Health Assessment of Looked After Children (LAC)

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					                                    GUIDELINES




         Health Assessment of Looked After Children (LAC)




                                        Issued by:


                             Director of Integrated Governance




Guidelines Classification:                    Guidelines No.
Clinical                                      GUD CC020
Issue No:                                     Date Issued:
001                                           30th June 2005
Page No:                                      Review Date:
1 of 27                                       30th June 2008
                    BROMLEY PRIMARY CARE TRUST
       Guidelines for Health Assessment of Looked After Children (LAC)


                                 CONTENT

1. Introduction                                            Page 3

2. Scope of the Guideline                                  Page 4

3. Promoting the Health of Looked after Children           Page 4

4. Health Assessment                                       Page 6

5. Mental Health                                           Page 9

6. Health Promotion                                        Page 11

7. Health records                                          Page 12

       Appendix 1: Contact details for key professionals

       Appendix 2: Vaccination of children with unknown or incomplete
       immunisation details

      Appendix 3: Content of Health Assessments

      Appendix 4: Strength & Difficulties questionnaire

      Appendix 5: LAC Health Project

     Appendix 6: Summary Report for transfer of records of LAC
     & Children placed for Adoption.

     Appendix 7: Covering letter for transfer of records

     References




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       Guidelines for Health Assessment of Looked After Children (LAC)

                             Section 1: Introduction



Every year in England and Wales over 80,000 children experience public care
because their parents are unable to look after them. “Looked after” is the term
introduced by the Children Act 1989 to cover all children in public care, including
those in foster or residential homes and those still with their own parents but subject
to care orders. Bromley borough has over 300 Looked After Children (LAC). LAC
are also placed in Bromley by other boroughs and health professionals have the same
responsibility for them as for Bromley LAC placed in borough. It is widely
acknowledged that Children and Young People who are looked after are amongst the
most socially excluded groups in the UK1. LAC are reported to have greater level of
health, mental health and health promotion needs than others of the same age2. Health
needs may arise from:
   •   living in families affected by drugs, alcohol or domestic violence
   •   parents with mental health problems and/or learning disability
   •   consequences of abuse and neglect
   •   special needs or a disability
   •   coming from highly mobile families
They may also have experienced poorer access to services including universal
services such as dental services, immunisations, routine child health surveillance,
school health services and health promotion. Despite increased needs LAC are less
likely to receive adequate health care and treatment or to be supported in developing
their knowledge and skills in making decisions that promote health and well-being3.
Paradoxically, when children become looked after, the “inverse care law” may apply:
these vulnerable children are 10 times more likely to be excluded from school than
their peers and thereby denied the input that school health services may have to offer.
Placements are unstable: each year about 19% of LAC move through three or more
different addresses4.

The aim of all who care and work with LAC is to improve their life chances ensuring
they gain maximum life chance benefits from educational opportunities, health and
social care. In order to achieve this all who care and work with these children have to
work collaboratively with a clear understanding of the roles and responsibilities of all
involved. All involved should have an awareness of their health needs and an
understanding of how to seek support in addressing these needs.




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Guidelines for Health Assessment of Looked After Children (LAC)


                 Section 2: Scope of Guideline

This guideline is for the use of all staff employed by Bromley PCT who
conduct health assessments on LAC. This includes staff not employed directly
by the PCT e.g. agency staff. It also offers guidance to all independent
contractors for whom Bromley PCT has responsibility e.g. general practitioners
and practice staff.




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       Section 3: Promoting the Health of Looked after Children1

In November 2002 the Department of Health published detailed guidance to promote
the health of Looked After Children(LAC). The guidance aimed at Councils, Primary
Care Trusts and Strategic Health Authorities, followed an extensive consultation
exercise. This document sets out:
   •   a framework for the delivery of services from health agencies and social
       services to more effectively promote the health and well-being of children and
       young people in the care system
   •   the document focuses on holistic health assessments with particular emphasis
       on mental health issues and health promotion
   •   key actions, new roles and responsibilities for Councils with Social Services
       Responsibilities, Strategic Health Authorities and Primary Care Trusts.


