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6.5.1 Health Assessments and Health Care Plans

SCOPE OF THIS CHAPTER

This procedure applies to all Looked After Children. Children remanded other than on bail will be Looked After Children. Different provisions will apply In relation to those children/young people - see Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Care Planning for Young People on Remand.

This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for Looked After Children.

ADDITIONAL GUIDANCE

This chapter should be read in conjunction with Statutory Guidance on Promoting the Health and Well-being of Looked After Children (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 - This is NICE guidance on the assessment and treatment of attachment difficulties in children and young people.

Initial Health Assessment Process for Social Workers

AMENDMENT

This chapter was updated in March 2018 when the Initial Health Assessment Process for Social Workers flowchart was added.


Contents

  1. The Responsibilities of Local Authorities and Clinical Commissioning Groups

  2.  Principles
  3. Health Assessments including Dental, Opticians and Immunisation Checks
  4. Health Care Plans
  5. Emotional Health and Strength and Difficulties Questionnaires


1. The Responsibilities of Local Authorities and Clinical Commissioning Groups

The local authority, through its Corporate Parenting responsibilities, has a duty to promote the welfare of Looked After Children, including those who are Eligible and those children placed in adoptive placements. This includes promoting the child’s physical, emotional and mental health; every Looked After Child needs to have a health assessment so that a health plan can be developed to reflect the child’s health needs and be included as part of the child’s overall Care Plan.

The relevant Clinical Commissioning Group (CCG) and NHS England have a duty to cooperate with requests from the local authority to undertake health assessments and provide any necessary support services to Looked After Children without any undue delay and irrespective of whether the placement of the child is an emergency, short term or in another CCG. This also includes services to a child or young person experiencing mental illness.

The Local Authority should always advise the CCG when a child is initially accommodated. Where there is a change in placement that will require the involvement of another CCG, the child’s ’originating’ CCG, outgoing (if different for the ‘originating CCG) and new CCG should be informed.

Both Local Authority and relevant CCG(s) should develop effective communications and understandings between each other as part of being able to promote children’s well being.


2. Principles

  • Looked After Children should be able to participate in decisions about their healthcare and all relevant agencies should seek to promote a culture that promotes children being listened to  and which takes account of their age;
  • That others involved with the child, parents, other carers, schools, etc are enabled to understand the importance of taking into account the child’s wishes and feelings about how to be healthy;
  • There is recognition that there needs to be an effective balance between confidentiality and providing information about a child’s health. This is a sensitive area, but ‘fear about sharing information should not get in the way of promoting the health of looked After Children’. (See Annex C: Principles of confidentiality and consent, DfE and DoH Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015);
  • When a child becomes Looked After, or moves into another CCG area, any treatment or service should be continued uninterrupted;
  • A Looked After Child requiring health services should be able to do so without delay or any wait should ‘be no longer than a child in a local area with an equivalent need’;
  • A Looked After Child should always be registered with a GP and Dentist near to where they live in placement;
  • A child’s clinical and health record will be principally located with the GP. When the child comes into local authority care, or moves placement, the GP should fast-track the transfer of the records to a new GP;
  • Where a child is placed within another CCG, e.g. where the child is placed in an out of Authority Placement, (see Out of Authority Placements for SBC Children procedure,) the ‘originating CCG ’remains responsible for the health services that might be commissioned.


3. Health Assessments including Dental, Opticians and Immunisation Checks

Good Health Assessment and Planning

Role of Social Worker in Promoting the Child’s Health

The social worker has an important role in promoting the health and welfare of Looked After Children: see: Initial Health Assessment Process for Social Workers.

  • Working in partnership with parents and carers to contribute to the health plan;
  • Ensure that consents and permissions with regard to delegated authorities are obtained to avoid any delay. Note: however, should the child require emergency treatment or surgery, then every effort should be made to contact those with Parental Responsibility to both communicate this and seek for them share in providing medical consent where appropriate. Nevertheless, this must never delay any necessary medical procedure;
  • Ensure that any actions identified in the Health Plan are progressed in a timely way by liaising with health relevant professionals;
  • In recognising that a child’s physical, emotional and mental health can impact upon their learning, where this is necessary, to liaise with the Virtual School Head to ensure as far as possible this is minimised for the child. (Should there be any delay in the child’s Health Plan being actioned,  the impact for the child with regard to their learning should be highlighted to the relevant health practitioners);
  • To support the Looked After Child’s carers in meeting the child’s health needs in an holistic way; this includes sharing with them any health needs that have been identified and what additional support they should receive, as well as ensuring they have a copy of the Care Plan;
  • Where a Looked After Child is undergoing health treatment, to monitor with the carers how this is being progressed and ensure that any treatment regime is being followed;
  • To communicate with the carer’s and child’s health practitioners, including dentists, those issues which have been properly delegated to the carers;
  • Social Workers and health practitioners should ensure the carers have specific contact details and information on how to access relevant services, including CAMHS;
  • Ensuring the Child has a copy of their health plan.

