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7.6.1 Health Care Assessments and Plans

SCOPE OF THIS CHAPTER

This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for Looked After Children. Note that different provisions will apply in relation to children/young people who become Looked After solely by virtue of being remanded other than on bail - see Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Care Planning for Young People on Remand.

RELATED GUIDANCE

This chapter should be read in conjunction with DfE and DoH 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 - NICE Guidelines (NG26) - This guideline covers the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential settings and other accommodation, or on the edge of care. It aims to address the many emotional and psychological needs of children and young people in these situations, including those resulting from maltreatment.

RELATED CHAPTER

Remands to Local Authority Accommodation and Youth Detention Accommodation Procedure

AMENDMENT

In August 2017, the above link was added to Children’s Attachment: Attachment in Children and Young People who are Adopted from Care, in Care or at High Risk of Going into Care - NICE Guidelines (NG26).


Contents

1. Statutory Requirement
2. Care Planning Requirements in Relation to Health
3. The Responsibilities of Local Authorities and Clinical Commissioning Groups
4. Principles
5. Health Assessments
6. Frequency of Health Assessments
7. Assessment for Emotional and Behavioural Difficulties
8. Health Plans
9. Out of Area Placements
10. Role of Social Worker in Promoting the Child’s Health
11. Procedures
  11.1 Initial Health Assessment
  11.2 Review Health Assessments
  11.3 Non-Attendance
  11.4 Refusal
  11.5 Out of Area
  11.6 Medical Claims


1. Statutory Requirement

There is a statutory requirement that a child has an examination by a registered medical practitioner either within the three months before they are Looked After or as soon as practicable after beginning to be Looked After, unless the young person withholds consent. The same medical practitioner must provide a written health assessment for Children’s Social Care and for the new carers. The completed assessment report should be with Children’s Social Care in time to inform the first LAC review.

The aim of this requirement is to provide a comprehensive health profile of the child and provide a basis for monitoring the child's development while he/she is being Looked After. In Newcastle the child should be examined by the community child health doctor most likely to know the child and the birth family.


2. Care Planning Requirements in Relation to Health

Responsible authorities are required to provide good health care for the child and the arrangements to monitor the child’s health care, in accordance with the health plan. Health care includes:

  • Medical and dental care and treatment; and
  • Advice and guidance on health, personal care and health promotion issues.


3. 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.


4. 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 Area Placements Procedure), the ‘originating CCG’ remains responsible for the health services that might be commissioned.


5. Health Assessments

Each Looked After child or young person has to have a medical assessment when they first come into care and then on a regular basis (see Section 6, Frequency of Health Assessments below) and the Local Authority is required to make arrangements for these to take place. A registered medical practitioner should carry out an initial assessment and provide a written report of the assessment. However, subsequent assessments may be carried out by a registered nurse or midwife so long as it is done under the supervision of a medical practitioner, who should provide the social worker with a written report.

The aim of the assessment is to provide a comprehensive health profile of each child/young person and to identify issues that may have been overlooked in the past and need addressing to improve their physical and mental health and well-being.

In order to fulfil this duty the Local Authority has to work very closely with the Clinical Commissioning Group (CCG) and inform them as well as GPs, if a child has come into care or has changed placement.

In order to inform the actions in the Health Plan, the health assessment should include:

  • An assessment of child’s state of health including his/her physical, emotional and mental health;
  • The child’s health history including, as far as practicable, the child’s family’s health history;
  • The effect of health and health history on the child’s development;
  • Existing arrangements for medical and dental care, appropriate to the child’s needs, including:
    • Routine checks of the child or young person’s general state of health;
    • Treatment and monitoring for identified health or dental needs;
    • Preventive measures such as inoculations;
    • Screening for defects of vision or hearing.
  • Advice and guidance on promoting health and effective personal care;
  • Planned change to current arrangements.


6. Frequency of Health Assessments

The first assessment should take place and the written report completed before the child is first placed. However, if this is not possible then the assessment and a written report should be completed before the first Looked After Child Review of the child’s case - within 20 working days of the commencement of the placement.

Subsequent health assessments should take place:

  • At least once every six months in the case of children aged under five;
  • At least once every 12 months in the case of children aged five and over.

If a health assessment has been carried out within the three months prior to the commencement of the placement and a written report has been received that meets the statutory requirements then a further assessment need not be completed in time for the placement or first review. The cycle of future assessments must start from the date of the first review.

It is good practice to involve the parents in health assessments to provide an opportunity to obtain child and family health history directly as well as to obtain consent to gather further necessary information from GPs, consultants and hospitals. Having a complete personal and family health history will considerably enhance the value of all current and future health assessment and facilitate better awareness of health needs when a child returns home or in future placements.

Where a child is provided with accommodation by the responsible authority under Section 20, the parents must be given the opportunity to be involved in the child’s Health Assessment.