The document states that Primary Care Trusts should
   •   ensure that the health and well-being of looked after children and young
       people is an identified local priority;
   •   ensure that structures are in place to plan, manage and monitor the delivery of
       health care for all looked after children;
   •   in collaboration with social services, identify an appropriate designated doctor
       and nurse to provide strategic and clinical leadership to a defined geographical
       population, and ensure that they are appropriately trained;
   •   ensure that clinical governance and audit arrangements are in place to assure
       the quality of health assessments and 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;
   •   where a child is placed “out of authority”, ensure systems are in place to
       provide continuity of the health assessment and planning process;
   •   through the commissioning process ensure that looked after children are
       registered with GPs and dentists near to where they are living – even if this is
       a temporary placement;
   •   when looked after children need to register with a new GP, ensure systems are
       in place to “fast track” the GP- held clinical records and dental records;
   •   ensure systems are in place through the commissioning process to make sure
       that looked after children are not disadvantaged when they move from one
       PCT area to another – i.e. NHS waiting lists;



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   •   ensure that arrangements are in place for the transition from child to adult
       health services;
   •   ensure that an appropriate data set is collected and reviewed annually.

Bromley Primary Care Trust has appointed a Designated Doctor and jointly with
Bromley Social Services a Designated Nurse both of whom work collaboratively with
others to discharge the above responsibilities. CAMHS
(Child & Adolescent Mental Health Service) have strengthened professional provision
in their service for LAC.


Appendix 1 lists contact details for some of the professionals working with LAC.




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                     Section 4: Health Assessments(HA)

The following core principles of good health care apply1:

Health assessments and health plans will promote the current and future health of the
child or young person who is looked after and not focus solely on the detection of ill-
health. Health assessments will be holistic covering a range of issues beyond those of
physical health which include mental health and emotional wellbeing, development
including hearing and vision and health promotion issues.

The individual child or young person should be at the centre of the process of health
assessment, planning, intervention and review. Each child or young person will be
given the opportunity at all stages to express their wishes and concerns and these
should be listened to. Health professionals should conduct health assessments in a
way that enables and empowers children and young people to take appropriate
responsibility for their own health.

Health assessments and services for children and young people who are looked after
should be sensitive to age, gender, disability, race, culture and language. They should
be non-discriminatory and promote equality of access to services.

Efforts must be made to ensure children and young people who are looked after have
“timely" access to services in accord with their significantly increased need for health
care compared with their peers, and the access problems caused by their greater
mobility.

The child or young person's informed consent to all health care and treatment should
be actively sought and recorded in a way appropriate to the child or young person's
age and understanding;

Planning

It is the responsibility of the child/young persons social worker along with the child’s
carer to arrange for the HA.

Before the assessment, it is vital to collate as much background information as
possible. Information held by social services should also be made available
particularly any information derived from an assessment undertaken in accordance
with the Assessment Framework, Essential Information Records and Placement Plans
including the child's personal and family history if this is known. Check Bromley PCT
information systems for relevant health information e.g. immunisations. The Personal
Child Health Record (Red Book) is often a source of useful information and should be
held by the child’s primary carer and brought to all HA’s.


Consent:
Responsibility for obtaining consent rests with Social Services. Consent can only be
given by those holding parental responsibility and as most children who are looked


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after are under a court Care Order this will be shared by birth parents and the Local
Authority i.e. Social Services. The new BAAF forms have a section for consent in the
Part A of the form which should be completed by Social Services prior to the
assessment and the form brought along to the HA by the child/young persons carer.
Children and young people who are considered by the health professional to be able to
understand the purposes of a health assessment should be invited beforehand to give
written consent and later given a copy of the summary and recommendations which
contribute to their health care plan9.

Statutory HA should be provided at least once every six months for children aged less
than 5 years and annually for all others.

A HA should be in place in time for a written report and health plan to be available
for discussion at the child’s first review, four weeks after the child starts to be looked
after1. If the child has been seen for a HA by a suitably qualified doctor in the
previous three months a new assessment is unlikely to be necessary but the health care
plan should be reviewed and updated. HA should not be an isolated event but part of a
continuous process to ensure the provision of high quality healthcare.

