Looked after Children (LAC): A Public Health Needs Assessment

 Aaron W. Bohannon MPH, CHES  Senior Public Health Manager  Leicestershire County Council Public Health Department, also providing PH function for Rutland County Council  Cancer and Tobacco Control lead HELLO, my name is

 Leicestershire is a rural county in the East Midlands and Leicestershire County Council (LCC) is a 2 tier local authority.  At present, we commission public health services on behalf of Rutland County Council (RCC), a small rural council and a Unitary authority.  Leicester City Council is also a unitary authority in the centre of Leicestershire County.  The issue (Public Health (PH) needs for LAC) is an LLR issue (indeed a national issue) but I am speaking as a representative of LCC.

 The proportion of children becoming looked after nationally has increased in recent years, and this is also the case in Leicestershire and Rutland.  In Leicestershire, 34 out of every 10,000 children under 18 (456) are LAC and in Rutland 44 out of every 10,000 children under 18 (34) are LAC.  The main reason for coming into care was abuse or neglect. Most are placed in Foster Care but around 10% live in residential placements.

 Looked After Children (LAC), or Children in Care, are an extremely vulnerable population and, as public health professionals and public servants, we have a duty of care for their health and their safety.  National studies have shown that Looked after Children (LAC) are much more likely to suffer mental health problems and to smoke, drink alcohol, take drugs and become sexually active at a young age than their peer group.  LAC also tend to have worse educational outcomes than their peers

 Following a report by the designated LAC nurse on the health of LAC, the stop smoking service was encouraged by Leicestershire Partnership Trust, LPT, to do some work with the care homes around smoking.  What, at first, seemed like simply providing cessation to staff and young people in a high smoking prevalence environment ended up revealing a myriad of issues; including using tobacco as a currency, bullying, links to fag houses and crime, Child Sexual Exploitation (CSE), safeguarding issues etc.

 In order to get some sort of handle on that and provide a possible way forward, PH felt it was appropriate to do a rapid health needs assessment for LAC.  Catherine Johns, the author, is a PH Specialty Registrar. Claire Turnbull is the Designated LAC Nurse.  The HNA was rapid, but comprehensive, due to the urgency of the issue. My understanding is that PH in Leicester City did similar.

 In the end, the HNA provided a good summary and baseline of where LAC health was in LLR;  Immunisation rates are similar to the national statistics.  Dental checks and health assessments are below the national average.  At any given time (high turnover changes population) smoking prevalence is estimated between %  The HNA put forward no less than 12 recommendations.

 Better data and information on LAC  LAC should be a Public Health Priority  Improve initial health assessment (IHA) times  Improve notification of out of area LAC  Use of the Strengths and Difficulties Questionnaire (SDQ) to measure mental health of LAC Recommendations

 Timely access to CAMHS – Commissioners and providers to develop plans to address  Sexual health commissioners and providers ensure better access to their services for LAC  Smoking cessation commissioners and providers should take into account the needs of LAC. Recommendations con’t…

 LA comprehensive tobacco control policy for children’s homes ideally includes private homes where beds are purchased and taking into account safeguarding and e-cigarettes.  Multiagency task group to look at the potential links between tobacco and bullying, grooming and exploitation in the context of children’s homes.  Better access for LAC to mental well-being services and early intervention  Improve the transition of LAC to adulthood Recommendations con’t…

 LAC health has been made a Public Health Priority area and we are working with Children’s and Family Services, and other partners, to address the recommendations.  Better information and data needs to be coordinated regionally and nationally but we are doing what we can locally.  Most progress so far has occurred with regards to smoking in LAC. Where are we now?

 From a smoking point of view, there is a multi-agency working group working on smoking and LAC. This includes tobacco free polices, fire safety, illicit, cessation, etc.  With all of the issues that could be addressed we agreed that one of the quickest things we could do was work with the house managers and related commissioners to strengthen their smokefree policy and enforcement.  Another important thing that has come out of this is a dedicated Tobacco Control worker housed within the stop smoking service and linked with the school nursing team and the LAC nurse team. Smoking and LAC

 Arm yourself with evidence.  Be patient but not complacent.  We need to recognise that this unfortunately isn’t new but it is HUGELY important.  None of the issues identified happens in a silo and the solutions won’t appear in one either. Food for thought…

E: P: Aaron W. Bohannon MPH, CHES