Professional referrals

Levels of need

A child and their family's needs will determine the response that is offered. Below are explanations of each level of need - their circumstances and key factors, plus examples of services offered at each level. 

Level 1 - universal needs

Most children’s needs can be met through their family and universal services such as health, education, community, or voluntary agencies and leisure services. Children at Level 1 make good overall progress in most areas of development. Find out more by clicking on the headings below.

Health and wellbeing

  • Meeting developmental milestone
  • Good hygiene
  • Adequate diet/hygiene/clothing
  • Appropriately cared for when unwell
  • Developmental checks/immunisations up to date
  • Regular dental/optical care
  • Health appointments kept
  • Age-appropriate social care and communication skills

Education and learning

  • Attending school and nursery
  • Appropriate stimulation, boundaries and guidance
  • Good relationships with peers
  • Achieving educational milestones
  • Good level of self esteem

Family and environment

  • Positive attachments
  • Suitable home environment
  • Able to recognise unsafe activities
  • Secure relationships/attachments

Social relationships/engagement

  • Parents are able to offer stability
  • Good access to appropriate support within the immediate and wider family members
  • Effective support networks
  • Suitable accommodation
  • Parents economically active

  • Early Years and Childcare
  • Children and Family Centres
  • Family Hubs
  • Education Services and Schools
  • Primary Health Care Services
  • Community Health Care
  • Voluntary and Community Services
  • Youth Services
  • Social Prescribing Teams

How to access Level 1 services

Each agency or team will have their own method for accessing services such as parenting, health and education. You can also Search the Liverpool Family Information & SEND Directory for universal services.

Level 2 - emerging needs/universal plus

These children and their families have additional or emerging needs that are starting to impact on their daily life. These needs cannot be met through universal services alone and these children and their families require additional support. Find out more by clicking on the headings below.

Health and wellbeing

  • Missing/poor attendance at medical appointments
  • Emerging evidence that developmental milestones are not being reached
  • Emerging concerns re: diet/hygiene/sleep routines
  • Frequent illnesses/infections/minor injuries
  • Experimenting with alcohol - consider age and social circumstance
  • Parents struggling to meet emotional needs
  • Presenting with sexual behaviour that is not age appropriate

Education and learning

  • Some identified learning or physical disability needs, requiring support
  • Emerging patterns of poor attendance at school/nursery
  • Young person refusing to go to school
  • Not always engaged in learning – poor concentration/low motivation
  • Fixed-term exclusion
  • Young person over 16 who is not in education, training, or employment (NEET)

Family and environment

  • Young parents who are struggling to cope
  • Parents struggling with their own emotional needs
  • At risk of eviction through non-payment of rent
  • Young person beginning to misuse substances
  • Inadequate/poor housing/home conditions due to overcrowding/lack of heating
  • Family where concerns are beginning to emerge about substance misuse
  • Parental conflict

Social relationships/engagement

  • Young carers
  • Some difficulties building and sustaining relationships with adults and peers
  • Child or young person presenting increasing problem behaviour and parents and school are finding it difficult to manage
  • Young person has started to go missing/absent from home

  • Fusion Short Breaks Service for children with SEN/Disabilities
  • Parenting Network - parenting courses
  • CAMHS
  • ADDvanced Solutions
  • Kinship Carers

Plus the Universal Services listed under Level 1

  • Early Years and Childcare
  • Children and Family Centres
  • Family Hubs
  • Education Services and Schools
  • Primary Health Care Services
  • Community Health Care
  • Voluntary and Community Services
  • Youth Services
  • Social Prescribing Teams

How to get Level 2 support

Find out how to register a Level 2 early help assessment.

Level 3 - targeted needs

These children and families have multiple unmet or partially-met needs that will likely require regular home visits and targeted interventions to address their support needs. Without additional support, the needs of the family are likely to increase and escalate, potentially resulting in statutory interventions being required. Find out more by clicking on the headings below.

