for a child charged, but not convicted of an offence of a serious nature, it is possible that during the course of the CARM process their legal status will change. In addition, following conviction at court, a child may become subject to multi-agency public protection arrangements (MAPPA) and/or sexual offender notification requirements. From 31st March 2016 and the commencement of section 10(1)(e) of the Management of Offenders.etc (Scotland) Act 2005 MAPPA now oversees not just individuals subject to sexual offender notification requirements (SONR) and mentally disordered restricted patients, it also includes "certain high risk offenders who are assessed by the responsible authorities as posing a risk of serious harm by reason of their conviction" (SG, 2016). Where a child meets any of these criteria and becomes subject to MAPPA robust connections must be in place to support the transition of any child in this situation. It is also critical to support and ensure their understanding of the expectations and implications of non-compliance or adherence with any additional requirements such as SONR which may be in place also.
It is the CARM chair's responsibility to liaise with the local MAPPA Co-ordinator to agree on the most appropriate local arrangements by which to manage safely the risk of harm presented by aspects of the child's behavior which may be of a serious nature. In particular, agreement should be sought in relation to:
- The process for managing a child's transition from the CARM process to MAPPA; and,
- The arrangements for risk management when a child reaches the age of 18 and continues to present significant concerns although not subject to MAPPA.
In preparation for a planned transition of a child from the CARM process to MAPPA, it may be useful for the incoming MAPPA Chair to attend the final CARM meeting prior to the change. Alternatively, there may be value in a CARM chair attending the first MAPPA meeting for the child following transition.
Preventative orders are aimed at protecting the public from harm through civil orders or notices, targeted against individuals that prevent or prohibit certain identified kinds of activity from occurring or recurring. In relation to offending of a sexual nature, MAPPA Guidance details four main civil orders, which seek to minimise the risk of serious harm to the public. These are Sexual Offences Prevention Orders (SOPO), Risk of Sexual Harm Order (RSHO), Notification Orders and Foreign Travel Orders. Further detailed information on these orders can be found in the MAPPA Guidance (2016).
CARM meetings may provide opportunity to assist in the decision-making of Police in whether seeking the imposition of such civil orders are necessary by ensuring decisions are informed by full discussions regarding assessment, management and intervention to reduce the likelihood of serious harm/harm occurring.
2.2.7 Exit planning
In accordance with the principle of minimum intervention, every effort should be made to ensure that a child is retained within the CARM process for no longer than is absolutely necessary. Furthermore, preparation for a child's exit from the CARM process, as with any transition, should be paced to meet their needs. The decision to remove a child from CARM proceedings should be made at a CARM Review meeting, and be based on an up to date assessment of the risk of further harm. The existence or otherwise of a legal order is a relevant factor here but is not the determining factor. There should be an agreed follow on support plan, with an identified lead professional to monitor any ongoing risks and co-ordinate the care plan accordingly.
Measuring progress as regards a child's compliance with risk management strategies can be challenging. However, assessing progress with reference to the four phases outlined below may prove instructive (Brady and McCarlie, 2011: 134-151):
- Phase One - Risk reduction is largely via the systems, and responsibility is owned by the systems around the child, not the child themselves. 'Systems' here are defined as the significant people in the individual's life who can have an impact on risk e.g. parents, carers, teachers, peers etc.
- Phase Two - The child is engaging in specific work on their harmful behaviour in order to allow a more meaningful discussion to take place about risk. In this phase, individual risk management strategies are introduced and rehearsed by the child and the systems. The systems move from a learning stage to proactively working with the child to meet their needs and assist them in skills development.
- Phase Three - Risk is now being reduced by the ongoing work with the child and the systems' engagement in risk management. Responsibility for managing the risk is now a shared ownership between the child and the systems. Developing skills and understanding which promote strengths and resilience to enable the child to meet their needs in a manner that allows them to flourish and achieve their potential.
- Phase Four - In this phase it is important to use the identified individual goals to determine whether or not a child can take responsibility for managing their risk. It would be expected that the achievement of these goals (skills and insights) would be evidenced in different settings. Where this is the case, risk is now reduced and the child has the ability and increased awareness to manage their own risk where developmentally appropriate, drawing on the strengths, skills and protective factors that have been identified and promoted in the preceding months.
