Sheila Morris Designated Nurse for Looked after Children Lancashire Care NHS Foundation Trust PSU Safeguarding Team Promoting the Health & Wellbeing of Looked After Children 2011.

2 About Children in Care Children in the care of LA’s are one of the most vulnerable groups in society. The majority of children who remain in care are there because they have suffered abuse or neglect. Promoting the Health & wellbeing of Looked After Children, Department of Health, 2009

Current LAC Numbers 65,520 looked after children at 31 March ,050 looked after children were adopted during the year ending 31 March 2011 BwD Figures 396 LAC

Looked After Children “Physical Health Needs” Two thirds of looked After Children have at least one physical complaint most commonly eye and or sight problems, bedwetting, speech or language problems, difficulty in co-ordination, and asthma. (Meltzer et al 2003) 52% of children Looked After for a year had a physical or health condition that required out- patient treatment. (Skuse et al 2001) Three quarters of children with a mental health disorder also had at least one physical complaint. ( ONS 2002)

Health Care Looked After Children The NHS has a clear role in ensuring the timely and effective delivery of health services to looked after children and young people. Under the Children Act PCT’s & LCFT have a statutory duty to comply with requests from Social Care to help them to provide support and services to children in need.

NHS Organisations The Children ACT expects NHS Organisations to provide:  Health Assessments.  Health Care Plans.  These should include: Family history, emotional and mental health assessment, physical health, personal care and health promotion.

 Good health care means more than the treatment of existing problems: it is also about recognising factors that may pose a risk to future health, and doing something about them  A holistic approach to health includes consideration of physical, sexual, emotional and mental health  It should also promote children’s general well-being, and provide them with the support to make informed decisions about their own health  Good health will have a positive impact on all other aspects of the child’s life, such as educational achievement Good Health

 LCFT looked after children’s health service aims to provide the children and young people, and carers with a flexible, easily accessible and holistic service. Health Service Aims

Statutory Health Assessments  An Initial Health Assessment should be undertaken within 28 days of a child/young person becoming looked after by a qualified medical practitioner Thereafter :  6 monthly review health assessments for children under the age of 5 by a registered nurse/midwife  Children/young people over the age of 5 yearly review health assessments by a registered nurse/midwife

Must include information on:  the child’s physical, emotional and mental health  the health history of the child and his/her family  effects of the child’s health on his/her development  arrangements for the child’s health care and treatment, including checks, preventive measures and health promotion  actions to be taken, who is responsible, timescales, and the intended outcomes  any planned changes to current arrangements  roles of all those who care for the child in promoting their health The Health Assessment Plan

Recent research on Health Assessments!! There is variability in the extent to which recommendations in the assessments had been implemented Many assessments appeared to function more to a disease screening exercise than as an opportunity to promote children's health There is considerable variability in the topics covered in initial health assessments, with nearly a quarter not including a complete health care plan ( Guidance on Promoting the Health & Wellbeing of LAC 2009)

Statistics LAC can move up to 20 times before adoptionLAC can move up to 20 times before adoption LAC 50% more likely to end up in prisonLAC 50% more likely to end up in prison 46% of young women and 59% of young men leave care with no educational qualifications46% of young women and 59% of young men leave care with no educational qualifications 25% of 16 year old girls leaving care have already fallen pregnant25% of 16 year old girls leaving care have already fallen pregnant ( British Association for Adoption and Fostering BAAF )

Statistics 66% of looked after children have at least one physical health complaint 45% have a mental health disorder, rising to 72% for those in residential care Many aspects of health worsen in the year after leaving care, including both physical and mental health and substance misuse

Issues  Gap in mental health provision for Children and Adolescents-SDQ  Initial health assessments gap in health provision (Paediatrician) for 16-18yr old LAC NEET/UAAS-signposted to GP’s

*If a child lives with criticism, he learns to condemn.  If a child lives with ridicule, he learns to be shy.  If a child lives with shame, he learns to feel guilt.  If a child lives with tolerance, he learns to be patient.  If a child lives with encouragement, he learns with confidence.  If a child lives with praise, he learns to appreciate.  If a child lives with security, he learns to have trust.  If children live with approval, they learn to like themselves and the world. Dorothy Law-Nolte ( ) Children Learn what they live.