Promoting the Health and Well Being of Looked After Children and Young People

The Scoping Review

Shirley Ayres

Consultant to Government office for London (Health of Children in Care)

Life Chances

• Children who come into the care system are likely to have been exposed to a number of traumatic events such as bereavement, violence and abuse, parental drug addiction and mental health difficulties.

• Children in care are fragile and vulnerable. A 2003 study found that 72% of children in residential care were diagnosed with a mental health disorder – 60% of whom had a conduct disorder and 18% of whom had an emotional disorder, such as anxiety or depression.

• Care Workers shocked by girls’ death point to pain of troubled youngsters

• “The system is letting down the most vulnerable young people and a debate needs to take place that seeks to change the way the system supports young people in care who exhibit suicidal behaviour”

• “The tragedy reminds workers to recognise the degree of emotional pain that young people are in”

Ian Milligan Scottish Institute for Residential Childcare Guardian 10th October 2009

The Context of the Scoping Review providing a snapshot across London

Activities: Developing the Database Literature Review A Review of Children and Young Peoples Plans Discussions with stakeholders to identify key

issues for consideration Identifying emerging practice and meetings with

local authorities Online Survey

The Online Survey

The questions were developed to gain awareness and

understanding of emerging practice in the following areas:

• The London Pledge for Looked After Children and Young People• Annual Health Assessments and Health Plans • Improving Immunisation and Vaccination Rates for Children in

Care, • Access to Child and Mental Health Services (CAMHS) • Supporting young women in care who become pregnant.• Sexual Relationship Education (SRE)

The Responses

• Invitations to complete the survey sent to over 500 named contacts. The list reflects the diverse stakeholders with a responsibility for the health and well being of looked after children in care

• There were 72 responses representing 24 London Boroughs, 9 Primary Care/Mental Health Trusts and 12 Voluntary and Independent Sector organisations.

The Challenges

• Placement stability is a key national indicator. Building and sustaining relationships with trusted adults is important to looked after children and young people.

• The lack of placement stability has enormous implications for the health and well being of looked after children and young people.

The Workforce

• Recruitment, retention and stable staff groups all contribute to the health and well being of looked after children.

• A workforce development strategy which includes access to support, training, supervision and consultancy for foster carers, residential care staff and other professionals is essential.

The London Pledge

• The survey indicated a high level of awareness of the Pledge. Some Children’s Trusts have adopted the Pledge in its entirety and other Children’s Trusts are adapting and adding to the Pledge. http://www.younglondonmatters.org/hottopics/pledge

Are you aware of the London Pledge for Children and Young

People in Care?• Yes 84.4%

• No 14.1%

• Not sure 1.6%

How can we ensure that the Pledge will really make a difference?

Health Strategy

Do you have a health strategy for looked after

children in your Children's Trust?• Yes 51.9%• No 20.4%• Not sure 27.8%

Contracting Services

Does your Health Services Contract specify any training

or competence requirements for Doctors and Looked

after Children Nurses which relate to the special needs

of looked after children?

• Yes 40.4%• No 11.5%• Not sure 48.1%

“training is in place but not statutory” “training needs have been identified in a SCR and are being implemented”

Monitoring and Evaluating Health Services

Is there a requirement for an Annual Report on

the Health Assessment Service?• Yes 50.9%• No 13.2%

• Not sure 35.8%

“It is not required but an Annual Report is produced”

How is progress measured in your Children’s Trust?

Annual Health Assessment and Health Plans

• The Annual Health Assessment requires considerable sensitivity because of the potentially stigmatising effect of this requirement for looked after children and young people.

• Do young people in care have a choice about where their Annual Health Assessment takes place?

• Yes 63.9%

• No 8.3%

• Not Sure 27.8%

Preparing looked after children for the Annual Health Assessment

What information is provided for children and young

people in care about their Annual Health Assessments?

• It is discussed with them in advance 83.3%

• They are given an information sheet with • age appropriate information

30.0%• Using text messaging and email 20.0%• None of the above 6.7%

Children living outside of their home borough

In London a number of looked after children (LAC) are placed outside of

their home borough.

“There are a lot of specialist services for LAC locally but 60% of our LAC are placed out of borough and these LAC may not receive an equitable service”

Who undertakes the Annual Health Assessment for looked

after children placed out of the home authority?

• LAC nurses from the home authority 60.0%• We have a contract with the PCT where the children are

resident 16.7%• Not sure 23.3%

What is included in the Annual Health Assessment?