The initial health assessment usually includes a physical examination and must he
undertaken by a suitably qualified medical practitioner and is usually done by the
child or young persons General Practitioner.

The first review HA following the initial HA on children under 5 years of age
should be booked with the Designated Doctor for LAC at the Phoenix Centre. The
Designated Doctor for LAC will usually conduct this HA but may choose to
delegate to another community paediatrician in the team. Arrangements for future
HAs will be decided at this review.

Most other review HA's should usually be booked with the GP. Some may however
have prior follow up arrangements made by the Designated Doctor for LAC or by
other specialist doctors. Unnecessary duplication of HA's should be avoided.

Review HA's may also be undertaken by a registered nurse. Some of these HA's will
be done by the Designated Nurse for LAC e.g. difficult to reach children and young
persons, children in residential units etc. but increasingly Health Visitors/School
Nurses should undertake to do the review health assessments.
A written record of the HA should be completed using the British Association for
Adoption & Fostering (BAAF) forms8 and returned to the child's Social Worker.
These are forwarded by Social Services to the Designated Doctor for LAC who
together with the Designated Nurse for LAC will complete Part C of these forms
and approve payments where necessary. Part C of the forms contains a summary
report and a health care plan. The health care plan should clearly set out the
recommendations, time-scales and responsibilities arising from the assessment. This
plan is discussed and monitored at each statutory LAC review and will form part of
the child's care plan. Copies of the form should be sent to the Carer, GP, and Health
Visitor/School Nurse. Young persons(adolescents) should also be offered a copy. A
copy will be kept by the Designated Doctor/Nurse for LAC.




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Content/Format of Health Assessment

The aim of the health assessment is to enable the child to have their health needs
assessed holistically and to develop a plan to meet those needs. Successful health
assessments will be appropriate to the child's age, stage of development and personal
circumstances.

Assessment should include a comprehensive review of health needs including dental
and oral health, hearing and sight.

Attention should also be paid to the child's behavioural or emotional development
including evidence of health risk taking behaviours.

In summary areas to be covered should include:
      Registration with local GP and awareness of Health Visiting/School Nursing
      Service.
      General health and well-being with a review of any medications clarifying
      follow-up arrangements. Common problems include Asthma, Eczema, Visual
      Problems, Dental problems, and Growth concerns (local data).
      Check immunisation history and advice on outstanding immunisations.
      Appendix 2 provides guidance on immunisations for children/young people
      with unknown immunisation history1.
      Growth and nutrition/diet.
      Dental care. Check up on registration and follow-up arrangements with local
      dentist.
      Vision and Hearing. Formal assessment if any concerns.
      Development/Schooling. Referral for a formal developmental assessment may
      be necessary in the 0-5 age group if there are concerns. For school-aged
      children explore school progress, every LAC should have a Personal
      Education Plan. Concerns regarding educational progress can be discussed
      with the LAC Education team (Appendix 1).
      Emotional well-being and mental health(see Section 4)
      Health promotion and lifestyle issues including hobbies and interests (see
      Section 5). Consider referral to Bromley Looked After Young People’s Health
      project if aged 14 years and over (Appendix 5).


The BAAF forms enable a standardised format for recording health assessments and
prompts on issues that need to be covered. The content of the HA should be age
sensitive and developmentally appropriate. The recommended content for the
different stages of childhood are outlined in Appendix 31.




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                            Section 5: Mental Health


Children and young people who are looked after away from their family of origin
have usually experienced loss and disruption in their lives; others have had to cope
with trauma and abuse. Many of these young people show remarkable resilience
given the experiences they have had, others go through periods when they may
struggle with the challenges of home life, school, relationships with peers and
developing their independence and sense of who they are. Research shows that
looked after children generally have greater mental health needs than other young
people, including a significant proportion who have more than one condition and/or a
serious psychiatric disorder (McCann et al,1996). But their mental health problems
are frequently unnoticed or ignored. The most common disorders include emotional
problems including problems with self-esteem, depression, anxiety, deliberate self
harm; attachment difficulties and conduct and attentional disorders. There is a need
for a system of early mental health assessment and intervention for looked after
children and young people, including those who go on to be adopted5. Professionals
working with looked after children and young people need to work to promote their
mental health and emotional well-being and support those who experience emotional
distress or develop mental health problems6.

