Healthy Care: Improving the Health and Emotional Wellbeing of Looked After children

1. Healthy Care: Improving the Health and Emotional Wellbeing of Looked After children Helen Jones ACWA Conference Sydney

2. Context and Rationale for Healthy Care “Children and young people who are looked after are amongst the most socially excluded groups in England and Wales. They have profoundly increased health needs in comparison with children and young people from comparable socio-economic backgrounds who have not needed to be taken into care. These greater needs, however, often remain unmet. As a result, many children and young people who are looked after experience significant health inequalities and on leaving care experience very poor health, educational and social outcomes.” (Department of Health 2002)

3. What affects our health? General socio-economic, cultural and environmental conditions Living and working conditions Work environment Unemployment Social and community networks Individual lifestyle factors Water & sanitation Education Health care services Agriculture& food production Age, sex and constitutional factors Housing Source: Dahlgren C and Whitehead M (1991)

4. National and International research indicates that looked after children and young people have a range of physical and mental health problems • Eye and sight (16%) • Speech and language (14%) • Bed wetting (13%) • Coordination (10%) • Asthma (10%) • Psychiatric disorder (45%) • Needing outpatient treatment (52%)

7. Correlation of poor attachment • Poor impulse control • Oppositional behaviour with carers and authority figures • Problematic peer relationships • Less competent social behaviour • Less empathy • Lower self-esteem

8. Looked after children may not have played because of: • Abuse and neglect • Damaged parental relationships • Illness and disability • Little opportunity to play and interact • Disrupted education and schooling • Bullying and exclusion

9. Chronic stress overdevelops areas related to anxiety and fear Stress hormone cortisol is produced at abnormal levels, evidence of altered activity in maltreated population Early trauma interferes with sub corticol & limbic development = extreme anxiety, depression, attachment difficulties, reduction in hippocampi, bio-regulation and stress response is impaired The Impact

10. Positive Parenting Building social capital: community networks, local involvement and identity, trust. Promoting physical activity C O M M U N I T Y L E V E L Building Resilience Regeneration in deprived areas Targeting depression with outreach programmes and social support Access to green open spaces Positive Mental Health Widen participation in education Enhancing social networks Health promoting schools approach focused on whole school environment, involving parents and wider community Encouraging voluntary work Evidence-based approaches to promoting positive mental health I N D I V I D U A L L E V E L Adapted from Key Topics in Public Health ed Ewles (2004)

11. What young people say promotes and maintains mental health? • Feeling safe – physically and emotionally • Being able to talk to an adult of their choice in confidence • Access to sports centres and youth activities • Personal achievement • Being praised • Generally feeling positive about oneself (Ahmad and others 2003, Kay 1999)

12. Healthy Care Programme • Is a holistic programme which promotes health and well-being and improves the life chances • Provides a child-centred national standard • Provides a portfolio of Healthy Care Resources • Provides an information service • Provides support and advice

13. Healthy Care Programme – history of development • In development for 5 years • Developed in partnership with national, regional and local partners including carers, parents, children and young people • Piloted with 13 local pilot including 3 secure units, with evaluation • Approx 80 Healthy Care partnerships • Well-being, Creativity, Play Project • Regional activity and development

14. Children and young people in a healthy care environment will: • Experience a genuinely caring, consistent, stable and secure relationship with at least one committed, trained, experienced and supported carer; • Live in an environment that promotes health and well-being within the wider community • Have opportunities to develop the personal and social skills to care for their health and well-being now and in the future; and • Receive effective healthcare, assessment, treatment and support

15. A child of young person living in a health care environment is entitled to: • Feel safe, protected and valued in a strong, sustained and committed relationship with at least one carer; • Live in a caring, healthy and learning environment • Feel respected and supported in his/ her cultural beliefs and personal identity • Have access to effective healthcare, assessment, treatment and support • Have opportunities to develop personal and social skills, talents and abilities and to spend time in freely chosen play, cultural and leisure activities; and • Be prepared for leaving care by being supported to care and provide for him/ herself in the future

