ANNUAL REPORT - Northumberland



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Looked After Children and Young People Annual Report

2013-2014

NORTHUMBERLAND

Authors of Report

Designated Doctor for Looked After Children and Young People

Designated Nurse for Looked After Children and Young People

|CONTENTS |PAGE |

|1.Introduction |4 |

|2. Aims and Purpose of this report |5 |

|3. Description of Service |6 |

|4. The Looked After Children and Young People Health Team |7 |

|5. The Looked After Children and Young People Population |8 |

|6. Health Assessments, performance and quality assurance |8 |

|Northumberland IHA | |

|Northumberland RHA | |

|Northumberland Immunisations | |

|Northumberland Dental | |

|7. Governance arrangements |13 |

|8. Health outcomes |14 |

|9. Assessment of Emotional and Behavioural Wellbeing |15 |

|SDQ data for Looked After Children and Young People | |

|Mental Health | |

|Sexual Health | |

|Teenage Pregnancy | |

|Substance Misuse Services | |

|10. Looked After Children and Young People placed out of borough/county |17 |

|11. Care Leavers |20 |

|12. Participation |21 |

|13. Support to Training |22 |

|14. Action Plan |23 |

|15. Appendices |25 |

|1. Case examples |25 |

|2. Health of Northumberland Looked After Children and Young People Placed out of county – Executive Summary |28 |

|3. Drop In dates at Netherton Park and Coanwood Drive site April 2013-2014 |27 |

|16. References |32 |

|5. Attachment and Resilience Training Strategy paper (Northumberland) |separate |

LOOKED AFTER CHILDREN’S HEALTH REPORT

1. Introduction

Northumbria Healthcare Foundation Trust is committed to ensuring all looked after children and young people (LACYP) have their health needs assessed in line with national guidance, and all identified health needs are addressed, including access to relevant services and health promotion. The Trust endorses the philosophy that safeguarding children is everyone’s business and that everyone working both within health and social care has a responsibility to protect children and adults.

Specific provision has been established by the Trust to ensure that LACYP have their health needs met. This comprises of two designated teams, each working to provide a quality service within a given locality.

The Trust acknowledges the importance of working closely with partner agencies, including the voluntary sector, to ensure that good communication is maintained so that LACYP are afforded optimum care to protect their health. Joint working that incorporates national and local guidance is achieved through robust and responsive partnership working.

The health data collected and discussed in this report is collated and informs the Department of Health and Children’s Services via SSDA903. The purpose of SSDA903 (cohort 2013 – 14) is national data collection used to compare the care of LACYP across all localities. The cohort is every child who has been looked after by the local authority for the full 12 months up to 31 March 2014(DfE 2013).

2. Aims and purpose of this report

The report aims to demonstrate the proactive work that is carried out by the teams working to address the health needs of LACYP in Northumberland.

The report will give assurance to the Trust Board and Local Authority that processes within the Trust are effective and services are being delivered, alongside partner agencies, to increase health benefits with work continuing to achieve optimal potential for each looked after child or young person.

The purpose of the report is to:

» Provide assurance to the Board and Local Authority that the Trust is compliant with the national guidance on promoting the health and wellbeing of looked after children and young people.

» Provide assurance that the appropriate systems are in place to identify and address the health needs of LACYP, including those living away from the placing Authority.

» Provide an overview of the activities taken in the last twelve months by both teams.

» Provide assurance on quality performance

» Identify actions and risks against the priorities set by both teams for the forthcoming year.

3. Description of Service

The clinicians responsible for the health of LACYP are all employed by Northumbria Healthcare NHS Foundation Trust. They receive professional supervision and line management from senior colleagues within the Trust.

The Designated Nurse (1.0 WTE) is managed within the Safeguarding Team and the Lead Nurse (0.8 WTE) is line managed by the Designated Nurse, both within the Child Health Business Unit. The Designated Nurse is vice chair of the Fostering Panel and attends as the health representative.

The Designated Doctor also sits within the Child health Business Unit and she also fulfils the role of Medical Advisor to the Adoption Panel. In this role she medically assesses children being considered for adoption, advises the Agency Decision Maker at the “suitability” stage, as well as providing advice to panel at the point of matching and advising prospective adopters. Medical assessments of prospective foster carers and adopters are conducted by their GPs but she also scrutinises these and provides written advice to the agency regarding suitability as part of her role, with a total WTE (0.4). The government national and local drive to recruit and assess more foster carers and adopters, in tighter time scales, in order to avoid delays for children has resulted in a 66% increase in the number of adults being assessed in the last few months compared with the previous. I.e. 82 adult assessments in the first 5 months of this year compared with 120 in the previous 12 months. Public policy to avoid unnecessary restrictions of adopters and carers, combined with the need to assess relatives as carers, has increased the complexity of the health issues involved.

