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4.7.1 Health and Medical Needs of Looked After Children

SCOPE OF THIS CHAPTER

This procedure outlines the health requirements for Looked After Children.

For further information see also the revised DH Statutory Guidance "Promoting the Health and Wellbeing of Looked After Children 2009"

Issue Date: March 2010

AMENDMENT

This chapter applies to all Looked After children and was updated in June 2011 in response to the changes set out in the Care Planning, Placement and Case Review (England) Regulations 2010 (Care Planning Regulations) and Associated Guidance.


Contents

  1. Introduction
  2. Departmental Policy
  3. Access to Health Care
  4. Statutory Health assessments: The Child's Health Report
  5. Health Records
  6. Consent to medical examination or treatment


1. Introduction

1.1 The aim of this policy is to promote the health and development of children and young people looked after by Ealing Children's Services.  It sets out the procedures that must be followed for all children who are looked after.
1.2 Each child who becomes Looked After must have his or her first Health Care Assessment completed within 20 days of first becoming Looked After - in time for the first Looked After Review unless a Health Care Assessment has been done within the previous 3 months.


2. Departmental Policy

2.1 Ealing Council are committed to ensuring that our looked after children have the opportunity to enjoy a standard of health and development as good as all children of the same age living in the same area. (Every Child Matters-Be Healthy Objective) Health care can be taken to mean a positive approach to a child's health, which would include general monitoring and care of health and developmental progress, as well as treatment for illness and accidents
2.2 It is essential that carers be provided with details of the child/young person's health history and status of placement.  In particular, allergies, medication, etc. The Individual child health record should be kept by the person providing the child's day-to-day care and updated at each health appointment.  Carers have the responsibility of ensuring that children's developmental progress is monitored. This includes dental, optical and immunisations. Health care must be provided as set out in this procedure.  Regular visits to the clinic are essential for young children to ensure that progress is monitored.  If they do fall behind developmental milestones then the earlier this is identified the sooner diagnosis of the problem can be made and treatment can begin.


3. Access to Health Care

3.1

GP
  3.1.1 All children must be registered with a GP as soon as possible. If the child is likely to be in placement for at least 3 months, they should be permanently registered so that their previous file can be obtained. The local Health Authority can assist if there is any difficulty.

3.2


Dentist
  3.2.1 All children and young people should be seen by a dentist every 6-12 months. NHS dentists provide free dental care for children under 16 years. The community dental clinics can provide assistance in finding a NHS dentist and in some cases can provide the treatment needed.

3.3


Optician
  3.3.1 All children and young people should have an annual eye test with an optician.

3.4


Emergency medical treatment
  3.4.1 All children and young people should be taken to their GP or to the local A&E department for emergency medical care. NHS Direct  provides telephone advice if needed

3.5


Child health promotion
  3.5.1 All children have access to a health visitor till the age of 5 and a school nurse till they leave school.  During visits, preventative advice is given, developmental and physical concerns are screened for and referrals made when needed.
  3.5.2 Ealing Health Authority provides the following health monitoring programme: it is the responsibility of foster carers and key workers to ensure that children have these assessments.  Social workers must monitor by recording dates of completion.  This information will also be recorded in the child's red book by the GP and Health Visitor.
 
3.5.3


Monitoring

Age of child     Type of monitoring:

 

Newborn-10 days

 Midwife to see baby in the home at least once. Statutory duty up to 28 days if required
2 - 4 weeks Midwife hands over to Health Visitor   
4 - 6 weeks check at home or clinic (by 4/12/06 all Health Visitors have to do)
6 -8 weeks physical and developmental check by GP or community medical officer
8 months developmental assessment by Health Visitor including hearing test
2 years 6 months   developmental assessment by Health Visitor


NB. Targeting of families takes place if any concerns. May involve regular visit or compulsory clinic attendance)

 
  3.5.4

Immunisations

All children should receive the recommended schedule of immunisations to prevent infections, which can have serious complications. Further information available at the Department of Health website

When Disease Vaccine
Two Months Diptheria, Tetanus, Pertussis, Polio, Pneumococcal Haemolpihilus Influenzae conjugate (PCV) type b (Hib), Pneumococcal infection DtaP/IPV/Hib
Three Months Diptheria, Tetanus, Pertussis, Polio, Haemolpihilus Influenzae conjugate (PCV) type b (Hib), Meningitis Group C

DtaP/IPV/Hib

Men C

Four Months Diptheria, Tetanus, Pertussis, Polio, Haemolpihilus Influenzae conjugate (PCV) type b (Hib), Pneumococcal infection, Meningitis Group C

