Looked After Children

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					Policy Number CH 002
Policy Name Procedure for Health Assessments for Looked
After Children
Area of application Looked After Children


Date approved October 2003

Approving Body PCT Professional Forum

Review Date December 2004



1.     Introduction

1.1    Health Assessment for Looked After Children is one component
       of a statutory requirement to review the care plans of children
       Looked After (Regulations and Guidance to Children Act Section
       23 and Schedule 2 paragraph 12).

1.2    This document details the responsibilities of both Health and
       Social Service in respect of Health Assessment to all children in
       the Looked After System.

1.3    The arrangements below, which have been agreed between
       Walsall Primary Care Trust and Walsall Social Services
       Department, describe how to arrange health assessments for all
       looked after children. The child’s Social Worker, or someone with
       delegated responsibility is required to make these arrangements.
       If a case is unallocated a Team Manager should ensure that the
       arrangements are made for the child’s health to be reviewed.

1.4    Elements of the health assessment are detailed within the
       CLINICAL Procedures for Health Assessment (to be attached
       later).



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1.5    Detailed below are the steps involved in arranging and providing
       Health Assessments for looked after children.

1.6 The Social Worker as key worker is responsible for ensuring that
    information is shared with the Trust’s Looked After Children office
    as soon as possible following the child’s admission. This notification
    will be done in accordance with 4.2 below.

1.7 These procedures only apply to children/young people up to the
     age of 16 years. For young people over 16 years, see section 7.


2.     Principles

2.1    One of the Corporate parenting responsibilities is ensuring that
       every Looked After Child is as physically and emotionally healthy
       as possible. The Looked After Childs attendance at regular
       health assessments will help to plan for this outcome.

2.2    It is the responsibility of the social worker to notify the appropriate
       health professional (health visitor or school nurse) when the child
       is admitted to the Looked After System.

2.3    There should be close liaison between the Health Visitor or School
       Nurse and the Social Worker with responsibility for the child, to
       ensure a continuity of health care.

2.4    Health Assessments are an important element in devising the
       health plan for looked after children. However, no child should
       be the subject of unnecessary repeated examinations. Where
       relevant, reports from previous examinations may be used to
       meet the requirement for a written assessment, e.g. pre-adoption
       medical examinations, developmental surveillance interviews,
       child protection examinations, ongoing medical reviews.

2.5    The need for any medical examination should be clearly
       explained to the child, their carers and parents.

2.6    Children should be helped to understand their health needs, and
       how these can be met. Social Workers, carers and health
       professionals should encourage children to attend their health
       assessments.

2.7    Parents should be involved with all processes which relate to
       meeting their child’s health needs providing this is consistent with
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       the child’s best interests and is agreeable to the child. Parents
       should be asked for information about the child’s previous health
       history when the child is first admitted. Health information from
       the Core Assessment should be made available to the health
       professional undertaking the health assessment.

2.8    Any difficulties in obtaining a Health Assessment or completing a
       Health Review should be discussed at the child’s next Statutory
       Review if this issue cannot be resolved.


3.     Consent

3.1    Parental signature consenting to Looked After Medical is
       included in the Looking After Children Placement Form Part 1.

3.2    Under Trust Consent to Treatment Policy (2002), informed consent
       should be obtained by the health professional from a person with
       parental responsibility, or the child/young person if deemed
       competent to do so, prior to the health assessment taking place.
       (DOH Guidelines).

3.3    A young person over 16 may give or refuse consent to medical
       examination (but see 1.7 above). Children under the age of 16,
       depending on their age and understanding, may also give or
       refuse consent to be examined. In the case of refusal by the
       child, the health professional should discuss the options with the
       child.

3.4    Parents may also refuse to allow a child under 16 to be
       examined. Before an examination is arranged their view should
       be sought. If parental responsibility is shared with the Local
       Authority because the child is the subject of a Care Order, then
       an examination may be arranged even if the parents object.
       The advice of Legal Services should be sought if there is a need
       for a specific examination or treatment and the child’s parents
       object.