The Designated Doctor also completes the majority of the initial health assessments for children, who become looked after, as well as some reviews, where the plan is adoption or where there is a need for paediatric review.

Administrative support and supervision is provided by Northumberland County Council.

The service delivers to all children within Northumberland that are classified by the local authority as being Looked After. On average there have been 330 children and young people in care in Northumberland, between April 2013 and March 2014. The cohort is a fluid one, due to children and young people becoming looked after for varying lengths of time dependent upon their Local Authority plans. Some looked after children are adopted or returned to live with their families. As the cohort is from birth to 18 it is diverse in its health needs and care required. The numbers of LACYP per 10,000 populations are 53 which rank Northumberland 91st nationally (DfE) with the national average being 60 LACYP per 10,000.

Profile

|Role |WTE |Agency |

|Consultant Paediatrician Designated Dr for LACYP, and Medical Advisor on |0.4 |Northumbria Healthcare NHS Trust |

|Adoption and Fostering (N/land) | | |

|Designated Nurse for LACYP (N/land) |1.0 |Northumbria Healthcare NHS Trust |

|Lead Nurse for LACYP (N/land) |0.8 |Northumbria Healthcare NHS Trust |

|Admin (N/land) |0.8 |Northumberland County Council |

4. The Looked After Children and Young People Population

There are currently 326 (data 31/03/14) LACYP, Northumberland County Council, Children’s Services.

Of this cohort there are:-

Under 5’s - 98 30%

5-11yrs - 75 23%

11-18yrs- 152 47%

Of the total cohort 101 (31%) were placed out of Northumberland. There were 107 looked after children and young people placed with independent fostering agency carers (IFA’s) both in and out of the county.

5.Health Assessments, Performance and Quality Assurance

Children and young people who become looked after should have an initial health assessment completed within 28 days, unless their health has been comprehensively assessed within the preceding 3 months.

Review health assessments are completed every 6 months for children under 5 and every 12 months for children and young people (CYP) aged 5yrs -18yrs.

The aim of the national data collection for LACYP SSDA903 return is to collect information about children who are looked after by local authorities continuously for a twelve month period. Statistics in this report are from 1/4/2013 to 31 March 2014.

Whilst systems to ensure the timeliness of assessments in Northumberland continue to be refined, there remain challenges

Initial Health Assessments (IHA’s)

Initial health assessments are all completed by the Designated Doctor with occasional support from trainees. Whilst working to this timescale is a significant challenge, the on-going audit demonstrates continuing improvement from the situation 3 years ago, and improvement thorough the year.

Of the 154 LAC entering care (which stayed in care at least a month), 128 (83%) were seen within 20 working days

 

Of the 26 who weren’t seen in time scales, there were delays of less than a week in 13 (50 %). The reasons for delays were grouped into LA factors, child/ family factors and health provision factors, and combination.

Child / family factors:

• 5 young people refused assessments though 2 subsequently were persuaded and had late assessments,

• 2 were delayed by 4 days because one of sib ship had a school trip and carer wanted to bring together

• One was delayed because assessment due in run up to Christmas as carer preferred to wait till Jan

• One parent refused consent for health assessment and the local authority had to go to court to share PR

Local authority factors were:-

• Late notification by 2 months of one child who by that point was placed in Glasgow.

• One YP admitted then LAC team offered appointment in time scale, but declined by SW who reported decision not taken yet that child LA, later reported admitted but only notification 3 weeks later so assessment 27 working days after becoming LA

• Late notification of one child who went to live with relatives after an injury and CP medical but became “LA” 3 months later, and info requesting health assessment was not made for a further 2 months

Health / Service factors:

• 1 child admitted in July was seen a week outside time scales because capacity was reduced by annual leave at a point when admission were peaking

• 1 child was admitted with sibling who had CP medical but it was wrongly believed both children had been assessed by paediatrician so IHA was delayed

Combination factors:-

• 4 siblings needed assessment but wanted appointments together and so needed a whole clinic and for carers convenience/ capacity reasons assessment was 3 days late

• 2 children were placed in the far north of the county (Berwick and Seahouses) and in order to avoid unnecessary travel, children’s appointments were combined with contact arrangements in one case and with clinician’s other commitments in another resulting in delays of 2 and 8 days

It should be noted that many of those that were seen within time scales did require multiple time-consuming prompts to social workers to get the information required, and further collaborative work has been done to simplify matters but further work is needed to avoid the process detracting from the other administrative tasks, such as circulating reports and data entry and collating of health information.