Emotional and behavioural difficulties should be routinely probed for as part of the
HA.
Areas explored should include:
Appetite, feeding/eating behaviour
Encopresis and enuresis
Toddler behavioural problems e.g. temper tantrums, breath holding attacks etc.
Pro-social skills, play, peer and family relationships
Sleeping behaviour
Self esteem and identity issues
Psychosomatic symptoms e.g. chronic headaches, recurrent abdominal pain,
Mood problems
Conduct problems and anti-social behaviour
Hyperactivity and attentional difficulties
Risk-taking behaviour in Adolescents
etc.

Concerns about emotional and behavioural difficulties can be explored using the
Strengths and Difficulties Questionnaire (SDQ)7 (Appendix 4). The SDQ is a brief
behavioural screening questionnaire that asks about 25 attributes, some positive and
others negative. The 25 items are divided between 5 scales of 5 items each,
generalising scores for conduct problems, hyperactivity, emotional symptoms, peer
problems, and prosocial behavior; all but the last are summed to generate a total
difficulties score. The questionnaire can be completed by the carer/parent, the teacher
and the child themselves if aged 11 years and above.




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Further information may be sought from the allocated Social Worker, the school and
other involved professionals e.g. Health Visitor, School Nurse so that a more
comprehensive picture can be obtained of the child/young persons difficulties. A
decision must be agreed on whether a referral is made to CAMHS( Child &
Adolescent Mental Health Service) or whether other forms of support/intervention are
more appropriate e.g. HV support, Bromley Y, Bromley Children’s Project, Surestart
etc.




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                         Section 6: Health Promotion


In order to be effective, statutory health assessments must be a health promoting
rather than disease screening exercise delivered by professionals skilled to address
diverse health needs9. The promotion of physical and mental health is identified as the
responsibility of all those involved with children and young people.

Skilful questioning is essential in exploring relevant areas which should include

   •   Mental health and wellbeing(see Section 4)
   •   Healthy eating
   •   Physical activity, Hobbies and Leisure
   •   Safety and keeping safe
   •   Sexual Health
   •   Drugs, alcohol, tobacco and volatile substances


Young people who are looked after are recognised as being vulnerable to risk taking
behaviour including unsafe sex, self-harming, substance and alcohol misuse1. The
Looked After Young People’s Health Project (Appendix 5) set up in 2004 targets the
over 14’s and aims using a more integrated approach to empower older LAC to
acquire the confidence and knowledge to manage their own health. The project is led
by a youth worker.

Children and young people need to understand their right to good health, to be able to
access services, and to have the knowledge and skills to communicate and relate to
others, and take responsibility for themselves and others1.

Advice on sources of information and relevant services should be sought from the
Designated Nurse/Doctor and the PCT Health Development Department (Appendix
1).




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                               Section 7: Health Records

Keeping good health records is essential to ensuring continuity of care3 and to foster
collaborative working between Health and Social Services such reports must be
included in the Statutory Care Review process. Most HA’s on LAC are recorded
using BAAF forms8. Reports provided by specialist doctors involved in the ongoing
care of LAC will in some cases replace the BAAF forms and children should not be
put through unnecessary re-assessments just for the purposes of paperwork.

Use of BAAF forms has been adopted locally because:

   •   they collate important health information for children and their families;
   •   they provide a standardised method for collecting information on
       children who could otherwise lose health information about themselves
       and their families;
   •   use of a standardised form throughout the UK sets the same standard of
       practice and facilitates placement across borders;
   •   they are designed by agency medical advisers in consultation with social
       workers and legal advisers and are reviewed by the BAAF Health Group
       in accordance with change in government guidance and subsequent
       practice.