The wellbeing indicators which underpin the GIRFEC model may also provide a useful means by which to monitor a child's progress as well as the indicators relating to the harmful behaviours. The indicators ought to be at the core of any Child's Plan and related risk management strategies. A further consideration will be the extent to which the risk factors which were assessed as increasing the likelihood of the child being involved in future harmful behavior have been reduced. This will involve leveraging the strengths of the child and the support system around them to develop factors which buffer against risks and vulnerabilities they may experience. In addition, promoting the child's resilience to be able to respond to and engage with others and the wider world in a manner that reduces the likelihood of harm occurring, and supports them to achieve their potential.
Unless they have exited for positive reasons prior to this, the CARM process automatically terminates when a child reaches the age of 18. Where concerns persist regarding risk of serious harm, appropriate arrangements and continuity of service provision will be necessary owing to the ongoing level of assessed risk. This may require consideration of adult protection legislation and/or seeking preventative civil order (SG, 2018) to protect the public or individuals such as Risk of Sexual Harm Orders (ROSHs).
2.2.8 Case transfers and out of authority placements
It is not uncommon for children - where aspects of their behaviour present a risk of serious harm - to lead relatively transient lives. This may involve frequent changes of address within one local authority area, movement across different local authority boundaries or movement out of Scotland to other jurisdictions.
When a child who is being actively managed through CARM processes moves from one local authority to another within Scotland, it will be incumbent upon the CARM chair in the originating local authority to make contact with their counterpart in the receiving local authority to inform them of this development.
If it appears to be the case that the child in question intends to reside in the receiving local authority on a permanent basis and this is a viable move, arrangements will be made for an official case "handover". This will be best managed through direct liaison between both CARM chairs and the exchange of relevant information (including risk assessments, single/multi-agency assessments of wellbeing reports and the Single Plan). Furthermore, best practice would be for the CARM chair from the originating local authority (or nominee) to attend the first CARM meeting to be held in the receiving local authority.
CARM chairs should enter into case transfer negotiations in good faith and aim to agree upon mutually satisfactory arrangements for seamless transitions, respecting both the needs of the child and the need to protect the public.
When a CARM chair becomes aware of the planned or actual move of a child involved in CARM processes to a location outwith Scotland, they will make all reasonable efforts to alert the appropriate authorities in the relevant geographical area. If the location is in the UK, this will in all likelihood involve the CARM chair liaising with Emergency Social Work Services and/or the Police.
When during the course of involvement in the CARM process a child's living arrangements change owing to the decision of a Children's Hearing (e.g. imposition of an out of authority secure or residential placement/returned from an out of authority placement) or the Court (e.g. remand or custodial sentence), this change will not automatically trigger the cessation of the CARM process. The implications of any change in living arrangements should be taken into account at a CARM meeting with the expectation that the CARM process remains active for as long as it is deemed necessary to manage the risk presented by aspects of the child's behaviour. The originating local authority will retain responsibility for risk management while the child is in an out of authority placement but certain functions, may, through negotiation, be devolved to the host local authority. CARM processes are likely to have particular value at the point of a child's reintegration to their local community following an extended period accommodated outwith the area.
2.2.9 Governance and oversight
Requirement 10 - CPC will provide oversight and scrutiny of the functioning of the CARM process, the decision-making, views of children and their parents/ carers involved.
Requirement 11 - When a child subject to CARM process has been involved in an incident where further harm has resulted from their behavior the CARM chair must notify the CPC for consideration about whether a Learning Review is required.
Meeting the requirements-
In relation to quantitative data it should be possible at any point to identify the:
- Number of children referred to CARM proceedings;
- Age of children in years at time of CARM referral;
- Gender of children at time of CARM referral;
- Ethnicity of children referred to CARM;
- Legal status of children at time of CARM referral;
- Percentage of children referred to CARM who are progressed to an initial CARM meeting;
- Number of children progressed to an initial CARM meeting who have previously been open to CARM (or equivalent risk management process);
- All types of risk concerns that were recorded for children at the initial CARM meeting (there may be more than one recorded for each child);
- Key people in/not in attendance at initial CARM meeting;
- Number of children leaving the CARM process and reason for leaving;
- Type of assessment tools used to inform risk assessments (there may be more than one recorded for each child);
- Incidents of further serious harm by children whilst subject to the CARM process;
- Number of months children spend in the CARM process prior to exiting.
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