3.5    The child/young person may give consent to the examination if
       viewed to be competent under Fraser guidelines.

3.6    Difficulties in respect of consent should be considered at the
       child’s statutory review if these cannot be resolved.



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4.     Arranging the Initial Health Assessment

4.1    Subject to the principles set out above, the following action
       should be taken.

4.2    The Looked After Children Health Co-ordinator’s office should be
       notified as soon as possible following admission. This is the
       responsibility of the Social Worker. The completed WSS 962
       document should be forwarded to the office as soon as possible.
       It is particularly important that evidence of consent to the
       examination is given.

4.3    The Health Co-ordinators office will flag child as Looked After
       (LA) on the working register on Child Health.

4.4    The Social Worker should inform the Health Visitor/School Nurse of
       where the child is now living and the name of the carers and the
       circumstances of the child’s admission to care. If the identity of
       the Health Visitor/School Nurse is not known to the Social Worker,
       the Child Health Department at Short Heath Clinic on 01922
       858645 can usually assist in providing this information.

4.5    The Health Co-ordinator’s office will arrange the health
       assessment, negotiating with the child, carer, Social Worker, and
       health professionals. This should be done within 4 weeks of
       notification. The Co-ordinator’s office will provide an up-to-date
       report on the child’s immunisation and health assessment status
       as recorded on the Trust Child Health system.

4.6    Any other relevant health information will be sought by the
       Health Co-ordinator from the child’s General Practitioner and
       any other identified sources, with consent from the young person
       or person with parental responsibility, prior to the assessment
       taking place.

4.7    The Social Worker should attend with the child and carer.
       However, where this is not possible, the carer and child should
       attend the health assessment. The Social Worker as key worker
       will decide on the appropriateness of the birth parent attending.

4.8    If the child has a Personal Child Health Record, this should be
       brought to the assessment.
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4.9    Opportunity should be given for both the child/young person
       and the carer/parent to speak to the doctor/health professional
       alone.

4.10   When the assessment is completed, a Personal Health Plan will
       be written in consultation with the child/young person, the carer,
       the health professional, social worker and the birth parents where
       appropriate.

4.11   The health professional, following health assessment, will
       complete the documentation, making any appropriate referrals
       and return it to the Looked After Children Co-ordinator`s office.
       An Unscheduled Developmental Examination Record (DER) form
       will also be completed by the health professional and forwarded
       to the appropriate Child Health office.

4.12   A copy of the personal health plan will be sent to the Social
       Worker, and to the child`s General Practitioner by the health co-
       ordinators office. A copy will be filed in the child`s Trust health
       record (Child Health Record for under 5 years old and 10m for
       school aged children).

4.13   The health professional will ensure that a copy of the Personal
       Health Plan is sent to the child at their current address.

4.14   The Social Worker will ensure that a copy of the health plan goes
       to the parent and carer.

4.15   PCT Child Health Department will enter outcome details from the
       Unscheduled DER, including planned review date, onto the
       Working Register, which is attached to the Trust Child Health
       database.

4.16   If there are any questions about the appropriateness of sharing
       the details of the health assessment with parents or carers, this
       should be discussed with the health professional either before or
       at the time of the assessment, by those persons with such
       concerns.

4.17   The administrative staff at the Social Services area office should
       be informed by the Social Worker that a health assessment has
       been completed. The administrative staff will then ensure a
       further date is recorded in SOSCIS for the next health review. For


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        a child under 5 years this will be in 6 months. For a child over 5
        years a health review is required every 12 months.

4.18    If the appointment is cancelled prior to the assessment date, a
        new appointment will be offered and the social worker notified.

4.19    If no contact is made and the child does not attend, the Health
        Co-ordinator`s office will attempt contact with the carer. The
        social worker will be notified of the outcome. No further
        appointment will be offered until the social worker confirms the
        placement details and the compliance of the carers.


