Services for Children and Young People Children’s Social Care · Children’s Social Care Promoting the Health of Looked After Children LAC 1.17 2 reality, staff and carers will

Services for Children and Young People

Children’s Social Care Section 1: CSC – LOOKED AFTER CHILDREN Title: Status: Procedure and Guidance Version: Final October 2008 Date Agreed by CMT: October 2008 Date for Review: December 2009

Location: Looked After Children Ref: LAC 1.17

Promoting the Health of Looked After Children

Children’s Social Care Promoting the Health of Looked After Children LAC 1.17

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Section 2 2.1. Legislation, Regulations and Guidance Children Act 1989 The Children (Leaving Care) Act 2000 Care Standards Act 2000 Promoting the Health of Looked After Children DoH 2003 National Healthy Care Standards 2003 Healthy Care Training Manual, NCB, 2005 Fostering Services Regulations 2002 NMS for Fostering Services 2002 2.2. Links to Other Documents Tameside Safeguarding Framework 2007 2.2. Content and Scope This procedure and guidance informs staff and carers of the processes to be followed when promoting the health of looked after children. It applies to all looked after children, placed with foster carers, kinship foster carers, in residential children’s homes or placed at home with parents. 2.4. Monitoring and Reporting This procedure and guidance will be monitored via the Service Unit Manager for Looked After Children, with an annual report on the health data for looked after children, the Quality Assurance Unit via Independent Reviewing Officers audits and children’s statutory review processes, Regulation 33 visits in Children’s Homes and Ofsted (Office for Standards in Education) inspections in fostering and residential children’s homes. 2.5. Introduction

Children and young people who are looked after have profoundly increased health needs in comparison with children and young people from comparable socio-economic family backgrounds who remain at home. Looked after children are frequently reported in research, policy and data to have greater needs than their peers with regard to their physical, sexual, emotional and mental health needs. They need to receive healthy care in settings that actively promote health and wellbeing for looked after children and their carers and involve them in designing and transforming services that actively engage them and meet their health needs. Looked after children should live in settings that promote their health, with staff and carers that are trained and supported in this area. They should have access to effective and timely health assessments, treatment, information, support and care. Looked after children should be given all opportunities to develop the personal, social and life skills necessary to care for their own health and wellbeing, now and into the transition into adulthood. This guidance recognises that the most important promoters of health are the staff and carers who look after and/or have regular face to face contact with children and young people. For looked after children’s health to be effectively promoted and for good health to become a


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reality, staff and carers will need to provide children and young people with accurate information, support, guidance and networking and meaningful involvement in formulating and achieving their own health plans and achieving good health.


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Section 3 – Procedure Index ACTION PERSON

RESPONSIBLE TIMESCALE

1. When a Child or Young Person Becomes Looked After 1.1. Prior to any child or young person

becoming looked after, basic factual health information needs to be collated, and inserted into Essential Information Form Part 1. This information needs to be collected in a sensitive manner from the child’s parents/carers so it can be passed on to the staff/carers who will be caring for the looked after child/young person. All too often there are gaps in a looked after child’s health history, which gives uncertain, or misinformation to the staff/carers who are looking after the day to day care needs of the child.

Child’s Social Worker

Prior to child/young Person becoming looked after

1.2. Consent to Medical Treatment Form This form needs to be completed with the child/young person’s parents after discussing the need to have appropriate consent for any emergency medical treatment that might be necessary. In some circumstances the child will be able to give consent without referral to their parents/carers e.g. when the child is considered to be competent according to the Fraser rules. These rules set out that children who are under 16 are competent to give valid consent to a particular intervention if they have sufficient understanding and intelligence to enable them to understand fully what is proposed and are capable of expressing their own wishes (see Tameside Safeguarding Framework for further information).

Child’s Social Worker Prior to child/young person becoming looked after.


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1.3. All necessary health information on PROtocol needs to be completed fully. This includes details of immunisations, forthcoming appointments, treatments, any medication, family history of illness and children’s health records and information from health Visitors or GP’s.


Prior to child/young person becoming looked after or by latest 10 working days after child is admitted to care.

1.4. All relevant health professionals need to be informed when a child becomes looked after, and need the necessary information relating to the background and circumstances of the looked after child/young person.

