Looked After Children

Dr Christine Arnold, Designated Doctor22.05.2014

• Gain knowledge of guidance and legislation framework for Looked After Children 

• Gain an understanding of the Looked After Child’s journey

• Gain an understanding of the health needs of Looked After Children  

• Gain an understanding of how health services can contribute to the overall care and planning for the child/young person

• Gain an understanding of the CQC LAC and Safeguarding Framework

This training has been developed to meet the Level3 Safeguarding Intercollegiate Competencies 2014:

To be able to know how to ensure the processes and legal requirements for looked after children, including after-care, are appropriately undertaken.

 

Learning Outcomes

QUIZ

The Looked After Child’s Journey

Definition of Looked After

Children Act (1989) defines a child as being “looked after” by a local authority if child in its care or is provided with accommodation for a continuous period of more than 24 hours 4 main groups:• accommodated under voluntary agreement with parents

(s17) or if unaccompanied asylum seeking child• children subject to a care order or interim care order (s31)• children subject of emergency orders for the protection of

the child (s47)• compulsorily accommodated/remanded (LASPO)

• Abuse or neglect: 62%

• Family dysfunction: 14% • Family in acute stress: 9%• Absent parenting: 5%• Parent’s illness or disability: 4%• Child’s disability: 3%• Socially unacceptable behaviour: 2%

At 31st March 2012 • 67,050 looked after children in England

• Ref: National statistics: Children looked after by local authorities in England Gov.UK September 2012

Why does a child/young person become “Looked After” ?

Parental vulnerabilities

• Domestic Abuse• Alcohol misuse• Substance misuse• Disadvantaged upbringing• School failure and unemployment• Unplanned pregnancy• Mental health problems• May have been ‘looked after’ themselves

In Surrey at 31st March 2014– 798 Looked After Children– 10% aged 1 year and under– 56% aged between 10 and 18 years– 9% asylum seekers– 43% placed outside Surrey border

• 260 approx. from other Local Authorities• 390 enter and leave care every year

Surrey LAC Profile

Placements

• Majority are in Foster Care (including Mother and Baby foster placements)

• Family and Friends (‘kinship’)• Residential• Supported lodgings (Care leavers)

Key Legislation and Guidance

Types of Order- Children Act 1989• Section 20 or voluntarily accommodated – the Parent

retains full Parental Responsibility• Section 38 or Interim Care Order – PR is shared

between the parent and Local Authority• Section 31 or Full Care Order – the Local Authority

has full PR, child remains ‘Looked After’• Adoption Order – adoptive parents hold PR and child

is no longer ‘Looked After’• Special Guardianship Order – PR is transferred to SG

and child no longer ‘Looked After’• ‘Delegated responsibility’ for Foster carers

Monitoring

• All Looked After Children have an Independent Reviewing Officer who is responsible for overseeing the Care Plan which includes the Health Plan developed by the Social Worker

• Reviews are held on a regular basis

HEALTH NEEDS OF LOOKED AFTER CHILDREN

Rocks blocking the path to successful outcomes

Two thirds of all looked after childrenhave at least one physical health complaint

Looked after children are more likely than peers to experience problems including speech and language problems, bedwetting, co-ordination difficulties and eye or sight problems

About 60% of those looked after in England have been reported to have emotional and mental health problems around four times the rate for children generally

Nearly a quarter of looked after young people aged 11-17 report having experienced some kind of sexual abuse

Looked after children are around 3 times more likely to drink regularly and more likely to smoke than their peers

Nearly a quarter of looked after children and young people are more likely than their peers to have experienced the death of a parent or sibling

Looked after children are around ten times more likely than their peers to have significant learning difficulties

Increased risk taking behaviour – both looked after young women and men are more likely to become teenage parents than their peers

Removing the rocksListen to the voices of children/young people and their families

Deliver holistic care tailored to individual need

Provide services that address health, wellbeing and promote high quality care

Effective integrated professional working

Competent, caring professionals

Children & young people are helped to develop a strong sense of personal identity

Young people are prepared for and supported in their transition to adulthood

Child / young person is supported to participate in wider network of peer, school and community activities

Warm and caring relationships between child/young person and carer

Children & young people have a stable experience of education

Effective joint commissioning

National Framework

Universal and Targeted Services

• GP services• Enhanced Service from 0-19 Teams• Camhs Children in Care Team• Catch 22• Virtual School• LAC Health Team (Specialist Nurses, Medical

Advisers in Adoption and Fostering)• Paediatricians

Initial and Review Health Assessments

• IHA is a comprehensive assessment of the child’s needs

• IHA should be carried out by a doctor resulting in a health plan within 4 weeks (Statutory)

• RHAs 6 monthly for under 5s and annually for over 5s (Statutory)

• Reviews may be completed by a doctor or nurse• Intercollegiate Competencies defines skills and

competencies expected from practitioners completing Health Assessments

What would you do?

• A ‘short term’ foster carer wants to register a child but is not sure how long the placement will be for

• An unaccompanied asylum seeking young person wants to register but does not have an NHS number

• A relative has just taken on the care of a child and wants to register the child with your practice as it is nearer than her own (but she does not want to change her GP)

• A foster carer asks for a copy of the child’s immunisation history

• An adoptive parent asks to see her adopted child’s records

Promoting health in Primary Care• Full registration and request for fast track of

records within 48 hours • Alert on records• Health Assessment reports should be readily

identifiable• Social Worker contact details should be known• Ensure that all practitioners understand who can

provide consent• Identify a Practice Lead for LAC

CQC Safeguarding and LAC Inspection

Key objectives

• The experiences and views of children and their families.

• The quality and effectiveness of safeguarding arrangements in health.

• The quality of health services and outcomes for children who are looked after.

• Health leadership and assurance of local safeguarding and looked after children arrangements.

CQC

• Inspection area – the Local Authority area and Health Providers

• Case tracking of children and young people• Out of County placements also considered.• Published reports on CQC websitehttp://www.cqc.org.uk/public/publications/themed-inspections/child-safeguarding-and-looked-after-children-inspection-progr

Any questions?

• Dr Christine Arnold Designated Doctor for Looked After Children c.arnold1@nhs.net

• Mrs Elizabeth Channing Designated Nurse for Looked After Children elizabeth.channing@nhs.net