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Contents

1. Health Care Assessments
2. Health Plans

1. Health Care Assessments

The purpose of the Initial Health Assessment is to provide a baseline regarding children’s physical and mental health at the point they are placed in Local Authority care and to inform the child’s Health Plan.

The first health assessment must be undertaken before the first placement, or if not reasonably practicable, before the first Looked After Review unless one has been done within the previous three months.

It is the responsibility of the allocated Social Worker to make sure that Initial Health Assessments are carried out for every looked after child/young person and to ensure that the Consent Section of the child’s Placement Plan has been completed and signed by the parent or Unit/Community Manager where a parent cannot be located or refuses to give consent. The Initial Health Assessment must be arranged by the child’s Social Worker. When making these arrangements, please note the following:

• Each looked after Child/Young Person should have a holistic health assessment on entering care within 28 days which results in a Health Plan being drawn up
• Statutory timescales for health assessments must be followed; every six months for children under 5 and every 12 months for children aged over 5
• Initial Health Assessment  must be carried out by a registered medical practitioner and who will specify who will undertake the Review Health Assessment
• The first assessment must be by a registered medical practitioner
• The Review Health Assessment may be undertaken by registered nurse/midwife
• The person undertaking the assessment will require all available information about child’s health
• The health assessment is a continuous process ensuring actions in health plan are being taken forward by the child’s carer, Social Worker and relevant professionals from health
• The assessment should  be child centred and appropriate to the child’s age and development.

See LAC Initial Health Assessment Process Maps 2 for further details.

See LAC Review Health Assessment Process Maps 4 for further details.

Refusal to have initial/Review Health Assessments

Where a child/young person refuses a health care assessment, this must be recorded. The child/young should be encouraged to take advantage of the opportunity of the health care assessment to discuss health issues.

1.1 Children in secure settings or on remand

The health needs of these children/young people in secure accommodation and/or on remand should not become secondary to any other issue, nor should health expectations be lower than for any other groups of children/ young people.

1.2 Care Leavers

Multi-agency approaches are particularly crucial for care leavers and health needs cannot be separated from their wider needs. There is an important health promotion and advisory role here, and, young people should be able to continue to obtain health advice and services. Leaving Care Services should ensure that health and access to positive activities are included as part of a young person’s Pathway Planning process. Child and Adolescent Mental Health Services (Camhs) transitions should be planned at least 6 months in advance of their 18th Birthday in line with the Camhs review. Care leavers with complex needs, including those with disabilities may transfer direct to adult services - transitions should be seamless and supported.

1.3 Unaccompanied Asylum Seeking children and Refugees

Unaccompanied asylum seekers are unlikely to have medical records from their country of origin, and any medical history they give is likely to be incomplete. Those undertaking health assessments with this group of children/young people require access to good local interpreting services or link workers familiar with the child’s culture and able to advocate on their behalf.

Also see Unaccompanied Asylum Seeking Children Procedure.

1.4 Children with Complex needs/Disabilities

If a child has disabilities or a Statement of Special Educational Need (SEN), or when a child is known to have complex needs and regularly attend hospital, the medical information already available should be accepted as being the child’s health record. In these circumstances, the child’s Social Worker in conjunction with his/her manager and the designated Nurse for LAC can decide to record the dates of medical assessments as the dates of the child’s health care assessments. 

2. Health Plans

Each looked after child/young person must have a Health Plan completed in time for his/her first Looked After Review, with arrangements as necessary incorporated into the child’s Placement Plan.

The child’s Health Plan will be drawn up at the Initial Health Assessment, in conjunction with the child, staff/carer (as appropriate), Social Worker, GP and any other relevant professional. The plan will then be passed to the child’s Social Worker who needs to ensure that a copy is placed on the child’s social care file and ensure that copies to be sent to the child (depending on age), the parents and the staff/carers and GP.

Making sure every looked after child/young person has a Health Plan which forms part of their Care Plan is the responsibility of the child’s allocated Social Worker. Key principles to be adhered to when preparing, drafting and reviewing Health Plans:

• Objectives, actions, timescales and responsibilities arising from Initial and Review Health Assessments as set out in the plan must be clear
• The Health Plan should be integrated into overall Care Plan for the child/young person, ensuring actions are monitored
• The G.P held record is the lead health record for the child/young person, copies of any health assessments/plans and the Care Plan should be part of this
• The Health Plan is drawn up with a health care professional and with the child’s parents or foster carers where possible
• Fostering and Residential Services providers should work with foster/residential carers to provide information re child’s health needs.

2.1 Content of Health Plan

As a minimum, this plan must contain:

• Details of the child’s state of health, including physical, emotional and mental health
• Details of the child’s health history, including if possible their families health history
• The effect of the child’s health history on their development
• Arrangements for the child’s medical and dental care appropriate to their needs including:
  • Routine checks of the child’s general state of health including dental history
  • Treatment and monitoring for identified health, including physical, emotional and mental health, or dental care needs
  • Preventative measures such as immunisations
  • Screening for defects of vision or hearing; and
  • Advice and guidance on promoting health and effective personal care
• Any planned change to the arrangements.

Confidentiality

The principles and legal requirements concerning confidentiality should be adhered to at all times.

Confidentiality, information sharing and consent are three key issues which arise in the provision of effective health care to Looked after children.

End