The following table provides a list of new recently introduced BAAF forms.


                                                  New approach from 2005

                                                  Consent to assessment is on the initial and review health
                                                  forms. Consent to obtain and share information is on the
  Consent on each form
                                                  Consent Form, to accompany all other children's forms,
                                                  except Forms ICA and ICA-UK

 (Obstetric)/(Neonatal)                           Form M/B
  A form recording the general health of birth
                                                  Form PH
  parent and their family
                                                  Form IHA-C (birth to 9 years)
  Initial Health Assessment
                                                  Form IHA-YP (10 - 18 years)

                                                  Form RHA - C (birth to 9 years)
  Review Health Assessment
                                                  Form RHA - YP (10 - 18 years)

  Form for Intercountry Adoption                  Form ICA

  Adult Health Assessment and Update on
                                                  Form AH and AH2 (Adult 2)
  prospective foster-carers and adopters



Original forms are returned to Social services and a copy kept in the Child’s Health
Records i.e. Community file, Health Visiting Records, School Medical records, GP
records and a copy retained by the Designated Doctor/Nurse for easy access.
Medical/Health reports complying with the Arrangements for Placement
(General) Regulations 1991 and clearly compiled with a view to the care of the


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children concerned fall within the ambit of the Data Protection Act 1998. In the
overwhelming majority of cases, particularly in the light of the sharing of
information necessary in planning and reviews for children, it would be
appropriate for health information to be shared with children and their carers.



Transfer of Health/Medical Records of LAC including children being placed for
Adoption.

A formal request must be made for the records transfer either by Social Services or an
NHS Trust including Primary Care Trusts and advice sought from the Medical
Adviser for Adoption and/or Designated Doctor/Nurse for LAC.

Transfer of records for Adoptive placements will be dealt with by the Medical
Adviser for Adoption. As it is in the best interest of the child for local health care
professionals to be aware of the child’s health and medical history, original records
will be transferred including the Community File, Health Visitor and School Health
records. Summary reports on the child’s current health status and relevant past health
issues should be done by the Medical Advisor and Health Visitor(HV)/School
Nurse(SN), and included with the transferred records. Appendix 6 provides a
template for the HV/SN summary. A copy of the summary reports will also be sent to
the child’s General Practitioner.

Original records are not anonymised and therefore contain details of the child's birth
family and other third party information which are highly confidential. A covering
letter by the Medical Advisor Appendix 7 emphasises the importance of maintaining
confidentiality of the records which should only be seen on a "need to know" basis by
the professionals who are directly responsible for the child’s care. The letter suggests
that as a precaution old records should be kept in a sealed envelope within the new
records file.

Requests for medical records on Looked After Children are dealt with in a similar
fashion but queries should be directed to the Designated Doctor/Nurse for LAC. This
population of children can be highly mobile and responsibility for their care remains
with Bromley borough hence the need to keep track of their medical/health records.

With electronic records, if the child remains in borough, a new dataset should be set
up but with cross referencing or a link to old records so that the whole record of the
child is available to clinicians. In the case of a child moving out of the borough, they
would need to be discharged.

Request for disclosure/access to records will be dealt with as per Trust procedures and
advice is sought from the relevant clinicians.




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                                  Appendix 1
                Contact details of key professionals & services

Address                                         Telephone Number
Medical Advisor for Adoption & Fostering        020 8466 9988
Phoenix CRC, 40 Masons Hill
Bromley, BR2 9JG
Designated Doctor for Looked After Children     020 8466 9988
Phoenix CRC, 40 Masons Hill
Bromley, BR2 9JG
Designated Nurse for Looked After Children      020 8464 3333
LAC Team, Bromley Social Services
Joseph Lancaster Hall
Civic Centre
Rafford Way, Bromley, BR1 3UH
Group Manager                                   020 8464 3333
LAC Team, Bromley Social Services
Joseph Lancaster Hall
Civic Centre
Rafford Way, Bromley, BR1 3UH
LAC Education Team                              020 8464 3333
LAC Team, Bromley Social Services
Joseph Lancaster Hall
Civic Centre
Rafford Way, Bromley, BR1 3UH
Tier 2 CAMHS                                    020 8466 9988
Psychology and Behaviour Management Service
Phoenix Centre, 40 Masons Hill
Bromley, BR2 9JG
Bromley Y                                       020 8464 9033
17 Ethelbert Road
Bromley, BR1 2SH
Tier 3 CAMHS                                    020 8315 4430
2 Newman Road
Bromley, BR1 1RJ