Graph below shows numbers entering care per month, and %s seen in 20 working days of entering care.

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145 IHA’s have been completed between 1st April 2013 and 31st March 2014.

Review Health Assessments (RHA’s)

Review health assessments are allocated to reflect those best placed to assess the child. Some review health assessments are completed by the nursing staff and designated doctor within the LAC Health Team, and others by colleagues from School Health and Health visiting. Where it is clear that children are in long term placements, then their school health advisor or Health visitor are likely to be best placed to complete, but where children remain in care proceedings, and have possible or twin track plans to be placed for adoption, the medical advisor/ designated doctor will see to ensure advice is available to panel/ adopters when needed. Where children are of school age but in short term placements, whilst their future care is being decided, this group is often mobile, and difficult/ complex to engage, and the LAC health team (lead nurse/ designated nurse) are better placed to provide assessments and support. The older young people, those not in educational placements and care leavers are also offered assessments by the LAC health team A few are completed by Nurses in residential units, specialist Nurses (SORTED, Targeted Adolescent Service TAS) and Designated LAC staff (Doctors and Nurses) from other areas.

The population requiring assessments includes Northumberland LACYP (337) and those from other authorities (50) who are placed in the county. 85% of the 12 month cohort received RHAs on time

For Northumberland looked after children and young people who are placed out of the county, some are seen for review assessment by the Lead Nurse or arrangements are made for completion through Designated LAC staff in other areas.

Immunisations for Looked After Children and Young People

93% Northumberland LACYP currently in care have had their scheduled immunisations. For the older LACYP this can be challenging but a flexible approach by community nursing staff, including delivery at home and negotiation has enabled these to be completed.

Dental Checks for Looked After Children and Young People

Northumbria Healthcare NHS Trust have a dedicated dental service for LACYP which was set up in 2011 and is currently run by the community dental service which supports LACYP to access high quality dental care swiftly and for treatment to be given. There has been a continuing trend over the past five years for LACYP dental assessments remaining on average 96%, Northumberland have 95% returns on this data.

Northumberland

4. Governance Arrangements

Northumberland LAC Health Team meet weekly to discuss LACYP who are a cause for concern and to plan service delivery to meet their specific needs.

The administrative staff of the LACYP Health Team, continue to develop, maintain and update a spreadsheet of all Northumberland LACYP which traces their individual health assessment status. It also provides the basis for data collection and informs the annual SSDA903 returns. The spreadsheet has recently been amended and reformatted to make it more efficient in terms of ensuring information is sufficient and able to be easily completed.

A quarterly report for MALAP is provided by the Designated Doctor. In Northumberland further work is needed to ensure that reports are produced automatically on a more regular basis which will assist in enabling identification of problems. Commencing 1st April 2014 LACYP Health Teams will also produce monthly statistics and a quarterly report that will be used to populate the Safeguarding Children Dashboard for Northumbria Healthcare

5. Health outcomes

Appendix one provides some examples of good practice.

Northumberland

To understand of the profile of the health needs of the LAC population it was agreed to track the impact/value of health assessments. In order to do this, a rating system was developed in January 2012 to identify in each case areas of health (medical, hearing and vision, emotional/mental health, health promotion, dental health, immunisations, and risk taking behaviours) and each were rated as to whether there were no issues (0); issue known already and being addressed (1); issue known for which additional intervention required (2); or newly identified issue (3). This then allows as indication of the added value provided by a health assessment, with higher scores indicating greater health interventions.

Serial measurements over time may also indicate that issues have increasingly been resolved, though it is notable that at review assessments young people may be less anxious and more willing to disclose health concerns that previously they were not.

LACYP in Northumberland all have their IHA and RHA coded and the scores are entered onto the spreadsheet/database. Analysis of this information has been undertaken.

Northumberland are requesting support to ensure that regular analysis is possible for input data.

