Health Needs of Unaccompanied Asylum Seeking Children(UASC) CLA Health Team Calderdale December 2016

Introduction Unaccompanied children seeking asylum are children and young people under 18 years who are applying for asylum in their own right due to fear and persecution in their home country and have become separated from their parent and where there is no adult to care for them in law. (Care of Unaccompanied and trafficked children 2014) UASC are defined as both unaccompanied asylum seeking children and unaccompanied refugee children who are Looked after Children and Young People.

National Dispersal Programme The National Unaccompanied Asylum Seeking Transfer Scheme has been created to enable the safe transfer of children from the receiving Local Authority into another allocated Local Authority from the 1st July 2016. This decision has been made by agreement of all Local Authorities to ensure a fairer distribution of children across all regions.

Dispersal Calculation A calculation has been made by the Home Office that when a child first enters the country and the place of entry has over 0.07% of UASC to child population the child will be eligible for the child transfer scheme. This will be managed by a central team who will decide the region and a regional team will then decide which Local Authority the child will be placed in. If the receiving Local Authority exceeds 0.07% of UASC that Local Authority will not receive any further children and will be able to access the transfer scheme.

Overriding Principle In all decisions the welfare and best interest of the child is paramount and will be the primary consideration in line with section 1(3) of the Children Act 1989.

Recognised health needs both from research and Public Health in Kent. UASC have significant physical, psychological and mental health needs. These are influenced by basic healthcare in their home country, experience of hardship, witnessing traumatic events and the duration and difficulty of their journey to the UK. Health Need Kent’s Experience Screening for Tuberculosis 70% screened Screening for Hepatitis B 100% screened Poor dental health 43% Visual disturbance/problem 35% Immunisations 100% needed full vaccination Psychological/mental health concerns 41%

Other Physical Health Needs Include; Poor nutrition and anaemia. Sexual health concerns, pregnancy, STI’s and need for contraception. Rashes, scars and fungal infections. Parasitic infection, lice and scabies. Musculoskeletal complaints. Smoking, drugs and alcohol dependency.   Most of the physical conditions that children present are non- urgent, emergency care was needed for respiratory illness in a number of cases.

Psychological and mental health issues. Most common concern; Post Traumatic Stress Disorder (PTSD) Anxiety Depression Sleep disturbance Nightmares and flashbacks   The experience from Kent referenced that most of the concerns around trauma and mental health difficulties had a delayed presentation. This needs to be taken account of when assessing children’s needs and the provision of services.

Calderdale :Local Picture Currently we have provided Initial health intervention to 11 UASC HEALTH NEED CALDERDALE Screening for Tuberculosis 11=100% Screening for Hepatitis B Poor dental health 3=27% Visual disturbance/problem Immunisations Psychological/mental health problems 1=9%

Additional Health Needs Kidney problems G.P registration Dental registration Interestingly there was no identified substance misuse, smoking or sexual activity….

Issues that need to be considered to meet health needs of UASC Quick response in relation to first assessment (IHA) Blood born virus screening. TB screening. Immunisations. Physical health intervention (impetigo / scabies etc) Mental health assessment and intervention (maybe immediate intervention or delayed) Follow up of interventions from IHA and completion of RHA Development of a health passport (as per statutory guidance Named health professional to ensure continuity and communication with relevant stakeholders / professionals. Quality Assurance of health assessments.  

Don’t Forget Safeguarding Issues Communication   Safeguarding Issues Unaccompanied Asylum Seeking Children are at higher risk being trafficked for CSE or modern slavery. These children are at a high risk of going missing. Girls may have been the victim of FGM and rape. All of these safeguarding issues need to be considered at the time of the Initial Health Assessment or at any other health contact. Communication It is likely that UASC will have none or very poor command of English. This will be taken into account for their placement and interpreters will be needed for every health contact.

References:- Care of unaccompanied and trafficked children (DfE 2014) Promoting the health and well-being of looked after children (DoH 2015) Unaccompanied Asylum Seeking and Refugee Children Briefing Note (HO 2016) Interim national UASC transfer protocol (HO DfE 2016-17) Health Needs Assessment – Unaccompanied children seeking asylum. (Kent Public Health Observatory 2016) The Health Needs of Unaccompanied Asylum Seeking Children and Young People (Simmonds and Merredew)  

Children Looked After Health Team Designated Nurse Named Nurse Designated doctor Administrator Contact the team 01484 728930