ASSESSING THE HEALTH NEEDS OF LOOKED AFTER CHILDREN

1
ASSESSING THE HEALTH NEEDS OF LOOKED AFTER
CHILDREN

• The Residential Care Health Project
• City of Edinburgh Council

2
The Social Context

• Scotland heads league table of major diseases in
  developed world
• Reflects social inequalities and poor lifestyles
  including diet, drug and alcohol misuse etc.
• Health Care Outcomes for children Looked After
  away from home are particularly dire
• Majority affected by neglected health care prior
  to becoming looked after victims of social
  inequalities

3
The Research Context

• General Health looked after children
• Undiagnosed chronic health problems
• Poor and uncorrected eyesight
• Significant weight problems
• Glue ear
• Incomplete immunisation programmes
• House of Commons Select Committee on Health(1998)

4
The Research Context

• Mental Health looked after children
• Prevalence of psychiatric disorder in care system
  - 67
• Prevalence of psychiatric disorder in res care -
  96
• McCann et al (1996)
• Oxford
• 50-66 mental health disorder
• Chetwynd and Robb (1998)
• Glasgow
• Depression scores 40 higher than general
  population
• Robinson et al (1999)
• Edinburgh

5
The Research Context

• Care Leavers
• 35 deliberate self-harmed
• 60 thought about taking their own life
• 40 attempted suicide between 15-18yrs
• Saunders and Broad (1997)

6
Problem Areas

• Frequent moves in the Care System lack of
  continuity in health care
• System of delivering health promotion, preventive
  health, and screening centres through schools
  assumes that all children attend school
• Looked after children from deprived, chaotic,
  neglectful backgrounds often unable to access
  health care services

7
The Edinburgh Residential Care Health Project

• Who was involved?
• 2 Nurses
• 2 Part-time paediatricians
• Part-time GP researcher
• Part-time mental health worker
• 1 Admin worker

8
The Edinburgh Residential Care Health Project

• What was done?
• Comprehensive Health Assessment of 105 children
  and young people
• Audit of unit held health records
• Primary Care needs analysis
• Audit of residential care staff training needs

9
Key Findings

• 82 - Physical health problems
• 41 - Development, Learning or Growth problems
  (e.g. speech language)
• 86 - Incomplete screening and prevention (e.g.
  immunisations, sight, hearing tests)
• 97 - Emotional, behavioural and mental health
  problems (e.g. self harm, parasuicide, eating
  disorders)

10
Key Findings

• 54 of children had no written health assessment
• Only 11.9 had NHS number on file
• Only 9 had record of immunisations
• Only 12 had details of past medical history
• Staff had little or no training on health topics

11
Recommendations

• PREVENTION comprehensive health assessment and
  access to screening and preventive services
• PROTECTION action to rectify gaps and improve
  health of child
• PROMOTION training for care staff , access to
  consultation advice, education support to
  young people

12
Where Are We Now?

• First LA Childrens nurse appointed by Health
  Authority in Scotland
• Service now offered from birth to Through Care
  After Care post 16 years - 21 years
• Residential Care staff no longer see Health Care
  as crisis driven but it is an integral part of
  their care planning
• New carer Health Record now in operation and
  follows young person wherever they may move on to

13
Where Are We Now?

• Leaflet Staying Healthy Feeling Good now given
  to all children and young person and/or their
  carers
• System for Health Care professionals has now been
  accepted for core funding and staffing has been
  increased
• Article 27 of the UN Rights of the child to
  access Health Care is enshrined in this whole
  approach

14
What Has Changed?

• Greater awareness of co-operative Inter Agency
  working between professionals involved in the
  child/young persons life
• Young person and children now being seen by the
  most appropriate Health Care Professional e.g.
  dentists or sexual health professionals
• Health model is encompassing the social care
  model approach and taking on a more holistic view
  of the child
• Health needs of young person and child now
  recognised and addressed at a much earlier period
  in the childs time in care

15
What Has Changed?

• The importance of health and the health needs of
  children and young person now more recognised and
  accepted as important by Social Care staff
• The development of a named GP practice for Secure
  Services has been accepted by Health Service
• Team work between Health and Social Care staff
  now firmly established

16
The Way Ahead

• Health assessment of child and young person takes
  place in the Foster Carers home on a flexible
  basis
• Child/young persons health needs now being
  reviewed every 6 months
• Carers can access health assistance directly
  through the Looked After Nurse

17
The Way Ahead

• Health Resource pack has been developed which
  provides an easy to understand simplified health
  issues directory for carers and residential staff
• Regular and specific Health Care input to post
  approval support group for carers
• Multi-Disciplinary training across Health
  Social Care is now in place

18
EU Support?

• ENSA (European Network of Social Authorities) -
  Aims
• To encourage international co-operation, mutual
  understanding, and exchange of knowledge and
  experience within the field of social services
  and health
• To foster transnational projects in which
  partners can learn from one another and gain new
  perspectives on their own work
• To raise awareness of regional and local social
  issues within the European Union
• To deepen and broaden the dialogue concerning
  health and social issues within the European
  Union