Designated staff for LAC include a Clinical
Psychologist and a Nurse Therapist
Health Development                              01689 86643
Beckenham Hospital
379 Croydon Road
Beckenham, BR3 3QL
Looked After Young People’s Health Project,     020 8778 3566
LAC Health Worker
Penge Community Centre for Education, 101a
Parish Lane, Penge, SE20 7NR




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Appendix 2
Vaccination of children with unknown immunisation status

It is very rare that children born in the United Kingdom will not have received any
immunisations whatsoever. Where a child presents with an inadequate
immunisation history, every effort should be made to clarify what immunisations
have been given in the past using the following routes:

Personal Child Health Record (Red Book)
GP and Health Visitor records
Child health departments

Social Services provided Essential Information Records and Placement Plans on
the child

In the unusual event of the relevant data not being available via any of these
routes, then the designated nurse/doctor should be informed. Advice will be sought
if necessary from the District Immunisation Co-ordinator, who would be able to
help make a decision as to which immunisations a child should be offered,
dependent on his/her age.
Children coming to the UK, particularly from areas of conflict, may not have been
fully immunised as per the recommended schedule of their country of origin.
Details of these schedules can be found on wwwnt.who.int/vaccines. These
children should complete their immunisations in line with the UK schedule. The
following table will help to determine which immunisations should have been
given at which age.
                                      Full immunisation schedule
WHEN TO IMMUNISE                      WHAT IS GIVEN                                         HOW IT IS GIVEN

2, 3 and 4 months old                 Diphtheria, tetanus, pertussis (whooping cough),      One injection
                                      polio and Hib (DTaP/IPV/Hib)

                                      MenC                                                  One injection

Around 13 months old                  Measles, mumps and rubella (MMR)                      One injection

3 years and 4 months to 5 years old   Diphtheria, tetanus, pertussis (whooping cough) and   One injection
                                      polio (dTaP/IPV or DTaP/IPV)

                                      Measles, mumps and rubella (MMR)                      One injection

10 to 14 years old (and sometimes     BCG (against tuberculosis)                            Skin test, then, if needed,
shortly after birth)                                                                        one injection

13 to 18 years old                    Diphtheria, tetanus, polio (Td/IPV)                   One injection




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                                     Appendix 3

The Content of a health assessment

THE NEEDS OF THE VERY YOUNG - UNDER 5

For under fives, the focus will be on:


       • attachment behaviour;
       • physical health;
       • growth;
       • 7diet;
       • immunisations;
       • teeth;
       • monitoring developmental milestones, in particular the development of:

       speech and language
       gross and fine motor function
       vision and hearing
       play and pre-literacy skills
       social and self-help skills




THE MIDDLE YEARS - 5-10
For primary age children the focus will be on:
   •   physical health and management of specific health conditions e.g. asthma;
   •   communication skills;
   •   ability to make relationships and to relate to peers;
   •   mental and emotional health including depression, conduct disorders;
   •   progress at school;
   •   exercise and diet and understanding of a healthy lifestyle;
   •   maintenance of personal hygiene;
   •   awareness of basic safety issues including road safety;
   •   provision of a healthy balanced diet;
   •   where appropriate, to recognise and cope with the physical and
       emotional changes associated with puberty;
   •   access to accurate simple information about sexual activity;
   •   immunisation;
   •   dental health;
   •   attachment behaviour.