DtaP/IPV/Hib

Men C & PCV

12 Months Haemolpihilus Influenza type B (Hib), Meningitis C

Hib

Men C

13 Months

Measles, Mumps and Rubella (German measles)

Pneumococcal infection

MMR and PCV
3 years- 5 years Diptheria, Tetanus, Pertussis, Polio, Measles, Mumps and Rubella

DtaP/IPV

MMR

12-13 years (Girls only) Cervical Cancer HPV
13-18 years Tetanus, Diptheria and Polio Td/IPV

 
  3.5.5 In later childhood and adolescence, health education is taught within the school curriculum. Children who are not attending school and have had numerous changes in their schooling may not receive this input.
  3.5.6 It is important that carers and social workers promote healthy lifestyle choices and support all aspects of health education e.g. diet, exercise, drug and alcohol use, sexual health, emotional well being.

3.6


Specialist Services Supporting Children and Young Peoples Health
  3.6.1

Children and Adolescent Mental Health Service (CAMHS)

  1. This service works with children, young people and families with social, emotional, behavioural or mental health issues, in order to prevent matters becoming more serious. Specialist multi-agency support is available from social workers, family therapists, psychologists and psychiatrists. The service is currently under review and re-design in order to improve access and outcomes.
  2. A referral may be made to the CAMHS service that is local to the child's placement. 
  3.6.2

Looked After Children's Nurse

  1. Social Workers and Ealing's looked after children have access to the services of the Looked After Children's Nurse for health advice, education and support. The nurse can be contacted at Carmelita House.
  3.6.3

Teenage Pregnancy Service

  1. A Teenage Pregnancy Co-ordinator is responsible for delivering on the National and Local Teenage Pregnancy strategies. The co-ordinator works across Social Care, Health, Education and other agencies towards reducing the number of teenage conceptions. Increasing support to teenage parents is a focus in order to reduce the risks of long term social exclusion. Emphasis is placed on work to assist teenage parents with education, training and employment.
  3.6.4

Substance Misuse Service

  1. This service provides consultation, evaluation, education, counselling, training and support to all teams (and carers) in Children and Families regarding substance (drugs, alcohol) misuse. The team focuses on prevention and harm reduction. The team works closely with health, mental health, criminal justice and wider substance misuse services.
  2. Referrals to the service can be made via the Adolescent Service
  3.6.5

Looked After Children's Clinical Psychology Support

  1. This service has been set up by Ealing Children's Services in collaboration with Ealing Child and Adolescent Mental Health Services in order to improve the emotional and psychological wellbeing of looked after children
  2. The service offers;
    • Consultation and support to social workers, link workers, foster carers and residential staff to decide how to best help looked after children and young people who have emotional and behavioural difficulties. This includes help in identifying and accessing appropriate mental health services for children who are placed out of borough.
    • Training to social workers, link workers, foster carers and residential staff on relevant psychological issues and behavioural management.
    • Psychological Assessment of looked after children and young people. These assessments can be used to decide if there is a need for therapeutic input and also to assist in the care planning for looked after children.
    • Therapeutic work with looked after children and young people either individually or jointly with their foster family.
  3. How to make a referral
    1. Any Social Worker or Supervising Social Worker with concerns about a looked after child or young person can make a referral to the service. Other professionals, the young person or their foster carer can also request help from the service and can do this by contacting their social worker who will then initiate the referral.
    2. Please phone the service first for a telephone consultation about the child or young person you are worried about. This will help to determine whether making a referral to this service would be the best way forward.
    3. Following the telephone discussion, a referral can be made by completing a referral form. These are available from your team administrator or from the Psychological service. Completed referral forms should be posted or e-mailed to Tamsin Owen, Child Clinical Psychologist, Perceval House, 2nd Floor Plum Zone, 14-16 Uxbridge Road, Ealing, W52HL.
    4. The referral will be acknowledged within two weeks of receipt.
    5. Once any assessment or therapeutic work has been carried out, you will receive written reports detailing any findings and intervention plans.
  3.6.6 Every looked after child will also have a 'strengths and difficulties' questionnaire completed annually in order to monitor emotional/mental wellbeing.


4. Statutory Health assessments: The Child's Health Report

4.1 The Child's Social Worker is responsible for ensuring medicals are completed and the required medical information is obtained. 
4.2 It cannot be emphasised strongly enough the importance of obtaining as much health information and family history as possible. Early health information is not only needed to provide current health care, it is essential in planning for long term placements and helping permanent carers deal with issues which may occur later. Research shows that adults who were separated from their birth families in early childhood often become anxious about their own or their children's health when they do not have access to their early health history.

