Looked After Children – Medical Needs and Health Assessment

1. Looked After Children – Medical Needs and Health Assessment Information Module for GP’s undertaking Health Assessments for Looked After Children. Dr. Carole Anne Colford, Designated Doctor For Looked After Children and Care Leavers In Hertfordshire. Updated August 2013.

2. Looked After Children – Medical Needs and Health Assessment There are 4 Sections to the information module: • Background Information. • Health Assessments and Statutory Guidance. • Summary of Health Assessment administrative process. • Guidance on completing a health assessment.

3. Looked After Children – Medical Needs and Health Assessment The objectives of the information module are: • To highlight the specific health needs of Looked After Children (LAC). • To highlight the statutory obligations health has to the needs of LAC. • To provide guidance around the completion of the health assessment process. • To raise awareness of the role of the LAC Health Team based at Harpenden Memorial Hospital.

4. Background Information

5. LAC & Care Leavers DofE 2012: 67,050 LAC in England. 3450 adopted from care • Main reason – Abuse/neglect, 56%. - Changed little in last 5 yrs. • 75% Foster Placements. • 9% Residential Placements. • 2680 Unaccompanied/ Asylum Seekers (87% male).

6. LAC – Impact of Abuse and Neglect Affect 2/3rds of LAC: • Long term impact on health and development. • Health Inequalities arising from poverty e.g. missed immunisations, developmental checks, incomplete health records. • Separation from Family: - Emotional trauma. - Impaired formation of trusting adult relationships. - Compounded by frequent moves in care and placement breakdown.

7. Meltzer et al 2003 Looked at the medical and mental health needs of LAC. • 45% 5-18 year olds had a mental health disorder. • 20% Under 5’s – emotional/behavioural problems. • Compared with 10% general population. • Increased to 72% in residential placements. • 37% Conduct Disorder. • 12% Anxiety/ Depression. • 7% Hyperactivity.

8. LAC Health 2/3rds LAC had at least 1 physical complaint. • Speech and Language difficulties. • Enuresis. • Coordination Difficulties. • Sight difficulties.

9. Care Leavers – 16 to 18 years More likely to have health problems compared to peers. Within 3 months of leaving care: • 2x’s risk of drug/alcohol problems. • 2x’s risk of mental health problems. • 44% incidence of other health problems e.g. asthma/weight loss/ allergies/flu/ drug or alcohol related.

10. Care Leavers More likely to become teenage parents: • > 50% CLA become pregnant within 18-24 months leaving care, 25% in 1 year. • 3x’s incidence post-natal depression. • 25% low birth weight babies. • 60% higher infant mortality.

11. Health Assessments and Statutory Guidance

12. Health Assessments DOH Guidance: • Statutory. • Not a safeguarding medical. • Aim is to: - Identify Health Needs. - Identify Health Neglect. - Promote Child Health.

13. Health Assessments • Initial Health Assessment (IHA) must be undertaken by a registered medical practitioner. • IHA should be completed within 28 days of coming into care. • Review Health Assessments (RHA) - Under 5’s - 6 monthly. - Over 5’s - Annually.

14. Health Assessments DOH Guidance noted: • 25% no completed health plan. • 22% no recording of family history. “ … Appeared to function more as a disease screening exercise than as an opportunity to promote children’s health.”

15. Statutory Guidance Nov 2009 CCG’s Contribution: • Originating CCG remains responsible for secondary healthcare services. • Referrals to specialist services are timely and not affected by the high mobility of children in care. • Provide, when necessary, health summaries. • Ensure that clinical records of CLA clearly acknowledge CLA status. • Temporary registration with a GP should be avoided. If any doubt over length of stay, opt for full registration.

16. Statutory Guidance Nov 2009 Lead Health Professional: • Act as Key health contact for Child’s social worker. • Work with the social worker to co-ordinate health care plan and ensure health actions are tracked. • Likely to be HV, School nurse, Paediatrician but in some cases could be GP. NOTE: The Lead Health record should be the GP held record.

17. Health Assessment Process in Hertfordshire

18. HA Process in Hertfordshire • Social worker initiates the HA process by sending a BAAF IHA form or RHA form to the LAC & Care Leaver Health Team Office, with Part A completed. • If you receive a HA request directly from a social worker, please contact our office urgently to discuss. • LAC Health service team will identify the correct Health Professional to carry out the HA and liaise with them to arrange appointment. • We provide background information supplied by social care, a payment form, record of immunisations from Systm 1 and additional support information regarding HA’s on unaccompanied children from abroad. • If a Review Health Assessment, a copy of the last health assessment will be sent.

19. HA Process in Hertfordshire • As soon as the request is received by the health professional, the completed HA must be returned to the CLA Health Service Team within 5 weeks. • We recommend you allocate 3 appointment slots for a health assessment as a minimum. • Ensure you keep a copy for your own records. If on Systm 1, scan the document under “Communications and Letters”. • PAYMENT - Please return the completed HA with a completed GP payment form to the LAC health team – NOT the social worker. • The LAC health team now process the payment and scan the HA onto the HCC IT system.

20. Advice on Completing Initial Health Assessments.

21. Health Assessments • Need to document the Child’s physical and emotional/ mental health needs. • If possible/safe, the birth parents should be encouraged to attend and it is best practice for the social worker to attend. • For some children, this may be the last opportunity to document relevant family history, antenatal and birth history. • Factors such as maternal drug and alcohol usage in pregnancy are still relevant to the development and behaviours of older children e.g. Foetal alcohol syndrome.

22. Health Assessments • All sections should be completed, so a holistic picture of the child can be gained from the information in the HA. • Any pre-existing diagnoses should be documented – don’t presume it’s been documented elsewhere. • Please document any known medication. • If on Systm 1, please document height, weight, smoking, alcohol, drug misuse, pregnancy, chlamydia/STD screening and any diagnoses. • Section C - Health Summary and action plan are best completed by the health professional undertaking the HA. This is a recommendation from BAAF.

23. Health Assessments • Advice as to issues over lifestyle choices, drugs and alcohol, sex education can be gained from the LAC health team – but should be put as an action in the action plan. • Any queries regarding the Health Assessment process can be answered by contacting the LAC Health Team which consists of Administrative team, Designated Doctor and 2 LAC nurses.

24. Contact Details Looked After Children and Care Leavers Health Team. Harpenden Memorial Hospital Carlton Road Harpenden AL5 4TA Tel: 01582 711561 Email: CLA.Healthadmin@hchs.nhs.uk Safe Fax: 01582 767235