If a child or young person refuses a health assessment, and it is decided that they are of sufficient understanding to do so, there is no requirement to carry out a health assessment. However, in these cases the child or young person’s health should still be considered as part of the care planning and review process. The child or young person is more likely to attend if supported and the assessment is designed to address the issues that are of most important to them. A suitable and accessible environment will also help enable attendance.


7. Assessment for Emotional and Behavioural Difficulties

Understanding a Looked After Child’s emotional, mental health and behavioural needs is as important as their physical health. From April 2008 all Local Authorities in England have been required to provide information on the emotional and behavioural health of children and young people in their care. CCGs and Mental Health Trusts have a duty to support Local Authorities to make sure this process is carried out in a way that best reflects the needs of the child or young person.

All local authorities are required to use the Strength and Difficulty Questionnaires (SDQs) to assess the emotional needs of each child. A Strengths and Difficulties Questionnaire (SDQ) is completed for each looked after child or young person aged between 4 and 16 inclusive. The questionnaire should be completed by the main carer, preferably at the time of the child’s statutory annual health assessment.

The SDQ Questionnaire, along with any other tool which may be used to assist, can be used to identify the needs and be part of the child’s Health Plan.

SDQ’s should be used when placements commence and built into the annual health assessment. SDQ’s are a reliable and valuable screening tool for mental health problems and can be helpful in uncovering previously unidentified mental health problems and may be useful in supporting referrals to Child and Adolescent Mental Health Services (CAMHS).

(See Annex B of the ‘DfE and DoH Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015)’, Strengths and Difficulties Questionnaire).


8. Health Plans

The Health Plan is developed from the assessment of child’s needs and forms health dimension of the Care Plan which is recorded on the ICS data base.

The content of the health plan will vary according to the age and development of the child. The content should reflect the issues that are addressed at the health assessments including physical and emotional health. It should specify those actions to be taken and services provided to meet the health needs identified in the assessment; the person or agency responsible for undertaking each action/providing each service; the likely timescales and the intended outcome.

This Plan must be reviewed after each subsequent Health Care Assessment and at the Looked After Child Review or as circumstances change.


9. Out of Area Placements

Where an Out of Authority placement is sought, the responsible authority should make a judgment with regard to the child’s health needs and the ability of the services in the proposed placement area to fully meet those needs. The placing authority should seek guidance from within its own partner agencies and the potential placement area to seek such information out.

The originating CCG, the current CCG (if different) and the proposed area’s CCG should be fully advised of any placement changes and to ensure that any health needs or heath plan are not disrupted through delay as a result of the move.

Where these are Placements at a Distance the Care Planning, Placement and Case Review (England) Regulations 2010 make it a requirement that the responsible authority consults with the area of placement and that Director of the responsible authority must approve the placement.

Where the child’s health situation is more complex, it is likely that both health and Social Care services will need to be commissioned; this will need to be undertaken jointly within the originating agencies’ respective fields of responsibility together with the health  and social care services in the area where the child is placed.


10. 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:

  • 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 carers 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.


11. Procedures

If there is evidence of previously undiagnosed abuse, Child Protection procedures should be followed, please see Newcastle Safeguarding Children Board Procedures Manual.

11.1 Initial Health Assessment

The process detailed below must be followed for all planned/unplanned placements of Looked After children.

Social Worker:

  • Initial request to Placements;
  • Completion of Request for Placement Form;
  • Completion of Initial Health Assessment Form - this is an age related form;
  • IHA - C Initial health Assessment on child aged 0 - 9 being looked after or referred to adoption;
  • IHA YP Initial health Assessment on child or young person aged 10 or over, being looked after or referred to adoption;
  • Completion of CoramBAAF Consent Form - This form should only be completed once for each child. This form must be completed and signed by the parent/carer when completing the Placement Plan and Placement Agreement;
  • Completion of CoramBAAF forms M/B Neonatal and obstetric where applicable;
  • Completion of CoramBAAF form BH report on birth parent where applicable.

Parent/Carer:

  • Consent form signed by Parent/Carer.

The Social worker will forward the following forms to Placements:

  • Placement form;
  • Completed Initial Health Assessment;
  • Placement Plan;
  • Placement Agreement Form;
  • Signed CoramBAAF Consent Form;
  • Completed CoramBAAF form M/B where applicable;
  • Completed CoramBAAF form B/H where applicable.

Placements

  • Check all relevant details on IHA and forward to Lac Health Administration (LAC/YPHT).

LAC/YPHT

  • Liaises with appropriate doctor;
  • Posts appointment letter to foster carer direct;
  • Informs the social worker of appointment details, either via a copy of appointment letter or by fax;
  • Obtains community health records (I0m or Health Visitor record & Special File, hospital records if available and computer printout);
  • Supplies doctor with age appropriate Initial Looked After Medical Pack.

