Guidance on Promoting the Health of Looked After Children

REGULATIONS AND STANDARDS

The Health and Well-being Standard

SCOPE OF THIS CHAPTER

Looked After Children will have health assessments (at specified intervals, depending on their age). The health assessment will review their physical growth and development, dental health and any outstanding eye tests, and consider whether the child has any emotional or psychological health needs that are not being met.

RELEVANT CHAPTERS

Health Assessments and Plans Procedure

RELATED GUIDANCE

Promoting the Health and well-being of looked-after children - Statutory Guidance for Local Authorities, Clinical Commissioning Groups and NHS England (March 2015)

Children’s Attachment: Attachment in Children and Young People who are Adopted from Care, in Care or at High Risk of Going into Care NICE Guidelines [NG26]

Also see: Registration of Healthcare at Children’s Homes


Contents

  1. Health Promotion
  2. Children’s Social Care Responsibilities
  3. Placements Outside the Local Authority
  4. Summary
  5. The Parenting Role


1. Health Promotion

Health promotion should become part of the child / young person's health plan and any concerns around their health and well being should be supported by practical advice and information.

  • The first health assessment is to be undertaken by qualified registered medical practitioner;
  • Review assessments, which replace the annual medicals may be carried out by an appropriately qualified nurse i.e. school nurse or health visitor;
  • Children aged under 5 years should have a review health assessment every six months i.e. twice yearly;
  • When Looked After Children are to move to a placement outside of the local authority boundaries both the local Clinical Commissioning Group (CCG) and the CCG for the area where the child is moving too must be notified before the move.

Good Health Care

The holistic approach

  • Health assessments and plans promote good health and do not focus solely on the detection of ill-health;
  • Each child or young person must be given the opportunity to talk about any health concerns they have and their worries need to be heard;
  • The health professionals should conduct health assessments in a way that enables and empowers children and young people to take responsibility for their own health;
  • The health assessment will be non-discriminatory and sensitive to the child's age, gender, disability, race, culture and language;
  • Children’s Social Care must act as a concerned parent in promoting and monitoring the child or young person's health and development. Where possible the child or young person's birth parents and carers should be actively involved in the health assessment.


2. Children’s Social Care Responsibilities

Duties to Children

Arrangements must be put in place to ensure that every child who is looked after has a Health Plan:

  • The child's health needs will be fully assessed;
  • The child's health plan will clearly sets out how the health needs identified in the assessment are to be addressed;
  • The health plan must have outcomes for the child, with measurable objectives and actions to achieve these outcomes;
  • The person responsible for each action and the timescales for achieving this will be recorded;
  • The health plan should be reviewed on a regular basis (during Looked After Reviews or at an earlier date if the child's health needs change or are not being met).


3. Placements Outside the Local Authority

When children are placed out of area, medical records should be transferred without delay to allow continuity of any current treatment. Before the child's placement starts Children’s Social Care should have a written agreement with the receiving Clinical Commissioning Groups in the area the child is moving to, confirming they will meet the child's health needs.

  • Placements should not be made without first making arrangements to secure health services for the child;
  • There should be liaison between relevant personnel in Children’s Social Care and Health Services to confirm the arrangements.


4. Summary

Children’s Social Care should put in place arrangements to ensure that:

  • The health needs of children are met;
  • A health plan, which sets out how the health needs identified in the assessment, will be addressed;
  • The health plan is reviewed;
  • Children’s Social Care will need to work in partnership with Clinical Commissioning Groups at both strategic and operational levels to ensure effective delivery of health services;
  • In partnership, Children’s Social Care and Clinical Commissioning Groups should continue to develop mechanisms to identify and quantify need, to set clear objectives and target resources;
  • Children’s Social Care to establish and maintain a protocol for sharing relevant information about care placements and health, both within the local authority boundary and outside it;
  • Placements outside the boundary of the Local Authority should not be made without first making arrangements to secure appropriate health services for the child;
  • Children’s Social Care need to have a system in place to monitor whether children's health needs are being met;
  • A senior manager in Children’s Social Care to have specific responsibility for the health of looked after children;
  • The child's social worker is responsible for ensuring the health assessment plan is implemented and reviewed;
  • Where there are problems these are to be reported the designated manager.


5. The Parenting Role

Foster carers and residential staff have responsibilities for meeting the child's health needs:

  • Achieving best health starts early and good quality health care starts in infancy but where their health has been neglected this can be put right by ensuring the child receives appropriate treatment;
  • We need to work with the child to develop a positive sense of identity and self-esteem;
  • Carers will encourage and support each child in achieving best possible health by accepting their responsibility as a health educator;
  • Provide a home environment which actively encourages and supports a healthy lifestyle;
  • Ensuring the child attends health appointments and clinics as necessary;
  • Contributing to the child's health plan and care plan;
  • They will facilitate contact and communication with the child's parents and family as agreed in the care and health plans;
  • Make sure that the child or young person benefits from education and enjoys broader experiences through leisure activities, hobbies and sport;
  • Residential staff should have sufficient understanding of relevant health services including the function of the Designated Nurse for Looked After Children. The home should liaise with the child’s placing authority to enable proper and immediate access to any specialist medical, psychological or psychiatric support. Staff challenge if these services are not met or they do not happen for the child.

Education

It is important to link the promotion of good health for looked after children to their educational experiences. Access to good education has a direct influence on a child's well-being, developing their self-esteem and confidence. It can enable integration within a social network and establish positive peer relationships.

Leisure, hobbies and sport

Sporting activities can enhance well being and promote a sense of identity and self-esteem. Sporting activities can provide an opportunity for safe risk taking and for developing teamwork skills. Arts, dance and drama can have an effect on children and young people as a means for expressing feelings in a safe environment.

