Transcript Children Looked After – Medical Needs and Health Assessment

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.
Looked After Children – Medical Needs
and Health Assessment
There are 4 Sections to the information
module:
1.
2.
3.
4.
Background Information.
Health Assessments and Statutory
Guidance.
Summary of Health Assessment
administrative process.
Guidance on completing a health
assessment.
Looked After Children – Medical Needs
and Health Assessment
The objectives of the information module are:
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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.
Background
Information
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).
LAC – Impact of Abuse and Neglect
Affect 2/3rds of LAC:
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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.
Meltzer et al 2003
Looked at the medical and mental health
needs of LAC.
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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.
LAC Health
2/3rds LAC had at least 1 physical complaint.
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Speech and Language difficulties.
Enuresis.
Coordination Difficulties.
Sight difficulties.
Care Leavers – 16 to 18 years
More likely to have health problems
compared to peers.
Within 3 months of leaving care:
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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.
Care Leavers
More likely to become teenage parents:
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> 50% CLA become pregnant within 18-24
months leaving care, 25% in 1 year.
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3x’s incidence post-natal depression.
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25% low birth weight babies.
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60% higher infant mortality.
Health Assessments
and
Statutory Guidance
Health Assessments
DOH Guidance:
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Statutory.
Not a safeguarding medical.
Aim is to:
- Identify Health Needs.
- Identify Health Neglect.
- Promote Child Health.
Health Assessments
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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.
Health Assessments
DOH Guidance noted:
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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.”
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.
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.
Health Assessment Process
in
Hertfordshire
HA Process in Hertfordshire
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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.
HA Process in Hertfordshire
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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.
Advice on Completing
Initial Health
Assessments.
Health Assessments
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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.
Health Assessments
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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.
Health Assessments
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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.
Contact Details
Looked After Children and Care Leavers
Health Team.
Harpenden Memorial Hospital
Carlton Road
Harpenden
AL5 4TA
Tel:
Email:
Safe Fax:
01582 711561
[email protected]
01582 767235