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7.5.1 Health Care Assessments and Plans

SCOPE OF THIS CHAPTER

This procedure applies to all Children in Care.

It summarises the arrangements that should be made for the promotion, assessment and planning of health care for Children in Care.

This chapter should be read in conjunction with Statutory Guidance on Promoting the Health and Well-being of Children in Care (March 2015).

RELATED GUIDANCE

Attachment in Children and Young People who are Adopted from Care, in Care or at High Risk of Going into Care - NICE Guidelines (NG26)

AMENDMENT

In November 2018, a new Section 3.5, Consent to Health Care Assessments was added to provide information on the circumstances when young people can consent to their own Health Care Assessments and medical treatment. Links were also added to the following local guidance documents:

  • Health Assessments - A step by step guide to practice;
  • Initial Health Assessment Process Map;
  • Review Health Assessment Process Map;
  • Refusal Health assessment Process Map.


Contents

1. The Responsibilities of Local Authorities and Clinical Commissioning Groups
2. Principles
3. Health Care Assessments
  3.1 Good Health Assessment and Planning
  3.2 Frequency of Health Care Assessments
  3.3 Who Carries out Health Care Assessments?
  3.4 Arranging Initial Health Care Assessments
  3.5 Arranging Review Health Care Assessments
  3.6 Consent to Health Care Assessments
  3.7 Young People Refusing Health Care Assessments
4. Health Plans
5. Strengths and Difficulties Questionnaire (SDQ)


1. The Responsibilities of Local Authorities and Clinical Commissioning Groups

The local authority, through its Corporate Parenting responsibilities, has a duty to promote the welfare of Children in Care, including those who are Eligible and those children placed in adoptive placements. This includes promoting the child’s physical, emotional and mental health; every Child in Care needs to have a Health Care Assessment so that a Health Plan can be developed to reflect the child’s health needs and be included as part of the child’s overall Care Plan.

The relevant Clinical Commissioning Group (CCG) and NHS England have a duty to cooperate with requests from the local authority to undertake Health Care Assessments and provide any necessary support services to Children in Care without any undue delay and irrespective of whether the placement of the child is an emergency, short term or in another CCG. This also includes services to a child or young person experiencing mental illness.

The local authority should always advise the CCG when a child is initially accommodated. Where there is a change in placement that will require the involvement of another CCG, the child’s ’originating’ CCG, outgoing (if different for the ‘originating CCG) and new CCG should be informed.

Both local authority and relevant CCG(s) should develop effective communications and understandings between each other as part of being able to promote children’s well being.


2. Principles

  • Children in Care should be able to participate in decisions about their healthcare and all relevant agencies should seek to promote a culture that promotes children being listened to and which takes account of their age;
  • That others involved with the child, parents, other carers, schools, etc. are enabled to understand the importance of taking into account the child’s wishes and feelings about how to be healthy;
  • There is recognition that there needs to be an effective balance between confidentiality and providing information about a child’s health. This is a sensitive area, but ‘fear about sharing information should not get in the way of promoting the health of Looked After Children’. (See Annex C: Principles of confidentiality and consent, DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015));
  • When a child enters Care, or moves into another CCG area, any treatment or service should be continued uninterrupted;
  • A Child in Care requiring health services should be able to access these without delay and any wait should ‘be no longer than a child in a local area with an equivalent need’;
  • A Child in Care should always be registered with a GP and Dentist near to where they live in placement;
  • A child’s clinical and health record will be principally located with the GP. When the child comes into local authority care, or moves placement, the GP should fast-track the transfer of the records to a new GP;
  • Where a child is placed within another CCG, e.g. where the child is placed in an out of Authority Placement, (see Out of Authority Placements: Approval, Consultation and Notification Process) the ‘originating CCG ’remains responsible for the health services that might be commissioned.


3. Health Care Assessments

3.1 Good Health Assessment and Planning

Role of Social Worker in Promoting the Child’s Health

The social worker has an important role in promoting the health and welfare of Children in Care:

  • Working in partnership with parents and carers to contribute to the Health Plan;
  • Ensure that consents and permissions with regard to delegated authorities are obtained to avoid any delay. Note: however, should the child require emergency treatment or surgery, then every effort should be made to contact those with Parental Responsibility to both communicate this and seek for them share in providing medical consent where appropriate. Nevertheless, this must never delay any necessary medical procedure (see Section 3.5, Consent to Health Care Assessments);
  • Ensure that any actions identified in the Health Plan are progressed in a timely way by liaising with health relevant professionals;
  • In recognising that a child’s physical, emotional and mental health can impact upon their learning, to the social worker will (where necessary) liaise with the Virtual School Head to ensure any adverse impacts are minimised for the child. (Should there be any delay in the child’s Health Plan being actioned, the impact for the child with regard to their learning should be highlighted to the relevant health practitioners);
  • To support the child’s carers in meeting the child’s health needs in an holistic way; this includes sharing with them any health needs that have been identified and what additional support they should receive, as well as ensuring they have a copy of the Care Plan;
  • Where a Child in Care is undergoing health treatment, to monitor with the carers how this is being progressed and ensure that any treatment regime is being followed;
  • To communicate with the carer’s and child’s health practitioners, including dentists, those issues which have been properly delegated to the carers;
  • Social workers and health practitioners should ensure the carers have specific contact details and information on how to access relevant services, including CAMHS;
  • Ensuring the child has a copy of their Health Plan.