Health and wellbeing

  • Evident concerns about diet/hygiene, sleep routines
  • Recurring health problems
  • Refusing to register with a GP
  • Substance misuse
  • Developmental milestones are unlikely to be met without additional support
  • Concerns around emotional and mental well-being
  • Non-attendance at essential health appointments
  • Basic care needs are not being consistently met
  • Serious lack of stability and routine appropriate stimulation, boundaries and guidance
  • Complex or multiple health issues being met by a variety of health professionals
  • Parental mental health needs effecting parenting

Education and learning

  • Frequent school absence
  • Repeated permanent exclusions
  • Repeated fixed-term exclusions
  • Reluctance to leave school
  • Frequent changes of school
  • Limited access to toys and stimulation
  • Young person is unable to cope with everyday life

Family and environment

  • Repeated incidents of domestic abuse
  • Exposed to unsafe situations
  • Financial difficulties preventing child or young person’s basic needs from being met
  • Young inexperienced parents with no support
  • Inadequate supervision/inappropriate care arrangement

  • Repeated episodes of parental conflict

Social relationship/engagement

  • Challenging and disruptive behaviour impact on daily life, achievements and relationships
  • Evident poor self-care for age, including hygiene
  • Parents have a learning disability that may impact on their parenting ability
  • Child or young person disappear from home regularly or for long periods
  • Challenging/disruptive behaviour putting others or self in danger

  • Early Help Hubs
  • 0-9 Team
  • Outreach Family Support
  • Therapeutic Social Workers
  • Step Forward Adult Mental Health
  • School Family Support Service
  • Targeted Services for Young People
  • Youth Justice Services

Plus the services listed under Levels 1 and 2.

How to get Level 3 support

Find out how to make a Level 3 early help referral.

Level 4 - safeguarding and specialist

These children and families have needs which cannot be met through early help and require specialist support from a statutory service such as Children’s Social Care. These include cases where there is ‘reasonable cause’ to suspect a child is suffering or is likely to suffer significant harm as defined by the Children Act. 

It also includes concerns relating to ‘harmful practices’ such as forced marriage or female genital mutilation. Find out more by clicking on the headings below.

Health and wellbeing

  • Severe/chronic health problems
  • Persistent substance misuse impacting on the ability to meet child’s needs and keep them safe
  • Developmental delay evident as a result of needs not being met by parent/carer
  • Serious mental health issues impacting on the ability to meet child’s needs and keep them safe
  • Severe and chronic mental health problems for which appropriate treatment is not being sought
  • No engagement with health professionals
  • At risk of female genital mutilation (FGM)
  • Children and young people whose parents fabricate or induce illness

Education and learning

  • Denied access to stimulation
  • Non-attendance at school/persistent absences which are seriously impairing development
  • Strapped in a pram or car seat for long periods resulting in restricted opportunity to be mobile

Family and environment

  • Subject to physical, emotional or sexual abuse or neglect
  • Person identified as posing a risk to children living in the family home
  • Child previously removed from parents
  • Family is experiencing serious domestic abuse
  • Children who abuse other children
  • Family with no recourse to public funds
  • Unaccompanied asylum seeker
  • Private fostering arrangements – child is under 16 and living with a family friend, distant relative or other non-immediate relation/parent as part of a private arrangement
  • Child at risk of harm from sexual or criminal exploitation
  • Serious parental conflict

Social relationship/engagement

  • Prosecution of offences resulting in court orders (sexual or violent)
  • Child subject to emotional abuse with no self-esteem/self-worth
  • Parents have a significant learning disability that may impact on their ability to meet child’s needs and keep them safe
  • Child at risk of forced marriage or honour-based abuse

Multi-agency Safeguarding Hub (MASH) Children’s Social Care:

  • Assessment Teams
  • Safeguarding Teams
  • Permanence Teams (Cared for Children)
  • CAMHS
  • Unaccompanied Asylum-Seeking Children Team
  • Care Experienced Teams

Plus services listed under Levels 1 and 2.

How to get Level 4 support

Professionals should complete a MARF Multi Agency Referral Form (MARF).

Further information