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ADOLESCENCE AND LEAVING CARE - 11-18


For seconday school age children and young people the focus will be on:
   •   ability to take appropriate responsibility for own health, including
       management of specific health conditions e.g. asthma, diabetes;
   •   communication and interpersonal skills;
   •   educational and social progress:
   •   lifestyle including diet and physical activity;
   •   mental and emotional health Including depression and conduct disorders;
   •   understanding of issues relating to sexuality and sexual activity including
       its role in relationships; contraception: sexually transmitted infection and
       the particular risks of early sexual activity;
   •   access to sources of information and advice about a range of health issues
       including the risks of alcohol, tobacco and other substance use and
       access to sources of advice on modifying health risk behaviours;
   •   ensuring that immunisations are up to date;
   •   for care leavers to hare a full copy of all social care health records
       (including genetic background and details of illness and treatments) and
       be equipped to manage their own health needs.




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                       Appendix 4
          Strength and Difficulties questionnaire




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Appendix 5
                 Looked After Young People’s Health Project

                                   Background and Context

1. Project Aim
This pilot project is a multi agency partnership which seeks to improve and promote the
physical and mental health of Looked After Young People aged 14 to 18 years who are
resident in the borough of Bromley.

2. Background to the project
There are currently about 60 young people in this age group (35 young men and 24 young
women). The project will be delivered using a youth work approach in partnership with
Bromley Youth Services. A full time youthworker is to be appointed to take forward the work
of the project and will work closely with the Looked After Children’s Nurse.

The project is funded for two years from The Development Fund of Bromley Partnership and
Modernisation Board which is part of Bromley Primary Care Trust. The project is managed
by Bromley Social Services and the lead officer for the management of this project is David
Bradley, Principle Services Manager (Care and Resources), Bromley Social Services.

3. The health of Looked After Young People
The health of Looked After Children and Young People is a cause of concern nationally. This
is because their physical and mental health is often poorer than that of children who are not
looked after by a local authority – this may be because their health needs are greater to begin
with, the reasons that they have come into local authority care may make them more
vulnerable and they may have less access to health care and health promoting activity and
may lack opportunities to acquire the skills to promote their own health. Research indicates
that Looked After Young People have high rates of unintended conceptions, early parenthood,
self harm, suicide, drug and alcohol problems, eating disorders etc and that this continues into
their adult lives.

4. Health Assessments
It is a statutory requirement that an annual health assessment must be carried out for every
Looked After Child/Young Person and a health plan drawn up for each child/young person.
Department of Health guidance for local authorities ‘Promoting the health of looked after
children’ (published 2002) notes that health assessments should:
Promote the current and future health of the child or young person who is looked after and not
focus solely on the detection of ill- health.
Ensure the individual child or young person is at the centre of the process of health
assessment
Be sensitive to age, gender, disability, race, culture and language

The guidance also notes that young people are often reluctant to participate or cooperate with
health assessments and this non cooperation often increases as young people get older. Young
people see health assessments as stigmatising ‘medicals’ which have no outcome for them.
Part of the purpose of this project is to find ways of making health assessments more
acceptable to and more appropriate for young people thus increasing the uptake of health
assessments and making them effective in promoting the young persons health and well
being.




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        Guidelines for Health Assessment of Looked After Children (LAC)

5. Key Documents and National Policy
Promoting the health of looked after children (Department of Health 2002)
This new guidance sets out a framework for the delivery of services from health agencies and
social services to more effectively promote the health and wellbeing of children and young
people in the care system. www.doh.gov.uk/lookedafterchildren/promotinghealth.htm
Every Child Matters (Dfes Green Paper 2003)
The Green Paper sets out the government’s proposals for reforming the delivery of services to
children, young people and families:
‘Our aim is to ensure that every child has the chance to fulfil their potential by reducing levels
of educational failure, ill health, substance misuse, teenage pregnancy, abuse and neglect,
crime and anti-social behaviour among children and young people. ’

www.dfes.gov.uk/everychildmatters

6. Pilot Project Partners
This pilot project has drawn together a number of partners who have worked together to
develop the project and who will continue to contribute advice and expertise as well as access
to their services.