It is important that at the point of accommodating a child, as much information as possible is understood about the child’s health, especially where the child has health or behavioural needs which potentially pose a risk to themselves, their carers and others. Any such issues should be fully shared with the carers, together with an understanding as to what support they will receive as a result.

3.2 Frequency of Health Care Assessments

Each Child in Care must have a Health Care Assessment at specified intervals as set out below.

  • The first Assessment (must be conducted before the first placement or, if not reasonably practicable, before the child's first Children and Young People in Care Review (unless one has been done within the previous 3 months);
  • For children under 5 years, further Health Care Assessments should occur at least once every 6 months;
  • For children aged over 5 years, further Health Care Assessments should occur at least annually.

If a child is transferred from one Child in Care Placement to another, it is not necessary to plan an assessment within the first month. In these circumstances, the social worker should furnish the carer/residential staff with a copy of the child's Health Care Plan.

If no plan exists, the social worker should arrange an assessment so that a plan can be drawn up and available for the child’s first Children and Young People in Care Review which will take place within 20 working days.

3.3 Who carries out Health Care Assessments?

The first Health Care Assessments must be conducted by a registered medical practitioner, usually the LAC lead paediatrician or a delegated colleague. Subsequent assessments may be carried out by either the child’s health visitor or school nurse. (See Section 3.4, Arranging Initial Health Assessments below).

3.4 Arranging Initial Health Assessments

Click here to access the Initial Health Care Assessment Process Map.

When a child comes into care the social worker requests a placement, which will trigger the Health Assessment workstep on MOSAIC.

The Health Care Assessments Step by Step Guide to Practice will also inform the social worker as to the correct forms they will need to complete, and those which they will need to get those with parental responsibility to complete.

3.5 Arranging Review Health Care Assessments

For details please see the Review Health Care Assessment Process Map.

3.5 Consent to Health Care Assessments

A valid consent will be necessary for a Health Care Assessment. Who is able to give this consent will depend on the age and understanding of the child. In the case of a very young child, the local authority as corporate parent can give the consent. An older child with mental capacity may be able to give their own consent.

A new ‘enduring consent’ form has been devised to seek consent on all matters relating to the child’s, and their parent’s health. Ideally, this will be completed at Initial Health Assessment stage, but if not, to be revisited at Review stage.

Where is it?

At initial stage of child being accommodated, the form is in built to the Health Care Assessment workstep

At review stage, the form can be downloaded from Forms Library, printed out, signed by relevant parties and uploaded to Health under the Health workstep blue paperclip.

If those with Parental Responsibility are unable/unwilling to give consent, the local authority can override this and give consent on child/young person’s behalf through completion of Part A of Review Health Care Assessment form.

Young people aged 16 or 17

Young people aged 16 or 17 with mental capacity are presumed to be capable of giving (or withholding) consent to their own medical assessment/treatment, provided the consent is given voluntarily and they are appropriately informed regarding the particular intervention. If the young person is capable of giving valid consent, then it is not legally necessary to obtain consent from a person with Parental Responsibility

See also Process Map for when young people (or their families on behalf of disabled young people) Decline / Refuse consent for a Health Care Assessment

Children under 16 – ‘Gillick Competent’

A child of under 16 may be Gillick Competent to give (or withhold) consent to medical assessment and treatment, i.e. they have sufficient understanding to enable them to understand fully what is involved in a proposed medical intervention.

In some cases, for example because of a mental disorder, a child’s mental state may fluctuate significantly, so that on some occasions the child appears Gillick Competent in respect of a particular decision and on other occasions does not.

If the child is Gillick Competent and is able to give voluntary consent after receiving appropriate information, that consent will be valid, and additional consent by a person with parental responsibility will not be required.

Children under 16 - Not 'Gillick' Competent

Where a child under the age of 16 lacks capacity to consent (i.e. is not Gillick Competent), consent can be given on their behalf by any one person with Parental Responsibility. Consent given by one person with Parental Responsibility is valid, even if another person with Parental Responsibility withholds consent. (However, legal advice may be necessary in such cases). Where the local authority, as corporate parent, is giving consent, the ability to give that consent may be delegated to a carer (foster carer or registered manager of the children’s home where the child resides) as a part of ‘day-to-day parenting’, which will be documented in the child’s Placement Plan. (see Delegation of Authority to Foster Carers and Residential Workers Procedure).