4.3


Initial Health Assessments
  4.3.1

When a child first becomes looked after the following medical forms should be completed;

  • FORM IHA -C Initial Health Assessment (children aged up to 9 years) plus one of the following Annex forms according to age.
  • ANNEX to FORM C - Emotional & Behavioural Development of Children (for children aged up to 5 years) or
  • ANNEX to FORM D -Emotional & Behavioural Development of Children (for children aged 6-10 years) should be completed by the child's carer and should be seen by the doctor carrying out the examination and be sent to the medical advisor.  OR
  • FORM IHA-YP - Initial Health Assessment (young people aged 10 and over
  4.3.2 These should be completed within 20 working days of the child becoming looked after. These medicals are completed at either Mattock Lane or Ravenor Park Health Clinics if the child is placed in Ealing and by a GP if the child is placed outside Ealing.
  4.3.3 The Area Deputy Team Manager Administration will send the carers the appropriate Medical form. The Social Worker will send any Statement of Special Education needs and Medical Consent forms. The carer books the appointment with the clinic or GP directly and accompanies the child.
  4.3.4 The carer needs to be given as much written background information as possible so that this can be given to the doctor undertaking the examination, for example, neonatal discharge summaries if the child had previously been in hospital, clinic letters. The carer should ensure that the child's health record (red book) is seen by the doctor.
  4.3.5 The Deputy Team Manager Administration will ensure that the basic details on the form are completed before this is sent out to the carer.  The completed medical form is returned to the Deputy Team Manager - Administration for recording and is then sent to the Borough Medical Advisor for comments and completion of the Health Assessment Plan (HAP).

4.4


Review Health Assessments
  4.4.1 Ongoing Statutory Health assessments should be completed every 6 months for children under the age of 5 years and annually for children over the age of 5 years.
  4.4.2

The following medical forms apply to review medical assessments;

  • Form RHA-C - Review Health Assessment (Children aged up to 9 years) plus one of the following Annex forms according to age.
  • ANNEX to FORM C - Emotional & Behavioural Development of Children (for children aged up to 5 years) OR
  • ANNEX to FORM D -Emotional & Behavioural Development of Children (for children aged 6-10 years)   should be completed by the child's carer and should be seen by the doctor carrying out the examination and be sent to the medical advisor. OR
  • Form RHA -YP - Review Health Assessment (young people aged 10 and over. 
  4.4.3 These should be completed every six months for a child under 5 and annually for children over 5.  These medicals are completed by either the LAC Nurse or if living outside Ealing by a GP.
  4.4.4 The area team Deputy Team Manager Administration will send the carers the appropriate medical form and a copy of the previous completed medical. The Deputy Team Manager - Administration will ensure that the basic details on the form are completed before this is sent out to the carer.  The completed medical form is returned to the Deputy Team Manager - Administration for recording and is then sent to the Borough Medical Advisor for comments and completion of the Health Assessment Plan (HAP).

4.5


Medicals for children who are being adopted or permanently fostered
  4.5.1 The most recently completed medicals can be used when adoption and permanent fostering is being considered by the adoption and permanency panel.  In circumstances where a medical is over six months old Social Workers should contact the Medical Advisor to confirm if the medical is still acceptable or an update is required.
  4.5.2 For children under the age of 5 years old where adoption is being considered Form M & B Obstetric Report on the mother and neonatal report on child should be completed. This form is completed by the hospital where the child was born. If the child was born at Ealing Hospital, the Midwifery Manager completes these. Each hospital has a designated Child Protection Nurse and Midwife who can advise about how the best person is to liaise with. If you experience difficulties obtaining these forms, please liaise with the agency medical advisor. The mother's consent is needed for the information required for Form M. 
  4.5.3 Form PH Health Report on a Birth parent.  This form records the general health of the birth parent and their family.  This is completed by each birth parent together with the social worker. Birth parents should be encouraged to complete this form so that the child's health records are as complete as possible.
  4.5.4 It is essential that the relevant health examinations are undertaken and the completed forms seen and commented upon by the agency medical advisor in advance of the case being submitted to the panel. Please note that the medical examinations referred to are part of the normal LAC procedure and not anything additional. There is no such thing as an adoption medical and no need for children to have additional medical examinations providing that the medicals have been done within the LAC timescales.

4.6


Medicals for Children with Disabilities
  4.6.1 Children with a Disability or long-term medical problem who have regular follow up should have their health assessments completed by their own Paediatrician.  In these circumstances, the Social Worker should liaise with the central administration team to send out medicals appropriately.