5.     Review Health Assessments

5.1 Review dates will be triggered from the Working Register of the
    PCT Child Health System.

5.2 The Health Co-ordinators office will request a completed up to
    date Essential Information Part 2 or SSD/PCT 962A from the social
    worker. It is imperative that all changes of circumstances of each
    child in the Looked After system are notified to the Health co-
    ordinator by the Social Worker as soon as possible. This includes
    movement within Walsall, out of borough, or cessation of the
    episode.

5.3 Arrangements for the health assessment will be as detailed in
    points 4.5 to 4.8 above.

5.4 The review will be undertaken by the health professional who is
    responsible for delivery of mainstream health services to the child,
    e.g. Health Visitor or School Nurse. Where the child does not
    attend school locally, arrangements will be made on an individual
    basis. A medical examination will not take place unless the need
    for one is identified either at the previous health assessment or by
    the health professional at this contact.


5.5 Following the health assessment, action should be taken as
    detailed for the initial assessment (4.10 – 4.19).



6      Children undergoing the adoption process


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6.1    It is a statutory requirement for children who are freed for
       adoption to undergo a specific medical examination by a
       named medical practitioner.

6.2    This examination takes precedence over other assessments and
       will take the place of the Looked After health assessment, in line
       with 2.4 of these guidelines.

6.3    When the Social Worker is aware that there is a plan to arrange
       permanent placement through adoption for the child, the need
       for and timing of a Looked After health assessment should be
       discussed with the health co-ordinator. It is important to do this
       as soon as possible after the decision is taken.

6.4    The designated doctors office will liaise with the health co-
       ordinator’s office to ensure all appropriate documentation is
       completed and the episode and outcome entered onto the
       child health system as for Looked After Health Assessment.



7. Young People aged 16 years and over, who continue to be the
   responsibility of the Local Authority

7.1    All young people transferring to the Leaving Care Team should
       be offered a health interview, by the Leaving Care health
       advisor, if they have not had one from school health service
       within the agreed timescale.

7.2   Details will be passed within the Leaving Care Team, to the health
      advisor.

7.3    The health advisor will support the young person in taking
       responsibility for addressing their own health needs as per the
       personal health plan, including registering with a General
       Practitioner and dentist.

7.4 The need and timing of any further health reviews will be discussed
     with the young person by the health advisor.


8.     Children Placed Out of Borough




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8.1 The social worker will inform the Health Co-ordinator’s office of the
    circumstances as soon as possible when a child/young person is
    placed out of borough.

8.2 Where children are placed outside Walsall, but still have a health
    visitor from Walsall, or are attending a Walsall school, it may be
    appropriate for them to have their health assessment undertaken
    within Walsall.

8.2     In such cases, action should be taken as detailed above.

8.3     Where children are placed outside Walsall and are receiving
        health services within the area of placement, the health co-
        ordinators office will make the arrangements with the Named
        Nurse or Consultant Community Paediatrician in that area.

8.3     This will be dealt with on an individual basis until agreement is
        reached with the service providers.


9.      Children Receiving Short Term Breaks

9.1     The regulations for children receiving short term breaks are the
        same as for all looked after children. However, as most of these
        children will be undergoing regular medical reviews either at
        school or the child development centre, a separate medical will
        not be required.

9.2     The Health Visitor/School Nurse for the child should be contacted
        by the Social Worker when short term breaks are first being
        considered.

9.3      Form WSS 360 will be completed by the Nurse or Doctor and be
         made available at
          the pre-admission meeting, to which the relevant Health
      Professional should be invited.
         This will be the initial health assessment.

9.4     An informal review will occur at the 6 month interval, to which
        the Health Professional will be invited to give an update.

9.5     Form WSS 360 will be updated annually for the formal statutory
        review to which the Health Professional will be invited.



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                                    References

DOH (1989) Children Act

DOH (1990) Regulations and Guidance to Children.

DOH (2002) Promoting the Health of Looked After Children.

DOH (2000) Children (Leaving Care) Act.

DOH (2002) Consent to Treatment Policy.




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