The partners include:
Bromley Social Services – Children and Families Division – Looked after children and
leaving care teams
Bromley PCT – Consultant Paediatrician (community) and the Looked After Children nurse
Bromley Youth Service
Bromley PCT – Health Development Unit (health promotion and teenage pregnancy service)
Drug Action Team
Bromley Leisure Services

The partners meet regularly within the Bromley Looked After Children’s Health Forum.

7. Monitoring and Evaluation
The project will report quarterly to the Bromley Looked After Children’s Health Forum and
to The Development Fund of Bromley Partnership and Modernisation Board who are funding
the project. Reports will be quantitative (how many young people have been worked with and
what the work focused on) and qualitative (examples and descriptions of how young people
and their carers are addressing health issues, descriptions of how health assessments have
been made more effective etc). It is planned that the project will be evaluated in year two to
identify key learning and best practice and implications of this learning for related services.




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       Guidelines for Health Assessment of Looked After Children (LAC)

                            Appendix 6
             Summary Report for transfer of records of LAC
                  & Children placed for Adoption.


Transfer of Records of Looked After Child including child being placed for Adoption.
Summary of Health Details – as identified from records.


Child’s Name:                                Date of Birth:


To:                                        Health Visitor/School Nurse
Address:

Telephone No:

From:                                      Health Visitor/School Nurse
Address:

Telephone No:



Past Health History of relevance including immunization status and outcome of any
developmental checks/educational concerns:




Current Health Status and any outstanding health care plans:




Signature:                                   Date:




                                     Page 25 of 27
                                   BROMLEY PRIMARY CARE TRUST
                      Guidelines for Health Assessment of Looked After Children (LAC)

                                                Appendix 7
                                   Covering letter for transfer of records




  Dear



  Name:
  DoB:
  Adoptive Parents:
  Address:
  GP:



  This file has not been anonymised. It contains details of the child's birth family and other third party
  information. It is therefore highly confidential.
  I am sending the information to your service, as it is in the best interest of the child for local health
  care professionals to be aware the child’s health and medical history. This file, however, should
  only be seen on a "need to know" basis by the professionals who are directly responsible for his
  care. As a precaution you may wish to place these records in a sealed envelope within the new file.


  Despite greater openness in adoption practice, it remains a matter of principle for a child's
  adoptive family to decide how widely they wish to share the information about their child's
  adoptive status. It is therefore good practice to discuss with the adoptive family the fact that
  this information has been transferred and the adoptive family given an opportunity to express a
  wish about how this confidential material should be handled.

  …………. however has not yet been legally adopted. Until his adoption is finalised by a court
  order, his legal status remains that of a looked after child, with Bromley Social Services
  holding parental responsibility.


  Please do not hesitate to contact me if you wish to discuss anything further.


  Yours sincerely



……………………………………………………..
Consultant Paediatrician (Community) and
Medical Adviser to Bromley Adoption Panel



CC



Courtesy of Dr Mary Mather, Chair of BAAF Health Group

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    Guidelines for Health Assessment of Looked After Children (LAC)

                                References


 1. Promoting the Health of Looked After Children – Department of Health 2002

 2. Promoting the Health of Looked After Children – Professor Leon Polnay –
    BMJ 2000; 320; 661-662

 3. Healthy Care – Building an evidence base for promoting the health and well-
    being of looked after children and young people- National Children’s Bureau
    making a difference.

 4. Department of Health Statistics – Children Looked After at 31.03.94 – 1998
    with three of more placements during the year.

 5. Young Minds – LAC Learning network.

 6. The Mental Health of LAC – Summary of a report commissioned by the
    Mental Health Foundation based on research by Jo Richardson, Focus, Royal
    college of Psychiatrists, August 2002.

 7. The Mental Health needs of Looked after Children - Jo Richardson and Carol
    Joughin – 2000.

 8. Statutory health assessments for looked-after children: What do the
    achieve? Child: Care, Health and Development 2003, Vol /Iss/Pg. 29/1 (3-12),
    ISSN: 0305-1862. Hill-C-M, Watkins-J.

 9. Using the BAAF Health Assessment Forms, BAAF Practice Note 47.

10. Doctors for Children in Public Care – Mary Mather. BAAF 2000.




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