• contents
• keywords & contacts
• quick guide
• values
• contact us
• search

Contents

1. Health Care Assessments
2. Health Action Plans 

1. Health Care Assessments

Many children who need to be accommodated or come into care of the Local Authority have been through adverse life experiences and may have missed out on routine child health surveillance. They are more likely to have unmet health needs, sometimes multiple and complex. These would include general health needs and deficiencies in areas such as dental care and preventative health care. Also there may be undetected problems with vision and hearing, as well as concerns about development and emotional and behavioural well being.

The purpose of Health Care Assessments which should include a Strengths and Difficulties Questionnaire is to promote children’s physical and mental health and to inform the child’s Health Action Plan. Where a placement is made in an emergency, an Assessment of Health and Development must be done as soon as possible and always within 14 working days unless the child/young person is of sufficient age and understanding and refuses consent for the assessment.

An initial health assessment should provide an opportunity to engage children and young people in positive discussion about their current health and other health-related issues and concerns. It should provide a positive experience that will encourage children and young people to take their health seriously and reduce fears and anxieties about contact with health professionals. Considerations must be given to what are age appropriate in terms of consent issues and the content of the health check. Younger children are expected to follow the advice on health matters of their parents, who have a responsibility to ensure they receive any necessary health care they require. Older children, particularly those over the age of 14, are regarded by health agencies as competent to make some choices about their health. It is important that information and advice is available for both groups of children to emphasise the importance of appropriate health care. 

Before the health assessment the social worker should discuss with the child/young person what they want to get from the health assessment, any particular issues which they want the opportunity to discuss and how that might affect who they want to be present. There may be a professional other than a doctor that they would prefer to see.

For detailed information on recording Health Care Assessments, See ICS Guidance, Section 19.0, Health Assessment CSICS19S.

1.1 Frequency of Health Care Assessments

The first assessment must be conducted before the first placement or, if not reasonably practicable, before the child’s first Looked After Review (unless the child has had a medical assessment within the preceding 3 months), each Child Looked After must have his or her first Health Care Assessment carried out by a paediatrician.

Second and subsequent Health Care Assessments must be conducted by a suitably qualified medical practitioner (including GP’s, school nurses or health visitors); who should provide the social worker and carers with a written Health Action Plan.

• The first Assessment (see shaded area below) must be conducted immediately before or within 14 days of the child first becoming Looked After - usually in time for the first Looked After Review.
• For children under five years, further Health Care Assessments should occur at least once every six months.
• For children aged over five years, further Health Care Assessments should occur at least annually

If a child is transferred from one Looked After 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.

In no plan exists, the social worker should arrange an assessment within a month of the placement so that a plan can be drawn up.

1.2 Who Carries Out Health Assessments?

The first Health Care Assessments must be conducted by a registered medical practitioner. Subsequent assessments may be carried out by a registered nurse or registered midwife under the supervision of a registered medical practitioner, who should the social worker with a written report – See Arranging Health Care Assessments.

1.3 Arranging Health Care Assessments

The social worker is responsible for ensuring that Health Care Assessments are undertaken through liaison with the Health Advisor (LAC). They must provide the Health Advisor with contact details of the child's:

• GP
• Health Visitor or School Nurse
• Dentist
• Hospital Doctor (Where Appropriate)
• Optician
• School
• Any other Health Professional (E.g. specialist, CAMHS)

The social worker will inform the child, parents and staff/carer of the purpose of and arrangements for the Health Assessment, and accompany the child and parents (or arrange for staff/carers to accompany the child, as appropriate). 

In order for the Health Assessment to be conducted, the social worker must ensure that the Consents section of the child’s Placement Information Record has been completed and signed by the parent. 

Where the child refuses a health assessment, this must be recorded by appropriate practitioners and contained within their case record. The child should be encouraged to take advantage of the opportunity of the health assessment to discuss health issues.

1.4 Merging Health Care/Health Checks

Some Children Looked After receive a great deal of health intervention; it may therefore be appropriate to combine Review Health Care Assessments with other necessary health checks. For example, if a child has disabilities or a Statement of Special Educational Need (SEN) or when children are known to have complex medical 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 or her Children's Social Care Manager can decide to record the dates of medical examinations as the dates of the child’s Health Assessments. The reasons for this must also be recorded and shared with carers.

1.5 Black and minority ethnic children 

Black and minority ethnic children can suffer considerable health disadvantage.

They can be vulnerable to certain hereditary illnesses (e.g. sickle cell anaemia), can be predisposed to certain forms of diabetes, and there is evidence of high levels of depression amongst certain ethnic groups. It is important that:

• an accurate family history is taken;
• the emotional and behavioural development of black and minority ethnic children is accurately and fully assessed
• prior discussion with the child takes place in order to enable choice (e.g. in the gender of the doctor that a child may see)
• arrangements are made for children undergoing health assessments to use the language in which they feel most confident.

1.6 Children in secure settings and/or on remand

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

1.7 Refugees

Unaccompanied refugee children are unlikely to have medical records from their country of origin, and any medical history they themselves give is likely to be incomplete. Their immunisation status may be unknown, and they may have had no previous health surveillance. Good interpretation services are likely to be necessary, and consideration should be given to seeking a link worker familiar with the child’s culture and able to advocate on their behalf.

2. Health Action Plans

Each Looked After Child’s Care Plan must incorporate a Health Action Plan in time for the first Looked After Review, with arrangements as necessary incorporated into the child’s Placement Information Record.

The will draw up the child’s Health Action Plan based on the information in the Health Assessment, in conjunction with the child, staff/carer (as appropriate), GP and any other relevant professional.  The plan will then be passed by the Health Advisor (LAC) to the child’s social worker who will arrange for copies to be sent to the child (depending on age), the parents and the staff/carers.  Where the child expresses a wish not to disclose the contents of the Plan to his or her parents and this is accepted by the social worker (having regard to the child’s age and understanding), the parents will not receive a copy.

The child’s social worker is responsible for implementing Health Action Plans for Children Looked After, and will do this with the assistance of the health professionals identified in the plan.  The specific responsibilities of the staff/carers will also be identified in the Plan and agreed at a care planning meeting.

The Health Action Plan will set out how the health care needs of the child will be addressed, including the following matters:

1. Whether it is necessary for any immunisations to be carried out and if so, when.
2. When it is necessary for a dental check to be carried out
3. When it is necessary for any hearing or vision checks to be carried out
4. Whether there are any specific health care needs - and how they will be met, including future hospital appointments, referrals to specialist services and/or any specific treatment, strategies or remedial programme's required.
5. Whether there are any health or education issues to be addressed, for example, nutrition, sexual health and relationships, substance misuse, personal hygiene.
6. Whether there are any illegal or other activities including self harming which it is known or suspected the child is engaged in which may be harmful to the child’s health, and the interventions/strategies to be adopted in reducing or preventing the behaviour.

See also Sexual Health and Relationships Policy and Guidance in relation to the provision of advice to children Looked After on sexual health, sexual relationships and contraception.

See also Consents Guidance in relation to issues of confidentiality for children under 16.

This Health Action Plan must be reviewed after each subsequent Health Care Assessment and at the child’s Looked After Review or as circumstances change.

End