Child’s Social Worker As soon as possible.

1.5. On becoming looked after, all children and young people over the age of 5 will be given a LAC book on their health and how carers and staff will promote this.

Child’s Social Worker Within 3 days of becoming looked after.

2. Placement Agreement for Looked After Children 2.1. All children placed with Tameside

contract foster carers, need a Placement Agreement Meeting. The purpose of the Agreement Meeting is to discuss the child/young person’s needs, the aims of their care plan, and who will be responsible for all of the day to day care of the child/young person (ie transport, pocket money, attending school, contact and health appointments.


Within 72 hours of child/young person becoming looked after.

2.2. Foster carers must be fully informed of all a child/young person’s health needs and agreement made as to who will organise and take the child/young person to all necessary health appointments.

Copies of the Placement Agreement should be circulated to the carer/carers supervising Fostering Social Worker, child/young person, parent, child’s Social Worker.

Child’s Social Worker Child’s Social Worker/Fostering Social Worker

At Placement Agreement Meeting. To be chaired by Fostering Team Manager or Assistant Team Manager. Within 5 working days of Agreement Meeting.


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2.3. Placement Agreements should document how the carers home environment actively promotes a healthy lifestyle, and which sports, leisure activities, in school and out of school activities carers will be supporting children and young people during their placement.

Child’s Social Worker/Fostering Social Worker

At Placement Agreement Meeting

3. Registering Looked After Child/Young Person with a GP and Dentist

3.1. Foster carers and children’s home

care staff will ensure that the looked after child/young person is registered with a local GP and dentist.

This is essential in order to provide the child/young person with comprehensive health care whenever this becomes necessary.

Foster Carer/Residential Child Care Staff

Within first 5 days of placement.

3.2. Foster carers and child care staff are responsible for ensuring that those in their care attend all health, medical and dental appointments. Often this will mean accompanying them and supporting them with appointments that may make them feel anxious and provide the health professional with any relevant information that is needed.

Foster carer/ResidentialChild Care Staff

Ongoing

3.3. Carers/child care staff should ensure that opticians appointments are also attended regularly and recorded.

Foster Carer/Residential Child Care Staff

Ongoing.

3.4. Foster carers and residential child care staff must keep an accurate and dated record of all health issues and treatment relating to the looked after child/young person and ensure this record along with any health concerns the carer/staff may have in respect of the child/young person are presented at Statutory Child Care Reviews. Supervising social workers from the Fostering Team will visit carers monthly and supervise them on health promotion activities, training, contacts, materials and advise to

Foster Carer/Child’s Social Worker Fostering Social Worker

Ongoing Monthly


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ensure all health needs are met and evidenced routinely. Social Workers should also be checking all health information during their regular statutory 4 weekly visits.

Child Care Social Worker

Monthly

3.5. Looked after children’s social workers need to be informed of any health and dental issues relating to the looked after child/young person, whether this is treatment needed or that has been carried out.

Foster Carer/Child Care Worker

Immediately

3.6. Children and young people should be fully involved in discussions and decisions regarding their health care in accordance with their age, understanding and in consultation with the child’s social worker, including issues around eating, hygiene, alcohol and drug use, mental health and hygiene.

Foster Carer/Residential Child Care Worker (in conjunction with Social Worker).

Ongoing

4. Routine Health and Medical Assessments for Looked After Children and Young People 4.1. An initial medical assessment should

take place within 14 days of children/young people entering the care system. If a child/young person has however recently been assessed under the Assessment Framework as a child in need, the assessment should ensure there are no gaps in information, but if the child/young person has had a health assessment by a suitably qualified doctor in the previous 3 months, a new assessment is not always deemed to be necessary.

Child’s Social Worker Child’s Social Worker to discuss with Team Manager

Within 14 days of becoming looked after. Within first 5 days of child/young person becoming looked after

4.2. A health assessment should be in place in time for a written report and health plan to be available for discussion at the child/young person’s review, 4 weeks after the child starts to be looked after. A ‘Health Plan’ should then be produced.

Child’s Social Worker For child’s first Statutory Review.


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4.3. A leaflet devised by looked after children/young people explaining health assessments should be given to all children/young people (over the age of 5) when they first become looked after.