For further information on consent, see Department of Health and Social Care's Reference guide to consent for examination or treatment.

3.7 Young People Refusing Health Care Assessments

See also Process Map for when young people (or their families on behalf of disabled young people) Decline / Refuse consent for a Health Care Assessment

Some Children in Care may, despite the best efforts of their social worker to explain their importance and value, find the Children in Care Health Assessment process intrusive or off putting. In such circumstances the social worker should consult the Children in Care Health Advisor, who will seek to undertake further work to try to engage the young person.


4. Health Plans

Once the Initial Health Assessment has been completed the Lead Paediatrician (or appropriate colleague) will produce a written copy of the summary and plan to give to the child at the conclusion of the assessment, if they are of an appropriate age and level of understanding.

A typed summary report, IHA Form (CoramBAAF) Part C, will be sent by the commissioned Looked After health team to business support through MOSAIC.

Business support at the work base of the social worker will notify the social worker that it has been received, send a hard copy to the carer and enter key information on the Mosaic database. They will then enter in a new date for a subsequent review, and close down the workstep.

The Independent Reviewing Officer will review the child’s Health Plan as part of the ongoing Children and Young People in Care Review process, making recommendations as appropriate in relation to the completion of actions and tasks.

4.1 Out of Area Placements

Where an Out of Authority placement is sought, the responsible authority should make a judgment with regard to the child’s health needs and the ability of the services in the proposed placement area to fully meet those needs. The placing authority should seek guidance from within its own partner agencies and the potential placement area to seek such information out.

The originating CCG, the current CCG (if different) and the proposed area’s CCG should be fully advised of any placement changes and to ensure that any health needs or heath plan are not disrupted through delay as a result of the move.

Where these are Placements at a Distance the Care Planning, Placement and Case Review (England) Regulations 2010 make it a requirement that the responsible authority consults with the area of placement and that Director of the responsible authority must approve the placement.

Where the child’s health situation is more complex, it is likely that both Health and Children’s Social Care services will need to be commissioned; this will need to be undertaken jointly within the originating agencies’ respective fields of responsibility together with the Health and Children’s Social Care services in the area where the child is placed.


5. Strengths and Difficulties Questionnaire (SDQ)

Understanding a Child in Care’s emotional, mental health and behavioural needs is as important as their physical health. All local authorities are required to use the Strength and Difficulty Questionnaires (SDQs) to assess the emotional needs of each child.

The SDQ Questionnaire, along with any other tool which may be used to assist, can be used to identify the needs and be part of the child’s Health Plan.

(See Appendix B of the ‘DfE promoting the health and well-being of looked-after children’, Strengths and Difficulties Questionnaire.)

Research evidence suggests that children in local authority care are more than 5 times more likely to have a mental health disorder than all children.

Whilst completion and reporting of results for the SDQ in respect of all Children in Care is a national requirement, Child and Adolescent Mental Health Services (CAMHS) in York can be accessed regardless of SDQ scores, and social workers should always access advice or consultation via the CAMHS Children in Care provision if they have significant concerns about a particular child’s or young person’s emotional health.

The SDQ is a short behavioural screening questionnaire. It has five sections that cover details of emotional difficulties; conduct problems; hyperactivity or inattention; friendships and peer groups; and also positive behaviour. The SDQ has been internationally validated and is appropriate for all black and minority ethnic groups. Alternative language versions of the SDQ can be downloaded from SDQ website.

A SDQ must be completed for every child who has been, or will be in care for over 12 months by the 31st March and is aged between 4 and 16 at their last Health Assessment (initial or review). Each child should have an up to date SDQ assessment completed on an annual basis.

The child’s social worker will be alerted that an SDQ assessment is due via their monthly Children in Care Activity Report.

The social worker will speak to the child about the assessment, including how the assessment will be conducted, as well as explaining the importance and value of the assessment, and seek their consent to go ahead with it.

If the child is in agreement to the assessment taking place, the social worker will make an appointment to meet with the child’s main carer. The SDQ should be completed by the child’s social worker in direct consultation with the child’s main carer so that there is full consideration of the issues if there are any emergent concerns about the child’s behaviour or emotional presentation.

When completed the completed SDQ form should be passed to business support for scoring. The scored SDQ will be returned to the social worker and a copy sent to the IRO. If the child or young person refuses to give consent to the assessment this needs to be communicated to business support so that a nul return can be recorded.

If any party is concerned that the SDQ identifies potential concerns that are not being addressed by the care plan / current provision of services they will discuss as part of the review process and determine how these needs can be best met.

Any identified concerns will be reviewed and addressed as part of the ongoing Child in Care Review process.

End