09 / HEALTH SERVICES
"I would like [Looked After children] to have the same healthy outcomes as children who are not Looked After. I want to get rid of the health inequalities.
"That's a tall order and probably not achievable. In a broader context, I would like to see all outcomes for Looked After children on a par with those who are not Looked After - educationally and in terms of jobs. Unfortunately Looked After children are much more likely get pregnant earlier and their life opportunities are substantially reduced.I would like to see that changed and I do my best from the health point of view.
"I think of my role as a parent to my three children and the love, care, attention and security you give. If you are a Looked After child those things may be absent.As corporate parents we must look at what we can do to provide that love, care and security. If you are a growing child part of your development is to learn to form attachments with people.
"However, some children may not get the chance to and their disaffection is said to be one of the causes of the problems we have in society. We have to do whatever we can for children who have missed the boat in this way.
"Some of the experiences you have working particularly with foster parents are remarkable. Foster carers are doing a great job, working all the time with kids in their care for little more than expenses. They are genuinely doing it out of the kindness of their hearts. To help them is humbling and rewarding.
"A lot of the kids are genuine characters and fun to work with. Their behaviour is challenging, but also entertaining. Then there are the kids we don't manage to deal with for whatever reason. You think if you had done more you might have made a difference. Potentially the circle repeats itself. [A care leaver's] baby might be at risk of a sub-standard parent because the mother doesn't have the wherewithal. It's possibly another generation of the same problem."
Dr Andrew Eccleston, Consultant Paediatrician, Dumfries and Galloway Royal Infirmary.
Scotland's Looked After children and young people will benefit from access to a range of appropriate services designed to meet their emotional, mental and physical health needs. Professionals, foster carers, residential workers, teaching staff and parents will be trained to understand the importance and value of meeting these needs. All of our Looked After children and young people should grow to be emotionally, mentally and physically healthy.
" I had to get my social worker to request my mother's death certificate as I did not know what she had died of … and the doctors were asking … in case it was anything genetic." (Hayley)
The health and well-being of Scotland's children and young people is essential to the future health and well-being of our nation. Looked After children and young people and care leavers have historically experienced poorer health than their peers (eg dental health, early pregnancy), and are less likely to engage with health services partly as a consequence of disruptive early family lives and sometimes due to being moved frequently when in care.
Looked After children and young people and care leavers are more likely to need specialist health services than their peers, whether Child and Adolescent Mental Health Services, help with addictions or sexual health advice. For example, The Action Framework for Children and Young People (Scottish Executive, 2007) [ www.scotland.gov.uk/Resource/Doc/165782/0045104.pdf ] indicates that 40% of children in care will have mental or emotional health problems. This is considerably higher than their peers who are not Looked After. However, they are also less likely to engage with universal health services such as GPs, dentists and opticians. Addressing the needs of Looked After children and young people, and care leavers, depends on effective assessment and planning. Better Health, Better Care (Scottish Government, 2007) includes a commitment to addressing the health needs of Looked After children and young people [ www.scotland.gov.uk/Resource/Doc/206458/0054871.pdf ].
For the NHS across Scotland to play its part in the corporate family, health services must be able to identify the population of Looked After children and young people accurately and councils must help them to do this. The NHS provides services to assess individual need and provides access to therapeutic services resourced to meet those needs. Transitions are crucial to Looked After children and young people and care leavers, and health services must support children and young people as they move through the Looked After system and into adult life, acknowledging and addressing the effects of their earlier lives in relation to all aspects of their health and ability to engage with services. Health professionals will also support parents, carers and professionals working with Looked After children and young people and care leavers.
NHS provision is generally provided free at the point of contact with the service. For children and young people, the NHS must provide services across the spectrum of health; to promote health, to protect health, to assess and identify health-related risks and to treat health problems. For Looked After children and young people and care leavers, these services must be provided both on an individual level and a population level to focus on the particular health needs ofthis cohort.
The number of children and young people with complex health needs who become Looked After is increasing, and they are likely to need a range of specialist or secondary health services. The most significant need is likely to be in relation to mental health services such as consultant paediatricians who will diagnose and treat any tertiary mental illness, therapeutic nurses, art, play or occupational therapists, psychotherapists, child psychologists.
Child and Adolescent Mental Health Services also provide support and mentoring to parents, family members, carers and other professionals working with Looked After children and young people and care leavers.
Increasingly, there are schools-based services which encourage young people to engage with health services. Where children are not within mainstream education provision, access should be co-ordinated by educational establishments as recommended in Health for All Children 4 (Scottish Executive, 2005), known as Hall 4 [ www.scotland.gov.uk/Resource/Doc/37432/0011167.pdf ] to make sure that children receive health promotion advice and child health checks and other health improvement activity. Provision in schools should provide support to individual children and young people as well as wider health promotion advice to support healthy lifestyles.