Child’s Social Worker Within first 4 weeks of placement.

4.4. The first health assessment should be undertaken by a suitably qualified medical practitioner and may include a physical examination, but later health reviews may be carried out by a LAC nurse or school nurse.

Suitably qualified doctor or LAC Nurse

Ongoing

4.5. All children from birth to five years have a ‘child health record’ given by the health visitor when the child is born. Carers and child care staff need to obtain this and ensure it is added to/kept safely/and taken to all relevant health appointments.

Child’s Social Worker Foster carers and child’s social worker

Within 3 days of child being looked after Ongoing

4.6. Children’s Health Assessments should always be child focussed and take into account the particular needs of the child/young person and their family or carers, particularly in relation to issues of gender, disability, sexual orientation, race, language and culture.

Doctor and nurses facilitating health assessments

Ongoing

4.7. The assessments should be carried out at a time and venue convenient to the child/young person and their carers and parents and be carried out in a way that facilitates the child/young person’s participation. This may mean in some circumstances appointments outside school, college and work are necessary, and various venues for appointments offered.

Doctor and nurses facilitating health assessments (co-ordinated by lead LAC Nurse).

Ongoing

4.8. Health Assessments should review immunisation status and any missed health screening episodes including dental and oral health.

LAC designated doctor and nurses Child’s Social Worker and Independent Reviewing Officer to check all information is complete.

Ongoing Ongoing


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Identify mental health, emotional difficulties and any developmental concerns, and discuss lifestyle issues in some depth with adolescents

LAC designated doctors and nurses.

Ongoing

5. Promoting Children and Young People’s Mental Health

5.1. Looked after children and young

people and their carers need access to a full range of child and adolescent mental health services (Child and Family Therapy Service), that will support the promotion of good mental health as well as reduce the impact of established mental health difficulties on their lives. Many of our looked after children will have been or be experiencing grief and loss by virtue of being a looked after child or young person.

• Secondary consequences associated with poor mental health such as poor placement stability, low self esteem, low school attendance and drug misuse are key for looked after children.

• Therefore everyone who cares for, and works with looked after children and young people has a responsibility to promote mental health, be trained to recognise the symptoms of distress and mental health disorders in children and young people and know how to access the necessary additional advice, support and therapeutic input when required.

Child’s Social Worker/Fostering Supervising Social Worker/Residential Child Care Staff/LAC Nurse Child’s Social Worker/Fostering Supervising Social Worker/Residential Child Care Staff/LAC Nurse

Ongoing Ongoing

5.2. Health assessments should include information on every child and young person’s emotional wellbeing, with young people aged 16+ specifically targetted for additional Child and Family Therapy Service support.

Child/Young Person’s Social Worker

Ongoing

5.3. Tameside Child and Family Therapy Service is a multi-disciplinary service that offers assessment, treatment and mental health services to Children


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and young people aged between 0 and 19. (see Child and Family Therapy Service: Roles and Referrals CIN 4.15 Policy and Procedure for further information on what the service offers).

5.4. A range of assessment, therapeutic

interventions, consultations, group work and family work is available to looked after children and their parents, carers and professional network around every LAC.

Child’s Social Worker/Professional with best knowledge of child/young person

When a problem/concern is identified.

5.5. Child and Family Therapy Services often work with looked after children/young people’s carers as looked after children may be reluctant to engage with them directly. Monthly consultation surgeries are held in our in-house residential and fostering provision, and referrals to the 2 specialist LAC Mental Health Workers or the wider Child and Family Therapy Services are screened on a weekly basis.

Social Work Team Managers/ Child and Family Therapy Services

At point of referral.

5.6. Child and Family Therapy Services are offered in a variety of different locations in irder to increase access and reduce the stigma for children and young people in their families.

Social Work Team Manager/ Child and Family Therapy Services

Ongoing

5.7. The promotion of good mental health is determined by a healthy lifestyle environment and it is essential that looked after children’s self esteem is monitored by their carers, the children’s network built around them, and with children and young people themselves. Being given regular praise, being listened to, having their potential and strengths recognised and building on their interests is hkey for all chuldren in building resilence and good self esteem.

All Staff and Carers All Staff and Carers

Ongoing Ongoing