9. Assessment of Emotional & Behavioural Well-being

Mental Health

Looked after children show significantly higher rates of mental health disorders than their peers (45%, rising to 72% for those in residential care, compared to 10% of the general population aged 5 – 15 years). Most prevalent emotional health issues are conduct disorders, hyperactivity, anxiety and depression. Many others have developmental problems and 11% are reported to be on the autism spectrum (RCN and RCP and CH 2012). Attachment problems are common among this population and can underlie both mental health problems and both educational and care placement stability.

The health teams assess the emotional and behavioural wellbeing of all the LACYP as a routine part of each child’s IHA and RHA by direct age appropriate questions developed with CAMHS. Emotional and behavioural issues are also screened for using the Strengths and Difficulties Questionnaires (SDQ). Carers of LACYP 3-16 complete the screening tool either annually or 6 monthly, for under 5s and over 5s respectively. Children over 11 years also complete an SDQ self report and these two reports are considered along with the IHA/RHA at monthly health supervision.

Strengths & Difficulties Questionnaires completed for 4-16 year olds who had been looked after for at least 12 months for year 1/4/13 - 31/3/14 (SSDA903 return)

From April 2008 all Local Authorities in England have been required to provide information on the emotional and behavioural health of children and young people in their care. This data is collected by Local Authorities through a Strengths and Difficulties Questionnaire (SDQ) and a summary is submitted to the DCSF through the SSDA903 return.

 

SDQ data for Looked After Children and Young People

Northumberland

A SDQ Pathway for LACYP in Northumberland had been developed some time ago and amended in the face of recent organizational changes in CYPS. SDQ’s are sent out, before health assessments, to all carers of children 3yrs to 17yrs, every young person aged 11yrs to 17yrs. We achieved return of SDQs and scores in 82% of the SSDA903 cohort. This is an improvement on last year (77%) but there are a number of children where carers have not returned SDQs

Scores were as follows:-

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There have been considerable developments in the area of mental health liaison in Northumberland over the last 6 months. Whilst looked after children aged 4-9 years old, who score high or are deemed of high/very high risk of having mental health disorder, have been notified to CYP Clinical Psychologist, who offers consultation as appropriate, where those with parental responsibility consent to this, and this continues to occur, the situation for children of 10y and older was much less satisfactory. Whilst high scorers were notified, it was often unclear what interventions took place, which children were being offered consultations and what the outcomes were. It was also often unclear if children remained under CYPS care. There was very little opportunity for 2 way dialogue regarding children and young people, though often there were both mental and physical health concerns.

Since Jan 2014, the LAC health team, paediatric and nursing staff commenced monthly liaison meetings with CYP Clinical Psychologist, who heads the “Disrupted Childhood Service” and CPN from the department. This has allowed high scorers to be discussed, information about health and circumstances of relevance to be shared where appropriate, issues of priority to be brought to attention and where children move, changes of address and appropriate services to be discussed. The psychology involvement is particularly valuable but has been impacted by recent sickness. There remain some issues regarding written correspondence but in general children’s needs are better considered and addressed.

By agreement through the MALAP we now have agreement from Children services that Mental Health correspondence on children subject to care orders will be shared with the LAC health team, to facilitate a holistic understanding of their needs and the therapeutic input being put in place, unless the young person declines for this to occur. There remain some operational issues around this but there is progress.

In addition there are a variety of access points to address mental health issues provided by the voluntary sector of Northumberland, including peer support within schools, MOSAIC service, run by Barnardos, for those who have been sexually abused, as well as the mainstream North Tyneside CAMHS and Northumberland Children and Young People’s Service (CYPS).

Northumberland have an Attachment and Resilience Training Strategy, which facilitates the understanding of attachment issues in the LAC population as well as providing specific therapeutic input where this is needed.

Sexual Health

Sexual health outcomes in this population are challenging to collect due to issues of confidentiality. One measure is pregnancies completed to term, but this does not include pregnancies which have resulted in termination or miscarriage.

Northumberland LAC and YP have excellent access to services to address their sexual health needs. Guidance and advice is also offered to staff and Carers about working with young people around any sexual health issues. During the last year this included supporting Genito-Urinary Medicine (GUM) visits, working with staff and carers to address young people’s self-esteem issues, puberty awareness talks, contraception awareness, pregnancy support, and issues re abusive relationships, sexual orientation and sexual exploitation.

When attending health assessments, young people are given information about local services, are offered Chlamydia screening if indicated, and can be referred on an individual basis to the Sexual Health Team as necessary.