You will want to:
- Be able to identify all Looked After children and young people and care leavers in your area.
- Make sure that local authorities placing Looked After children and young people give the health board where they will be living written notice of the placement and any relevant information. Health professionals should be informed as early as possible about a placement and you should make sure that it is clear who should be informed and how.
- Consider ensuring that health professionals are involved in the decision-making process regarding care placements.
- Work with your local authorities to meet the requirements of the Children (Scotland) Act 1995 which states that a local authority shall, where possible before the child is placed:
(a) make sure that arrangements are made for the child to be examined by a registered medical practitioner (where the placement or series of placements is likely to last for a year or more); and
(b) obtain from the medical practitioner who has carried out the examination a written assessment of the state of health of the child and her/his need for health care unless the child has already had such an examination with the 3 months prior to becoming Looked After.
- Work with the placing authority to make sure that arrangements are made for Looked After children and young people to be provided with health care services, including medical and dental care and treatment.
- Provide clinically effective services to assess need at individual level including accessing records detailing information relating to the child or young person's medical history.
- Make sure that whilst in the health board area the child or young person (either as an individual or through carers) is able to access primary medical care and specialist health services, as well as public health population-focused services identified and provided according to need.
- Make sure that young people in transition to adult services are provided with support to access primary and secondary care services as required to support their ongoing health and well-being.
- Make sure that your Looked After Children's Nurses, School Nurses and community paediatricians have the capacity to:
- receive referrals,
- identify health records and request them from the NHS Board in whose care they are held,
- provide a comprehensive health assessment,
- make sure that the child or young person is engaged with primary care, specialist care and secondary care as required,
- facilitate information transfer as the child or young person moves to another health board area, including addressing the resource implications.
- Make sure that Looked After children and young people and care leavers are registered with their local primary health care services, including GP services, dentists and opticians. The vulnerability of children and young people who become Looked After means that they may not have accessed routine services previously and they may have significant levels of undetected need which must be identified and addressed if they are to lead normal healthy lives.
- Encourage GPs to make sure that Looked After children and young people and care leavers are able to access medical care as necessary and to participate in public health programmes through universal screening and surveillance, and the routine vaccination programme.
- Encourage dentists to offer dental care and oral health advice as necessary, and opticians to offer eye checks and provide spectacles or other interventions as required.
- Engage with young people as they move out of the Looked After system and into independence, to make sure they are engaged with health services to meet their changing needs. As well as primary care services, it is likely that they will need to access sexual health services and may need to be actively directed towards these services as part of their throughcare and aftercare needs assessment (Pathways Plan).
- At NHS board level, actively seek to promote the needs of Looked After children and young people and care leavers within service design and improving patient care.
- Support board members to champion the needs of Looked After children and young people, and care leavers, in their local area and challenge community planning partners to share their commitment. NHS Boards may wish to nominate a Director who is the lead for Looked After children and young people and care leavers in their area.
- At chief executive and senior management level, promote a culture of aspiration and genuine inclusion in which your staff actively seek to tackle disadvantage and reach those children and young people who are least likely to engage with their services.
- Develop a charter approach in which the rights of Looked After children and young people and care leavers are explicitly described, consulting with young people and their carers to make sure that services are designed to meet their needs.
- Review the services within your local area and consider whether there are sufficient resources, for example in relation to Child and Adolescent Mental Health Services or school nurses, and use the data to monitor changing demands on services and whether your aims in relation specifically to Looked After children and young people and care leavers are being met.
- At practitioner level, consider whether services are accessible to Looked After children and young people and care leavers, and their carers or parents, and whether you are proactively engaging with this group.
- Challenge traditional stereotypes and guard against making assumptions about children and young people who are, or have been, Looked After and make sure that your approach to patient care is as inclusive as possible.
HOW WILL I KNOW I'VE MADE A DIFFERENCE?
- In the longer term, when health outcomes for people who have been Looked After have improved until there is no difference between the health outcomes of those who have experienced the Looked After system and those who have not.
- In the shorter term, when you can say that you understand your contribution to the corporate family and your service has systems in place to enable you to know who your Looked After children and young people and care leavers are, what their needs are and how you are meeting those needs.
- Your service is accessible and inclusive, and this is reflected in inspection reports and feedback from other professionals as well as service users.
- An increased number of Looked After children and young people and care leavers are using universal health services and they achieve the same rate of vaccinations or routine health checks as their peers who are not Looked After.
- Children and young people in residential care, foster care and secure accommodation have the same access to GPs, dentists, opticians and other universal health services as children and young people living at home with their birth families.
- Young people leaving care have their health needs included in their pathways plan and are supported in making the transition into adult services.
- Children and young people who require specialist health services such as CAMHS or sexual health advice are able to access those services when they need them.