4.7


Health Assessment Plans (HAP)
  4.7.1 Health Assessment Plan is drawn up by the Medical Advisor once she has considered the completed medical assessment forms. The Medical Advisor will make specific recommendations for actions that are required to take place for the child .  It is the Social Workers responsibility to ensure that the plans are followed and implemented.

4.8


Dental Examinations
  4.8.1 All looked after children should be registered with a dentist as soon as possible after placement.
  4.8.2 Children should visit their dentist every 12 months for a check up.
  4.8.3 The Deputy Team Manager - Administration will send out a request to the carer when a dental check up is due and will update the local authority records.
  4.8.4 The Deputy Team Manager - Administration will inform the Social Worker where the dental check is overdue and the Social Worker will then ensure that this is carried out as soon as possible

4.9


Ophthalmic Examination and treatment
  4.9.1 All looked after children should have an annual eye examination
  4.9.2 The need for and result of any examination and treatment should be considered at each statutory review and be included in the arrangements for health care in the Health Action Plan
  4.9.3 A child in full time education up to age 19 years will receive free services from an optician.

4.10


Hearing Examination and treatment
  4.10.1 A child's hearing is examined at age 8 months as part of the health surveillance programme and for all children looked after as part of the annual medical assessment (Form AME).  The need for a hearing examination should be considered when assessing health care in general
  4.10.2 The result of the examination and need for treatment should be considered at each statuary review and be included in the arrangements for health care in the revised service plan and agreement (Form SP1)
  4.10.3

Information is required regarding

  1. The child's state of health
  2. The child's health history
  3. The effect of the child's health and health history on his or her development
  4. Existing arrangements for the child's medical and dental care and treatment and health and dental surveillance
  5. The possible need for an appropriate course of action which should be identified to assist necessary change of such care, treatment or surveillance
  6. The possible need for preventative measures such as immunisation and screening for vision and hearing


5.Health Records

5.1 It is important that as much health information about a child is collected at the time of or soon after entry into care. Fragmentation of a child's health records exacerbates the difficulties in their accessing appropriate health care.
5.2 The health section on Frameworki should include the statutory health assessments and copies of any additional health related letters.
5.3 A health file on every child looked after will be kept with the medical adviser
5.4 The Social Worker must:
  5.4.1 Provide the foster carer with written information regarding the state of the child's health and need for health care and monitoring (including transfer of the child's parent held health record where possible.
  5.4.2 Ensure that the carer is aware of the required annual or six-monthly medical examinations
  5.4.3 Ensure that the carer is aware that medical information is strictly confidential
  5.4.4 Ensure that carers encourage children who are old enough to take an interest in their own health care
  5.4.5 Ensure that the Health Assessment Plan recommendations are implemented.


6.Consent to medical examination or treatment

6.1 Parents have the power to consent to medical or dental treatment on behalf of children who are too young to decide for themselves. 
6.2 If a child is accommodated under Section 20 of the children Act, the right to consent to medical examination and treatment remains with the child's parents.  Their consent should be recorded on the placement agreement form and the medical consent form.  However, if there are concerns about the possible implications for children of the parents withholding consent Social Workers should consult with their managers and the legal department. 
6.3 In circumstances where a child is looked after under S38/31 of the children act or the subject of an EPO, parents should always  be asked for their consent to medical examinations.  This consent should be recorded on the placement agreement form and the medical consent form.  If parents withhold consent Social Workers should consult with their managers and the legal department.  In most circumstances, the local authority can override the parents withholding consent if it is in the best interests of the child. However, the law regarding children who are the subject of Interim care orders is complex and should always be clarified with the legal department.
6.4 Young persons of 16 and over give their own consent to medical examination or treatment.
6.5 Young persons under 16 may also be able to give consent, depending on their capacity to understand the nature of the treatment; it is for the doctor to decide whether a young person is capable of giving informed consent.
6.6 Young persons who are judged able to give informed consent cannot be medically examined and treated without their consent.
6.7 It is important to encourage young people to understand the importance of health care and to support them in developing responsibility for their own health.  The LAC nurse is available at anytime for consultation and assistance in this area.
6.8 Where children are subject to care proceedings, no medical examination or assessment for the purpose of providing evidence in the proceedings may be undertaken without the courts permission.

6.9


Delegation of authority for urgent treatment and specified items of preventive treatment:
  6.9.1 Parents can authorise the Director of Children's Services or other named officer to give consent to urgent treatment and specified items of preventive treatment and can authorise them to delegate this power to carers.  This should be recorded on the placement agreement form and the medical consent form.   However, where possible, parents should be notified and consent sought before treatment commences.
  6.9.2  Where life is in danger, doctors may proceed without either the child's/ young person's consent.

End