Teenage Pregnancy

Over the last twelve months there have been 4 confirmed pregnancies for young women who are looked after. Of this cohort, there have been 3 successful deliveries with 1 of those babies remaining in her mothers care, 1 baby looked after with relatives and 1 baby released for adoption. There was one pregnancy which ended in miscarriage. All have been provided with support and have received advice and counselling around choices and contraception from the Teenage Pregnancy and 16+ Teams.

Substance Misuse

Health assessments include discussion around substance misuse and smoking. The quality of information that young people share is variable and dependent upon how comfortable the young person feels about disclosing any substance use. Information that is relevant on the day of the assessment can become irrelevant very quickly, as trends in drug use alter. In line with CQC Inspection recommendations, all young people over 10 years were screened, using the agreed screening tool within each area, to identify whether they were using substances.

SORTED are notified of admission of young people into residential care and an initial assessment is completed. The children and young people can also be referred for support from SORTED as needs are identified. Whilst all young people are asked about substance misuse at health assessments the study done of the effectiveness of the use a screening questionnaire was conducted a year ago and indicated that no new referrals resulted from its use. Young people were already involved with services, declined to access or were not reporting substance misuse at that point. Efforts have therefore been concentrated on ensuring residential staff and foster carers know what to look for and are able to make referrals when they recognise an issue. Smoking cessation work has been offered on an individual basis to some young people through the Health Promotion worker attached to SORTED, and more recently a specific worker within the Stop Smoking Service is available to work with young people. Whilst smoking is asked about routinely, our data input does not easily allow analysis of numbers of smokers.

10. Looked After Children and Young People Placed out of Borough/County

Local Authorities have a duty to provide children and young people with accommodation within their area, unless it is not reasonably practical or consistent with their welfare. Informing other Authorities about children placed with them by Northumberland is undertaken by the Local Authority rather than by health, although there is direct communication between Designated Nurses.

There are currently 101 (31%) Northumberland LACYP who are placed out of the county, in Specialist Schools and Residential Units or with Northumberland carers who live outside the boundaries.

The Designated Nurse attends Placement Planning Group and is not aware of any children being placed where their health needs cannot be met. Communication with health colleagues in other authorities continues, in order to ensure that the needs of specific children and young people who are placed outside of the County are addressed.

The Health of Northumberland LACYP Placed Out of County (31.01.14 cohort) was audited in April 2014 (Appendix 1)

11. Care Leavers

In line with NICE Guidance, work is on-going with some young people and the 16+ Team to develop effective procedures to ensure that young people leaving care have a health interview, appropriate information about their health background and family history and also access to services that will enable them to make good choices about their future health.

In Northumberland, representatives from Voices Making Choices (Children in Care Council) were asked to evaluate with looked after young people several different versions of health passports from a variety of different areas. The outcome was unanimous in that they had not liked any of the resources presented to them and requested that an App was made available instead. However they were interested in their own personal health history.

The Lead Nurse continues to complete review health assessments and offers intervention, information and advice to Care Leavers to address specific and individual health needs. On leaving care outstanding issues form the Health plans are followed up directly with the young person, Social Worker, or carer as appropriate. A letter is sent to the young person and Social Worker highlighting outstanding issues, for example dental registration and appointment, with a request to follow this up and that the LAC Health Team is available for future support. The nurse continues to make contact with Care Leavers to highlight outstanding issues and support them to register locally with GP’s and Dentists. However, routine appointments to ensure full health history information is available to young people has not been rolled out.

The Lead Nurse has a mobile phone number that she can be contacted on by Care leavers.

Development plan:

Care Leavers will be sent a standard letter around their 16th birthday that will offer them the opportunity to discuss their health/birth history, In order to ensure that they have information they need to make good future health decisions. Those young people wishing to access this will be offered an appointment with the Designated Nurse, (or Lead Nurse if already involved) a follow up letter will be sent, indicating that all of their health information and Health Plans are held in their GP record that they can request access to it and the letter will identify generic web links for health promotion.

This letter will also be sent to those young people who decline a face to face meeting.

The Lead or Designated Nurse communicates with the 16+ Care Team for young people who are on the cusp of moving into independence.

Communication with other provider agencies, such as Barnardo’s Housing Project, is maintained to ensure that a joint approach to supporting care leavers is on-going.

