1. CIC and Health Thresa McCarthy/Jill Sim Children in Care Nurses

2. Policy Context Healthy Lives, Brighter Futures: the strategy for children and young people’s health (2009) Statutory Guidance on Promoting the Health & Well-being of Looked After Children (2009) The NICE Quality Standard of the Health and wellbeing of looked-after-children and young people (2013)

3. Effects of Trauma and Neglect on the Child in Care These functions may be diminished or lost: language, especially spoken language words for feelings sense of meaning and connection empathy impulse control mood regulation short term memory capacity for joy

4. Physiological Effects Perpetual extreme levels of stress arousal may lead to: – hyper vigilance and loss of ability to concentrate – altered vision and hearing – hyperactivity or dissociation – avoidance of potential triggers to trauma – altered sleep patterns – altered eating patterns – compulsive self harm – attempts to self medicate with substances

5. What is the impact? Neglect and unmet emotional needs Children may: be slow to learn to walk and talk be very passive and unable to be spontaneous have feeding problems and grow slowly find it hard to develop close relationships be overfriendly with strangers find it difficult to make and sustain relationships be unable to play imaginatively think badly of themselves be easily distracted and find it difficult to learn

6. Children in Care - ‘ Physical Health Need’ Two thirds of Children in Care 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 in Care 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) (Quoted in the Guidance on Promoting the Health & Wellbeing of LAC, 2009)

7. Children in Care -“Lifestyle choices” DRUGS & ALCOHOL: In 2003 One in twenty with a mental health disorder drank alcohol daily One in five had used cannabis Next most popular substances were ecstasy and glue (ONS 2003) In 2007 5% identified as having a substance misuse problem of whom two thirds received treatment (formerly DCSF 2008 now Department for Education) In 2008 YP in care reported drinking alcohol, smoking and experimenting with sex at an early age but only 11% reported experimentation with drugs ( CAFCASS 2008 )

8. Children in Care “Lifestyle choices” Higher level of substance misuse, including smoking, among Children in Care than among the non – care population (Meltzer et al 2003) SMOKING: One third 11-17year olds are smokers 69% of those in residential care (DCSF 2008)

9. Children in Care “Lifestyle choices” Sexual Health Sexual Health Teenage girls in Care are 2.5 times more likely to become pregnant than other teenagers – Social Care Institute for Excellence 2004 Teenage girls in Care are 2.5 times more likely to become pregnant than other teenagers – Social Care Institute for Excellence 2004 - This is more likely if they are placed in residential as opposed to foster care. - This is more likely if they are placed in residential as opposed to foster care. Children and Young people in Care are at increased risk of sexual exploitation. The Children’s Society 2012. Children and Young people in Care are at increased risk of sexual exploitation. The Children’s Society 2012.

10. Role of CIC Nurse Undertake a holistic comprehensive health assessment Inform/support & challenge health professionals and others including CiC Clinical Supervision/advocacy and interpretation of health information Liaise with other CiC Nurses – Countywide/Regionally/Nationally Multi Agency Training - to a multi Agency Audience including Carers Lead and contribute to audits Influence Policy & Strategic Planning, Locally and Nationally Work with Partners Client focused meetings -

11. Issues of Consent Parental responsibility. Fraser Guidelines.

12. VSK East and South. Brook House John Wilson Business Park Reeves Way Whitstable CT5 3SS Tel: 01227 284475 VSK West and North. Commercial Services Gibson Drive Kings Hill West Malling Kent ME19 4QG Tel: 01732 525355

13. Service for OLA (Other Local Authority) Children 1 Specialist Nurse –Sally Galbraith 2 Part time administrators based at:- Aylesham Health Centre AyleshamKent CT3 3BB Tel: 01304 843768