Collating Information for the health assessment

Before the health assessment, it is necessary to bring together as much health related information about the child as possible. This information must be fast-tracked to the health professional undertaking the assessment.

This will include information held:

  • By Children’s Social Care copied from information in the Children’s Social Care Assessment which includes the child's personal history and family history if known (ask parents and other family members where possible);
  • By community dental services or family dentists;
  • By community health services;
  • On the child health computer system, especially immunisation status to date;
  • On the GP held record;
  • Within any database at hospital Emergency Departments;
  • Within local hospital record systems, especially where the child is known to have been in contact with services.

In the case of GP held records, a summary report should be requested from the GP holding them.

Steps should also be taken to fast-track the records to any GP with whom the child is known to have subsequently become registered (this should be done by the health authority or CCG of the previous GP).

Objectives of Health Assessments and the Planning Process

  • Assessment of health risk and opportunity to redress past health neglect, collate health history including pre and post natal history;
  • Find out and advise on relevant family history;
  • Review immunisation status and missed child health screening episodes including dental health and eye tests;
  • Assessment of current health and mental health concerns;
  • Advise on known existing health problems;
  • Check whether the child has any outstanding appointments;
  • Identify unrecognised health needs;
  • Identify mental health, behavioural and emotional problems;
  • Recognise developmental or learning concerns;
  • Plan appropriate action and ensure recommendations are carried through;
  • Discuss lifestyle issues;
  • Plan follow up.

Approach to the assessment

  • Be child focused;
  • The child should have their health assessed holistically and their health plan must meet these needs;
  • Take account of the particular needs of children who are looked after and their families, including attention to disability, gender, race and culture;
  • Be carried out at a time and venue convenient to the child or young person;
  • Invite contributions from all those involved with the care of the children, particularly the birth parents or other previous carers;
  • Allow sufficient time for the child to be given a clear understanding of the process and what is involved;
  • Encourage the child or young person to participate in discussion and to asking questions;
  • Be careful not to intimidate the young person during the health assessment process.

Reviews

The maximum time-scales for conducting further assessments of a child's health are:

  • At least once in every six months for children under 5 and at least once a year after a child's fifth birthday.

However, where reviews are required more frequently, the child's health plan should clearly set out the timing of these arrangements.

The social worker is responsible for co-ordinating this process.

Summary

  • Each child or young person should have a holistic health assessment on entering care;
  • This assessment should be undertaken by a suitably qualified medical practitioner, follow up review assessments may be carried out by an suitably qualified registered nurse, school nurse or health visitor;
  • The first health assessment should result in a health plan by the time of the first review, four weeks after becoming looked after;
  • Where children have already been assessed under the assessment framework, this assessment should be updated in the light of the child's changed circumstances;
  • Attention should be given to the continuity of previous plans and interventions where appropriate;
  • All health staff with information about the child's health should ensure this is made available to the person making the assessment as soon as possible;
  • Local areas may find it helpful to have a system of identifying one health professional to undertake the co-ordinating role for individual children's health;
  • Health assessment is not an isolated event, but part of a continuous process;
  • Successful health assessments will require a flexible approach, appropriate to the child or young person's age and stage of development;
  • The health plan should clearly set out the objectives, actions, time-scales and responsibilities, arising from the health assessment;
  • The health plan will be reviewed in line with the statutory review time-scales;
  • Health assessments must be undertaken twice a year for children under 5 years. Annually for children and young people 5 years and over;
  • The local arrangements for reviewing the health plan, will balance the sensitive and confidential nature of the child and young person's health information, whilst ensuring it is integrated into the overall care plan;
  • The lead health record for the looked after child or young person should be the GP held record. A copy of the health assessment and plan should be part of this and a copy must be sent to the child's GP;
  • The health plan should be continued and supported when the child returns home.

The Roles and Responsibilities of the NHS

  • The health of children and young people who are looked after is an identified local priority;
  • Structures are to be in place to plan, manage and monitor the delivery of health care to all children and young people who are looked after;
  • In collaboration with Children’s Social Care, identify a designated doctor and nurse to provide strategic and clinical leadership;
  • Clinical governance and audit arrangements are to be in place to assure the quality of health assessments and care planning;
  • Health professionals performing health assessments will contribute to health care planning;
  • Ensure that there is a named public health professional who will input into children in need issues including child protection as necessary. Looked after children are part of this wider group of children in need;
  • Health professionals undertaking health assessments and contributing to health care planning should have received appropriate training.

Primary care teams should

  • Act as advocates for the health of each child or young person who is looked after;
  • Ensure access to a general practitioner or other health professional when a child or young person who is looked after requires a consultation;
  • Keep a record of the health assessment and contribute to any necessary action within the health plan;
  • Ensure that the clinical records make the 'looked after' status of the child or young person clear, so that their particular needs can be acknowledged.

The roles of the designated doctor and nurse

The designated doctor and nurse role is to assist Primary Care Team in fulfilling their responsibilities as commissioner of services to improve the health of looked after children.

The designated role is intended to be a strategic one, separate from any responsibilities for individual children or young people who are looked after. The professionals may also provide a direct service to children and young people.

The designated doctor will:

  • Be a senior paediatrician, preferably but not necessarily a consultant community paediatrician;
  • Have undergone higher professional training in paediatrics;
  • Have substantial clinical experience of the health needs of looked after children - the designated doctor is likely to have worked or be working as a medical advisor to an adoption and/or fostering agency;
  • Be clinically active in community paediatrics in at least part of the geographical location covered by the post.

The designated doctor and nurse will work together to give advise colleagues in Health and Social Care on issues of medical confidentiality, consent and information sharing.