It is important that at the point of Accommodating a child, as much information as possible is understood about the child’s health, especially where the child has health or behavioural needs that potentially pose a risk to themselves, their carers and others. Any such issues should be fully shared with the carers, together with an understanding as to what support they will receive as a result.

Frequency of Health Assessments

Each Looked After Child must have a Health Care Assessment at specified intervals as set out below.

  • The initial Assessment must be conducted within 20 working days of becoming looked after. in time the child's first Looked After Review (unless one has been done within the previous 3 months);
  • For children under five years, further Health Assessments should occur at least once every six months;
  • For children aged over five years, further Health Assessments should occur at least annually.

If a child is transferred from one Looked After Placement to another, it is not necessary to plan an assessment within the first month. In these circumstances, the Social Worker should furnish the carer/residential staff with a copy of the child's Health Care Plan.

Who carries out Health Assessments?

The Initial Health Assessments must be conducted by a registered medical practitioner in Swindon this is usually a Paediatrician, individual arrangements will be made for children placed outside of Swindon. Review health assessments will usually be completed by a school nurse or health visitor unless the child has complex health needs or is in the adoption process. (See Arranging Health Care Assessments)

Arranging Initial Health Assessments

The Social Worker will inform the Designated Nurse for Children in Care that a child has become looked after within 2 working days of a child becoming looked after.

The Designated Nurse will complete Part A of the BAAF ‘Initial Health Assessment Form’ and send it to the Paediatric Department at The Great Western Hospital who will arrange for an appointment to be sent out. In order for the Health Assessment to be conducted, the social worker must ensure that the parent(s) have given consent - this will usually be recorded on the Placement Information Record on ICS.

The health professional conducting the assessment will complete a relevant BAAF Form which will be returned to the Designated Nurse for Children in Care.

Arranging Review Health Assessments

The Designated Nurse will send the child’s Social Worker the BAAF ‘Review Health Assessment form at least 2 months before the review is due. The Social Worker will complete Part ‘A’ and return it to the Designated Nurse within 1 week. The Designated Nurse will then send the BAAF form to the appropriate health professional for it to be completed within 1 month. The completed Review Health Assessment Form will be returned to the Designated Nurse.

Dental and Optician Checks

The carer for the child is expected to arrange for children and young people in their care to attend a dentist as soon as possible after becoming Looked After and annually thereafter. Dates of examinations should be given to the child’s Social Worker and noted on the Review of Arrangements on ICS.

If a specialist dentist is required due to disability or dental phobia contact the Designated Nurse for Children in Care who will make a referral.

Optician Checks

The carer for the child is expected to arrange for children and young people in their care to attend an optician as soon as possible after becoming Looked After and then every 2 years, unless directed more frequently by optician. Dates of examinations should be given to the child’s Social Worker and noted on the Review of Arrangements on ICS.

Immunisations

The Social Worker takes an Immunisation History from the parent and completes on the Placement Information Record. If this is not available a full immunisation history is available from the Child Health Department.

Where immunisations are outstanding this must be reflected in the health section of the care plan with clear actions to address it. For many refugee children their immunisation status will be unknown and a course of primary immunisation will need to be undertaken. Social Workers should seek advice from the CLA Health Team.

The current immunisation requirements are:

Two months old

Diseases protected against: Diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib), Pneumococcal infection.

Vaccine given: DTaP/IPV/Hib + Pneumococcal conjugate vaccine, (PCV).

Three months old

Diseases protected against: Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (Hib), Meningitis C.

Vaccine given: DTaP/IPV/Hib + MenC.

Four months old

Diseases protected against: Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (Hib), Meningitis C, Pneumococcal infection.

Vaccine given: DTaP/IPV/Hib + MenC + PCV.