12. Participation

The Voices Making Choices Group (VMC) are involved in developing resources and have provided feedback from the children and young people to the Looked After Children’s Health Team about the health assessment process. The work of this group is invaluable in directing service development. There focus in the past year has been on resources to train social workers, but it is hoped this year to involve them in looking broadly at how their health can be positively influenced.

Drop-in Session

Drop-in sessions are monthly lasting 45 minutes and offered to 2 residential placements in Northumberland by the Lead LACYP Nurse (appendix 3)

13. Support to Training & Workforce Development

The Designated and Lead Nurses support training for residential child care officers and foster Carers as requested by Children Services.

The majority of school health advisors and health visitors have been trained in the completion of the BAAF forms for health assessments and refresher sessions are planned for the coming year.

Training of Medical trainees around the needs of LAC, Care Proceedings and pathways for adoption has been developed into a module to be completed by trainees as part of their Child Protection on call training.

Multi agency Attachment and Resilience Training Strategy continues as described in the appendix, which facilitates good understanding of the needs of LACYP in all settings and accords with NICE/SCIE guidance that there should be widely available training specifically around the impact of attachment and that this should be taken up by those involved in caring for looked after children.

14. Action Plans

Northumberland Action Plan 2014-15

|Action |By When |RAG |By Whom |

|Data base to be refined to allow clarification easily of those |October 2014 | |Health team with support from LA |

|children in long term placements and those not yet to improve | |AMBER | |

|allocation of health assessments | | | |

|Notifications of children placed for adoption to be copied to LAC |June 2014 |GREEN |Dr Redfearn and family placement |

|Health to facilitate post placement health assessments where needed| | | |

|Request for completion of RHA’s of children in permanent placements|May 2014 |AMBER |Admin/Designated Nurse |

|to be sent out 2 months in advance of due by date | | | |

|Improving the timeliness of provision of health requests and |March 2015 |AMBER |Admin/Designated Nurse/Lead |

|consents. Consideration is being given to further training for | | |Nurse/Designated Doctor |

|social work teams. | | | |

|Plan to audit 10 % of LAC health assessments using annex H national|March 2015 |AMBER |Designated Doctor |

|tool to ensure comprehensive assessments being achieved of good | | | |

|quality. | | | |

|Request feedback from reviewing officers re value of health |October 2014 |AMBER |Designated Doctor with Local |

|assessments to care planning | | |authority |

|Confirm data base to ensure regular reports and analysis of LAC |August 2014 |AMBER |Health team with Information |

|information. | | |Services |

|Work with Performance Team to facilitate faster and efficient |July 2014 |AMBER |Health Team with Information |

|collection of statistical information and prevent duplication of | | |Services |

|data entry | | | |

|Joint work with Senior Managers from Children’s Services |July 2014 |AMBER |Designated Nurse/admin |

|Operational and Performance Team to ensure that notification | | | |

|timescales of children needing assessments is improved. | | | |

|Improving quality of HV/SHA assessments |Dec 2014 |AMBER |Designated and Lead Nurses |

|Development of a file on Integrated Children’s System, containing |July 2014 |GREEN |Admin/Designated Nurse/Lead |

|all relevant health documentation, to facilitate completion of |(Completed June 2014) | |Nurse/Designated Doctor |

|requests by Social Workers and improve timeliness of submission | | | |

|Re-establish fosterer carer training regarding health assessments |Oct 2014 |AMBER |Designated and Lead Nurses and |

|and health needs of LACYP | | |Designated Doctor |

|Further analysis of coding information regarding health needs of |SEPT 2014 |AMBER |Information support services |

|Looked after children to better understand profile of population | | |Admin/LA/Designated |

| | | |Doctor/Designated Nurse/Lead Nurse|

|Develop service to see LAC at point of transition for leaving care,|Over the next year |AMBER |Des Nurse |

|to ensure they have comprehensive understanding of their health | | | |

|history | | | |

15. Appendices

Appendix 1

Case studies demonstrating good practice

1. Email received from SW requesting information as to whether a Care Leaver had been prescribed anti-depressants in the past. This information was needed as there was a court case pending regarding removal of the Care Leaver’s baby. Care Leaver was stating that this had been the case, and was aware that SW was contacting Designated Nurse to confirm this.

Letter sent by Designated Nurse to Care Leaver asking for written consent to contact the relevant GP to request information.

Written consent received and letter sent to GP, by Designated Nurse, enclosing consent. Within a month, a letter was received from the GP confirming that the Care Leaver had been given a short course of anti-depressants several months earlier.