16. National Healthy Care Standard • Health is a ‘base from which to develop, enabling people to do or choose to do as many things as possible to achieve their potential’ (Seedhouse 1986) • Children and young people need to have opportunities to develop personal, social and life skills, talents and abilities to spend time in freely chosen play, cultural and leisure activities and are encouraged to develop their life skills

17. Healthy Care Audit and Action Planning Tool • Audit services – what is working well, what needs to be better – through consultation and inspection reports • Identify key priorities and key areas for action (e.g. fostering services, leaving care, LASCHS) • Plan action through partnerships, policy, participation and practice • Partners secure support and resources inform own agencies • Implement Action Plan • Monitor and Evaluate • Record, improve and celebrate success

18. Policy • Across all agencies meets health and well being needs • Secures stable placemats • Ensures participation, in care, health, policy and education, play, arts and leisure • Adheres to national minimum standards • Ensures training of staff • Ensures inclusion and non discriminatory practice • Supports the role of corporate parents • Ensures joining up of strategies and services

19. Effective Partnerships • Are multi-agency building on existing children’s local strategic partnerships or children’s trust, and usually include, Social Services, PCTs, Education, Leisure Department and Voluntary Sector; • Have a strategic Healthy Care Champion and an Operational Officer • Have sign up and commitment from Directors of all involved agencies • Secure funding and clarify accountability • Have effective communication and structures between partners • looked after children and young people are partners too

20. Practice • Carers and staff are committed to the health and well being of looked after children and young people and are trained and supported • Children and young people have consistent and caring relationships which support the development and transition into adulthood

21. Participation of children and young people will: • Identify need and steer direction • Develop partnerships • Inform and monitor improved practice • Creative participation is critical to success “It should be somewhere you feel supported and encourage both emotionally andphysically. You shouldn’t feel that you are responsible for everything as if you are alone”. “I never felt alone. There was always someone to turn to, they were really supportive”.

22. Key learning from early implementation • Local, engagement and champion to deliver local targets • Regional coordination and leadership • National networking and strategic support within ECM agenda • Provide evidence for joint inspection • A framework for partnerships to improve outcomes • Effective creative participation crucial • Development for other vulnerable groups

23. Interventions • Interventions must address the totality of the child’s life, providing frequent, consistent ‘replacement’ experiences so that the child’s brain can begin to incorporate a new environment, one that is safe, predictable, and nurturing. (Perry, 2000)

24. Play, creativity and well-being for looked after children Involvement in play and creative arts can: • Enhance self-esteem and resilience • Promote social inclusion • Improve sensory awareness • Help to counteract the consequence of childhood abuse and neglect (Chambers 2004)

25. Why should children and young people looked after participate in policy and practice development? • It empowers young people to take responsibility, rather than experience “learned helplessness” • Important to feel a sense of ownership and involvement in their own environment • Activities that empower contribute to development of self esteem, and promote well-being • Outcomes of creative participation are key to effective service development

26. Play and creativity for health and well-being • All young people 5-18 years should take part in at least one hour of moderate physical activity each day (DH 2004) • Unstructured ball games and outdoor play is effective for physical activity (Mackett 2004) • Physical activity can improve mental health and self-esteem (HDA 2003) • Play and creative activities can promote cultural awareness and sense of personal identity and self-esteem (Gilligan (1999,2001) Goleman (1996) • Participation and empowerment (Howell 2003)

27. Creative Participation enables looked after children and young people to: • develop their communication skills and interests in arts practice • improve self esteem, raising aspirations and self confidence • build sustainable relationships with carers and significant others • improve physical health and activity • engage with education and training opportunities • contribute to service development and monitoring

28. Creativity and play in practice • Song writing in Southampton • Circus skills in Sussex • Creative attachment therapy in Telford • Dramatherapy in a secure unit • Music therapy in Leeds • Artists in Walsall • ‘One Jam’ in Lincolnshire