The Community Paediatrician will carry out all Initial Health Assessments for Looked after Children.

11.2 Review Health Assessments

School Health Advisors (SHA) will carry out all review health assessments for LAC who are of school age and attending school during term time. Therefore all Review Health Assessments for these looked after children will have to be with the SHA’s before the start of each school term.

Health Visitors will carry out review health assessments on all children not yet attending school who are looked after within the Newcastle area, on a month-by-month basis. Reminders will be sent as normal from Children’s Social Care on a monthly basis.

Note that review health assessments will be carried out by the School Health Advisors (SHA’s) if the looked after child is of school age, unless the Doctor feels that there is a medical reason for the child to be seen by a Community Paediatrician. If the child attends school in Newcastle they will be seen by the SHA, if the child attends a school in a nearby authority i.e. Whitley Bay then a reciprocal arrangement will be made for the local SHA to carry out the assessment.

Arrangements for the Review Health Assessments for looked after children placed in out of authority placements will only be organised by Looked After Children/Young Peoples Health Team (LAC/YPHT). It is not the responsibility of Social workers to arrange these appointments direct.

Administrative Assistant

  • 8 weeks before start of term a CoramBAAF consent form must be sent out with a stamped addressed envelope to the Parent/Carer for signature. A covering letter should accompany the consent form to the Parent Carer for completion within 2 weeks. This consent form is to obtain permission from the parents to share information on the child.

NB If Parent/Carer refuses to sign or the form is not returned then the form should be signed by the child’s social worker, who will have parental responsibility for the child on behalf of the local authority.

  • 8 weeks - Administrative Assistant to notify worker if form is not returned within 2 weeks SW to contact parent/carer and follow up, if parent/carer refuses to sign the consent form, then SW to sign on behalf of the local authority;
  • 6 weeks - All Review Health Assessment forms for:
    • School age children - Forms to be completed in detail before the start of the next school term, with all relevant sections completed, ensuring that details of the school and the Carers GP are completed. Please note that if a child is between schools, detail which school the child will be likely to attend;
    • Pre-school Children - Forms to be completed 6 weeks prior to the date of the Review Health Assessment. Forms to be forwarded to the LAC/YPHT at least one week prior to the date of the health assessment.
  • 4 weeks - The forms should then be forwarded to LAC/YPHT for recording and distribution to SHA’s, HV’s and Other Health Authorities etc. It is essential that the forms be in the clinics waiting for the SHA’s at the start of each school term. The SHA will arrange an appointment with the child, and no notification will be sent or given to the social worker. All arrangements will be made with the child, foster carer or residential home;
  • The LAC/YPHT will follow up all outstanding requests with the SHA’s. Administrative Assistant staff must consult or contact LAC/YPHT if they have any queries in future. Administrative Assistants in Children’s Social Care will not be required to do any follow up of outstanding assessments for children who are of school age.

Looked After Children/Young People’s Health Team

  • All completed forms will be returned to the LAC/YPHT at the NGH;
  • LAC/YPHT will forward a copy of the Health Action Plan (HAP) to:
    • Relevant social work team;
    • Administrative Assistant contact;
    • Child;
    • Carer (as appropriate);
    • GP;
    • Person who completed the review health assessment (SHA, HV).

LAC/YPHT will follow up all appointments where the child failed to attend, and ensure that the ineffective visits procedure is followed.

Administrative Assistant

On receipt of the Health Action Plan the Administrative Assistant will be required to update CareFirst,and local reminder systems with the relevant information, forward a copy to the social worker for the child/young person’s case file and retain a central copy.

11.3 Non-Attendance

If the child or young person fails to attend on two occasions without an explanation, there will be a request made to the social worker by Designated Nurse for LAC to follow up reasons for non-attendance before a further RHA is arranged.

11.4 Refusal

If the young person refuses to have a health assessment, the Designated Nurse for LAC will contact the social worker to confirm that the child has refused. He/She will then send a letter to the young person, reminding him/her that we will offer an appointment on an annual basis as long as he/she continues to be looked after, a copy of this letter will be send to the Administrative Assistant (SSD), young person, carer, social worker and SHA. Administrative Assistants will need to continue to keep the young person within the review system and forward the forms to health as usual on an annual basis.

11.5 Out of Area

LAC/YPHT will continue to make the arrangements for review health assessments for all looked after children placed outside of the city.

(Social workers must not make their own arrangements with Carers and GPs for health assessments to take place).

11.6 Medical Claims

Any claims/expenses from other authorities or Doctors for carry out LAC health assessments will be reimbursed by Children’s Services. An invoice or claim form should be sent to the appropriate social work office. An expenditure approval form and fin 2 should be completed and authorised. Staff should use budget code 1MB09/E796 (assessment expenses for children, general purchasing) for any claims, and ensure that a copy of the information is held on site for audit purposes.

End