Ultimately, the baby remained with the Care Leaver.

2. Baby became looked after at 6 months

Back ground of concerns re neglect.

Local authority concerned that needs unlikely to be met in birth family so adoption to be considered

Initial health assessment identified need for family history information to ensure that is placed outside birth family relevant information available to adopters for future planning/ well being

Difficulty obtaining information through social worker but liaison with Children Permanence worker achieved completion of parental health consent and allowed liaison with tertiary haematology centre that were providing care for mother.

Information indicated mother had autosomal dominant condition Type 1 Von Willebrands, which means baby has 50 % likelihood of having same condition. This can lead to bleeding if dental extractions or surgery. Information now available to be passed to prospective adopters by medical advisor who will meet with adopter prior to matching

3. Child sustained shaking injury resulting in severe brain injury. This has led to visual impairment as well as motor impairment and developmental difficulties. Relatives have requested to be considered to care for the child. Because medical advisor provides paediatric over view for child as well as advice to agency, a meeting was arranged to help prospective carers to accurately consider the potential long term complex care needs of this child. As a result they decided they were not able to meet the child’s needs, which probably avoided an inappropriate placement with all the consequences of a placement breakdown. Child remains in committed foster placement as adoptive placement continues to be sought.

4. February 2014, LAC Health Team contacted by a SW re a young person who has a fear of dentists and although registered with a local practice had been unable to arrange a quick appointment and they were c/o toothache. The SW had been informed that the young person could attend the Dental hospital, but the practice was unsure if they would be seen immediately. The LAC health team rang the Dental Hospital and gave them some background info re this young lady who had only just started to engage with the dental service due to having a tooth removed at an early age which had been difficult. The dental hospital agreed to see the young person as soon as they could arrange to get to the hospital.

The young person was seen within the hour and treatment and antibiotics prescribed with a follow up appointment arranged.

5. Team contacted by a Care leaver who was requesting support with applying to a weight loss team for possible Bariatric surgery. This young person had gained a considerable amount of weight in the last year and was now classed as morbidly obese by her GP. She had been referred to a weight loss clinic but was requesting past health information and growth measurements for her application form. Information obtained from her Lac health file and the Northumbria notes and sent a supporting letter to the weight loss team. The young person did not want to discuss some of this information herself at her appointments as she felt there was a lot of sensitive information as to why she felt she had gained weight but had given consent for me to share. When she was offered an appointment she was supported to attend her 3 appointments at the weight loss clinic. After complying with the weight loss team and following their advice she lost almost a stone, this young lady was then referred to the Bariatric team in Sunderland; she has now had her surgery and has lost a considerable amount of weight.

6. Team was contacted by a SW who informed me that one of our carers had been diagnosed with cancer and was receiving chemotherapy treatment. The young person who was in placement had overheard his carer talking about her illness on the phone. His behaviour was reported to have deteriorated and informed that he wouldn’t take any notice of his carer, although she had sat with him and discussed her treatment and the likely outcome which was reported to be good at that time. I was asked if I could offer any support or advice as I had only recently met with the young person to complete their health assessment and he had been very interested in discussing how parts of his body worked. I liaised with the carer re her diagnosis, treatment and after care, obtained some information from our Health improvement service and then met with the young person and his carer. Having a diagram and some literature helped to show the young person the way in which the chemo was going to be administered and the effects of the treatment on his carer. The session went well and the young person asked a lot of questions. I followed up with the carer the week later who informed me that things were more settled and the young man was now talking to his carer about how he had felt on hearing the news.

Appendix 2

Judith Capstick-Meredith, Designated Nurse for Looked After Children, Northumbria Healthcare NHS Foundation Trust

April 2014

The full audit is available from Judith.Capstick-Meredith@nhct.nhs.uk

Executive Summary Northumberland LAC out of county audit.

Placing looked after children and young people (LACYP) out of Northumberland presents a challenge in ensuring that their diverse needs are being met with the provision high quality health assessments and interventions. Adequate monitoring and communication with health professionals in the areas where looked after children and young people are placed, is essential in order to fulfil statutory requirements and ensure good quality provision of care.

Identifying the cohort of LACYP placed out of county was initiated by requests to Northumberland County Council Performance Service, who are able to provide an up to date list. In future, a request has been made for a three monthly report of to be provided by the Performance Team, detailing all Northumberland children placed out of County, to be automatically generated.