• Dental and oral health checks 83.9%

• Eye test54.8%

• Hearing Test 51.6%• Emotional health and well being 90.3%• Sexual health and relationships 87.1%• HPV injection for teenage girls

25.8%• Condom distribution 38.7%• Testing for Chlamydia

38.7%• Developing hobbies and interests

48.4%

Immunisations and Vaccinations

• Looked after children and young people have often experienced considerable disruption in their lives. Consistency in their medical care is vital.

• It can require a lot of detective work to track down their immunisation and vaccination history and establish what is missing.

• Information appears to be held on a number of different information systems within local authorities and PCT’s.

How are immunizations and vaccinations tracked and monitored for children in care?

• The PCT has a database 20.0%• The local authority has a database 11.4%

• They are recorded on both the • PCT and local authority database 48.6%• Not sure

20.0%

“It is a timely process to keep these records updated due to high number of young

people living out of borough”

“I also have my own database for recording this information”

Children and Adolescent Mental Health Services

Is there a designated Child and Adolescent Mental

Health Service (CAMHS) for looked after children in

your Children's Trust?

• Yes86.1%

• No 8.3%

• Not sure 5.6%

Access to CAMHS

What are the waiting times for an initial appointment at CAMHS for

looked after children?

• Appointment available immediately 4.2%• Under 1 week 12.5%• 2 - 4 weeks 45.8%• 4 - 8 weeks 16.7%• 8 - 16 weeks 20.8%• Over 16 weeks 0.0%

CAMHS Emerging Practice

• An increasing number of Children’s Trusts have developed Tier 2 services which are more flexible and responsive to both the urgent and acute and chronic and long term needs of looked after children and their cares.

• Examples are detailed in the Emerging Practice Guide.

• However there is still a lack of consistency across London about the CAMHS services available for children in transition, aged over 16 and care leavers.

Access to information about CAMHS

Does the Family Information Service include a local

directory of CAMHS for children in care available to

referrers in all agencies, staff and families?

• Yes39.4%

• No 9.1%

• Not Sure51.5%

“Not sure but I have now been prompted to find out!”

Support for young women in care who become pregnant and young parents who are themselves

in care?

Two separate considerations• The pregnant looked after young person and their

support needs which will include discussion and consideration of all of the options available.

• The needs of looked after young parents and the separate needs of the child.

Responses indicate that local authorities have developed a

range of services to support pregnant looked after young

women and young parents.

CAMHS Service Improvement Models

Does the local CAMHS use any of the following

service improvement models?• The 10 Big Impact 3.2%

• The Choice and Partnership Approach (CAPA) 6.5%• Lean Thinking 0.0%• New Ways of Working in CAMHS 12.9%

• None of the above 3.2%

• Not sure 74.2%

“A full multi-disciplinary approach is taken and the work is broader than a medical model with a range of interventions undertaken”.

What information and training is provided to support social workers and carers in providing sexual relationship information for children and young people in care?

• Information Leaflets and Toolkits 78.1%• Access to In House Training Programmes

96.9%• Access to External Training Programmes

18.8%• eLearning 9.4%

The following organisations identified in the survey provide information and training to support social workers and carers in providing sexual relationship information for looked after children and young people.

• The Sex Education Forum hosted by the NCB is an 'umbrella' organisation made up of approximately 50 member organisations. All members are involved directly or indirectly in the provision or support of Sex and Relationships Education (SRE). http://partner.ncb.org.uk/Page.asp?originx_2359mj_5553657824498l87z_20061129539u

• Speakeasy training for parent support staff http://www.fpa.org.uk/Inthecommunity/Speakeasy/AboutSpeakeasy/training

• Barnardos Training for Carers http://www.barnardos.org.uk/skylight/microsite_skylight_what_we_do/microsite_skylight_what_we_do_training.htm

• NSPCC - http://www.nspcc.org.uk/Inform/TrainingAndConsultancy/Training/training_wda47917.html

• The Christopher Winter Project provides sex and relationships education (SRE). http://www.tcwp.co.uk/index.php?m=home

• Brook offer a number of specialist training programmes http://www.brook.org.uk/content/z_sys_conferences.asp

The Interface• The health and well being of looked after

children and young people is at the interface of social care, education, health, youth support and leisure activities.

• The challenges we are addressing are complex. Our responses will impact upon every facet of the experience of the child and young person in care.

Conclusions

The emerging practice guide shows how different ways of thinking and collaborating produces positive

outcomes.

Looked after children and young people deserve the best of our creativity and a vision for the future which

develops their resilience and nurtures their well being.

Promoting the health and well being of London’s looked after children- Learning from Emerging practice can be downloaded from:

http://www.younglondonmatters.org/uploads/documents/1supportingthehealthandwellbeingoflondonslookedafterchildrenreport.pdf