Around 12 months

Diseases protected against: Haemophilus influenza type b (Hib), Meningitis C.

Vaccine given: Hib/MenC.

Around 13 months

Diseases protected against: Measles, mumps and rubella, Pneumococcal infection.

Vaccine given: MMR + PCV.

Three years and four months or soon after

Diseases protected against: Diphtheria, tetanus, pertussis and polio, Measles, mumps and rubella.

Vaccine given: DTaP/IPV or dTaP/IPV+MMR.

Thirteen to eighteen years old

Diseases protected against: Diphtheria, tetanus, polio.

Vaccine given: Td/IPV.

Girls 12-18

Diseases protected against: The Human Papillomavirus Vaccine. This involves 3 injections given within one year. First injection followed by second 1 month to 2 months later and third 6 to 12 months after first injection.

Vaccine given: HPV.

Non-routine Immunisations

At birth (to babies who are more likely to come into contact with TB than the general population): Diseases protected against: Tuberculosis.

Vaccine given: BCG.

At birth (to babies whose mothers are hepatitis B positive): Diseases protected against: Hepatitis B.

Vaccine given: Hep B.


4. Health Care Plans

The Health Care Plan will be written following the Initial Health Assessment and updated after each Review Health Assessment or major change in health needs by the Designated Nurse for Children in Care. The Health Care Plan will be written on to the ICS exemplar and work flowed to the Independent Reviewing Officer. A copy will be sent to the carer, School Nurse or Health Visitor and Paediatric Department at GWH who will send a copy to the child’s GP. The Social Worker will send a copy to the child’s parents and the young person unless not felt appropriate (if it is not shared with the parents the reason for not doing this will be recorded on ICS.

The Health Care Plan will feed into the Looked After Care Plan and will be reviewed at each Looked After Child Review.


5. Emotional Health and Strength and Difficulties Questionnaires

Emotional Health of Children Looked After and Care Leavers including Strengths and Difficulties Questionnaire Guidance

Looked after children are five times more likely than their peers to have a mental health disorder. Children and young people with significant learning disabilities are three to four times more likely to have a mental disorder and at least forty per cent of young offenders have been found to have a diagnosable mental health disorder.

Experiences of abuse and neglect which are not treated continue to affect a child or young person’s sense of self even after they are physically safe. Research shows that living in an environment of serious emotional neglect or fear in early infancy can impair the growth and physical development of the baby’s brain as well as impacting on the emotional development of their relationships and impair their ability to learn.

It is also well documented that experiences of loss, delays and uncertainty, changes of placement and longer term instability of care are also major contributors to emotional problems in children and young people who are looked after and leaving care.

So clear care planning which minimizes delay and early identification and appropriate service provision for emotional difficulties are very important for children and young people who are looked after.

A screening tool called the Strengths and Difficulties Questionnaire has been introduced nationally with the intention of identifying children and young people who may need additional emotional support.

Strengths and Difficulties Questionnaire (SDQ) Guidance

The Department for Education “measures” emotional well-being of Children Looked After (CLA) as one part of an effort to increase children’s emotional well-being. To do so it uses Strengths and Difficulties Questionnaire (SDQ) (R Goodman’s 1997) Local Authorities are only required to use the SDQ (P4-16) for a child aged between 4 and 16 (inclusive).

The SDQ screens behaviour. It measures five core psychological attributes, (a) emotional symptoms, (b) conduct problems, (c) hyperactivity/inattention, (d) peer relationship problems, and (e) pro social behaviour. Also, “the SDQ will provide predictions about how likely it is that a child or young person has significant mental health problems (unlikely, possible or probable).”

It is designed to flag up a limited range of emotional difficulties, which in turn may form the basis for therapeutic or other intervention.

The SDQ is sent to the carers by their supervising Social Worker:

The SDQ is completed by the Carer and returned to the Designated Nurse for Children in Care.

The questionnaire is scored and the results entered onto the ICS system.

If the score is high (over 17) the results are work flowed to the Team Manager and a teacher SDQ requested from the child’s school. If the child is over 11 years old they will be asked by their Social worker to complete a Self SDQ.

Child and Adolescent Mental Health Service

CAHMS Referral Process

Any professional involved with a child or young person looked after can refer to CAHMS using the Camhs referral form.

As Looked After Children frequently have high levels of need a complex needs consultation may be arranged prior to a child or young person starting any therapy.

End