Involving health professionals in decisions around placement changes and planning will help to ensure that needs are well understood by the care team and local providers, before a child is placed out of County and can better facilitate their health needs being met. The Designated Nurse attends the Children’s Services Placement Planning meeting that takes place three weekly, where there is the opportunity to explore the appropriateness of potential placements.

The majority of health assessments were undertaken by Northumbria Healthcare NHS Foundation Trust employees. Interventions were provided by a variety of agencies including Northumbria Healthcare but also other NHS trusts, regional services and through residential care services.

All children were registered with a local GP and most had an up to date dental assessment. Overall, health assessments and provision was good, but recommendations are provided which may help in particular with improving assessment quality and monitoring of health care services.

Appendix 3

Drop In dates at Netherton Park and Coanwood Drive site April 2013-2014

24/04/2013 Attended by 2 YP discussed dental care and heights and weights recorded,

05/06/2013 Attended by 2 YP discussed diet and sexual health

10/07/2013 Attended by 3 YP heights and weights taken and acne treatments discussed and general hygiene.

28/08/2013 Attended by 1 YP the importance of immunisations discussed particularly the Human Papilloma Virus.

25/09/2013/ Only 1 person in placement and didn’t want to discuss any health issues

30/10/2013 Young people from Kingfisher House now moved to a new residence at Coanwood Drive. Drop-ins are now on 2 sites for 30 mins each. Sexual health nurse no longer able to attend drop-ins but Carlton Street are offering a service on Wednesday afternoons between 2-3pm. At Kestrel house 2 YP attended and discussed anger management and general advice about reducing smoking. At Coanwood drive 1 YP in placement discussed pregnancy and reducing smoking.

28.11.2013 At Kestrel house 2 YP in placement, heights and weights offered and general advice regarding diet and exercise discussed. No one at Coanwood; All YP were out on contacts and excursions.

19.12.2013 At Kestrel house 1 YP attended general chat about contact over the Christmas. At Coanwood there were 3 YP in residence and 1 YP just new into the placement. The role of the health team and the drop-ins, heights and weight measured and dental hygiene was discussed.

04.02.2014 At Kestrel house 2 YP in residence only 1 YP wanted to chat discussed recent health assessment issues, reluctant to engage. At Coanwood 2 YP at home only 1 YP wanted to engage discussed healthy eating and attending the dentist.

26.02.2014 Nobody at Kestrel - all out on contact. At Coanwood 2 YP in placement, they were playing with Lego so I joined in and attempted to bring in the theme of dentist appointments and attending Dr appointments, also the benefits of exercise .1 YP appeared interested, the other YP sat at a table nearby and appeared to listen.

27.03.2014 2 young people at Kestrel. One YP discussed immunisations and how he was feeling as he informed me he was moving placements during the week. The other YP had his ht and wt measured and a general discussion about growth.

At Coanwood 2 YP were playing with Lego figures and I joined in and we discussed how school was going, exercise activities now that spring was here.

1 other YP had recently only returned to the placement after having a baby, which had been removed. General discussion about her low mood and advice offered, a follow up appt arranged at the time.

30.04.2014 Attended the drop in on the wed 30th of April at Coanwood , 2 young people in placement both young people did not want to discuss any health issues on their own, I sat with one of the young people at the computer and we had a general chat about school, she kept wandering in and out and dipping in and out of the conversation, which was nice. When she got measured this did lead on to a brief chat about puberty and growing spurts.

Attended Kestrel for the drop in on wed the 30th of April. One young man and the new young man were there; as there was a counsellor there also we just sat at the table as the young people didn’t want to see me on their own. It was nice as I got to meet the new young man and as he was due his health assessment, we were able to be introduced. I told him I would ring next week to arrange an appt to come and see him and he was good with that. It was nice to just have a general chat with the other young man about school. I am going to get some dental products and drop them off and hopefully have a chat about teeth hygiene at the next drop in.

References

DfE (2013)Children looked after by local authorities in England: Guide to the SSDA903 collection 1 April 2013 to 31 March 2014 Department for Education, London

NHS Commissioning Board (2013) Who pays? Establishing the responsible commissioner. NHS Commisioning Board, London

RCN and RCP and CH (2012), Looked After Children: Knowledge, skills and competence of health care staff; Intercollegiate Role Framework. The Royal College of Nursing and the Royal College of Paediatrics and Child Health, London

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