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5.7.1 Health Care Assessments, Health Checks and Health Care Plans

SCOPE OF THIS CHAPTER

This procedure applies to all children looked after and summarises the arrangements that should be made for the promotion, assessment and planning of their health care. All children remanded other than on bail are Looked After Children. Different provisions will apply In relation to those children/young people - see Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Care Planning for Young People on Remand or Youth Detention Accommodation.

HCC is committed to providing a holistic assessment of an individual child and young person’s health care needs. These assessed needs refer to physical, mental and emotional health, including health promotion.

RELEVANT GUIDANCE

This chapter should be read in conjunction with the Department of Health January 2015 statutory guidance on "Promoting the health and wellbeing of Looked After Children" and the Young People with Mental Health Difficulties Procedure.

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

The issue of consent to medical examination and treatment is addressed in Consent to Medical Examination and Treatment Procedure.

Please also see: Practice Guidance: Supporting Young People with HIV Testing and Prevention (NCB).

AMENDMENT

In September 2017, additional information regarding the Strengths and Difficulties Questionnaire process was added to Section 2.8, Emotional Health of Children Looked After and Care Leavers including Strengths and Difficulties Questionnaire Guidance. A link to Children’s Attachment: Attachment in Children and Young People who are Adopted from Care, in Care or at High Risk of Going into Care - NICE Guidelines (NG26) was also added (above).


Contents

1. Obtaining Consents to Initial and Review Health Assessments, Health Checks, Examination and Treatment
2. Health Care Assessments, including Dental, Optician and Immunisation Checks
  2.1 When Required
  2.2 Initial Health Assessments
  2.3 Background Information
  2.4 Review Health Assessments
  2.5 Dental and Optician Checks
  2.6 Immunisations Up to Date
  2.7 Adoption
  2.8 Emotional Health of Children Looked After and Care Leavers including Strengths and Difficulties Questionnaire Guidance
  2.9 Merging Health Care/Health Checks
  2.10 Disabled Children
  2.11 Black and Minority Ethnic Children
  2.12 Children in Secure Settings and/or on Remand
  2.13 Refugees/Asylum Seeking Young People
3. Health Care Plans
4. Sexual Health, Education and Related Issues
5. Minor Accidents
6. Child and Adolescent Mental Health Service (CAMHS) for Children Looked After
7. LCS Recording of Health Information and Performance Indicators
8. 17 and 18 Year Old LAC and Care Leavers Health Information Pack

See LCS User Guide.


1. Obtaining Consents to Initial and Review Health Assessments, Health Checks, Examination and Treatment

Prior to an Initial Health Assessment, Part A of the IHA form must be completed and signed confirming that there is consent. Brokerage complete and sign the IHA form. Brokerage has to provide this information to Health within 3 days for a planned placement and 7 days for an emergency placement so obtaining the information Brokerage require to complete the IHA form at the Pre-Referral stage is crucial.

Prior to a Review Health Assessment, Part A of the RHA form must be completed and signed confirming that there is consent. The Social Worker completes and signs the RHA form.

For children looked after on a voluntary basis (s20), signed parental consent must first be obtained using the Placement Plan. Because a child may be placed out of area, signed parental consent must also be obtained using the BAAF Consent form.

Children Looked After under Interim and Full Care Orders (s31 & s38), parental agreement should still be requested where appropriate; however consent must be given by the local authority in respect of the child’s health since the LA shares Parental Responsibility. Because a child may be placed out of area the Social Worker signs a BAAF Consent form giving local authority consent.

Note: Unaccompanied Asylum Seeking Children do not require a BAAF consent form.

See Consent to Medical Examination and Treatment Procedure.

Children and Young people are encouraged to engage with their statutory health assessment unless it is specifically refused by the young person. Even if they initially refuse to go to their assessment they may be willing to see a Specialist Nurse from the Children Looked After and Care Leavers Health Team or have their health assessed by a Health Professional who they already know and trust.

A child at any age may refuse any part of the Health Assessment. No child will have the Health Assessment forced upon them, however, it is entirely appropriate to persuade and encourage children and young people to attend, in order to identify health needs and engage in participation of health care.

The Social Worker will inform Brokerage if the child refuses their initial Health Assessment prior to the appointment being booked. The Health Professional will inform the CLA Health team if the child refuses the appointment and this will be recorded on LCS.


2. Health Care Assessments, including Dental, Optician and Immunisation Checks

2.1 When Required

Each Looked After Child 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, in time for the Health Care Plan to be received before the child's first Looked After Review (unless one has been done, and a written report is available, within the previous 3 months);
  • 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.

If no plan exists, the Social Worker should arrange an assessment within a month of the placement so that a plan can be drawn up.

NOTE: This includes Family and Friend Placements.

Additionally each child should have an annual dental check, an optician check every two years and his/her immunizations should be up to date.

2.2 Initial Health Assessments (IHA)

Brokerage liaise with the Social Workers in order to complete Part A of the IHA form and ensure that the relevant paperwork is sent to the Children Looked After and Care Leavers Health Team within 3 days for a planned placement and within 7 days for an emergency placement.

2.3 Background Information

The social worker should obtain as detailed a history as possible about the child’s health from their parents/carers prior to the child becoming looked after, or as soon as possible afterwards if in an emergency. This should include an immunisation history. This must be recorded on the Placement Plan and in the health section of the C&F Assessment.

For new entrants into the care system please provide answers to the following health questions:

  1. Has there been/current significant parental ill health?
  2. Has there been/current parental substance misuse?
  3. Has the child had previous pregnancies / currently pregnant?
  4. Are there health issues relating to the need for the child to be placed in Care/ Accommodation?

It is ESSENTIAL social workers ensure the following information is given to Brokerage, using the Placement Request Form (PRF) as appropriate:

  • The child's name, DOB, LCS No, Legal Status;
  • The date the child was placed, and the carer's name, address, phone number;
  • The child's NHS Number and GP details i.e. GP Name, Surgery, Surgery Address and Phone Number and that these are loaded onto the Health section of LCS;
  • The signed s20 consent form / other legal documents are loaded on LCS/Live link - Brokerage will confirm to health this is completed;
  • The signed BAAF consent form is loaded on LCS/Live Link – Brokerage will confirm to health this is completed.

The purpose of putting the Initial Health Assessment process into Brokerage is to provide a central location for monitoring the progress of IHAs and to provide a timely response and ensure young people are assessed within timescales. Brokerage has to provide this information to Health within 3 days for a planned placement and within 7 days for an emergency placement so obtaining the information Brokerage require to complete the IHA form at the Pre-Referral stage is crucial.

To ensure that Initial Health Assessments are undertaken to meet the statutory time requirements, Brokerage will inform health that there is a new child coming into care and send an email containing following information to CLA Health Team (cla.healthadmin@hct.nhs.uk):

  • Completed BAAF Form;
  • BAAF Consent Form for those placed “Out of Area”;
  • Section 20 / Interim Care Order / Emergency Protection Order /Police Protection;
  • C&F Assessment which includes the current background history.

If it is possible that the final Care Plan will be adoption, the Social Worker must inform Brokerage and then the LAC Health team as soon as possible and in all cases should attend the medical if at all possible.

2.3.2 Process

  1. Prior to the child/young person becoming Looked After –
    The Social Worker obtains the background information as per section 2.2.1 Background Information, they ensure LCS is updated and include the relevant health information on the PRF which is sent to Brokerage;
  2. The child/young person becomes Looked After -
    Social Worker completes the health section of the C&F assessment and ensures the signed BAAF Consent form and signed section 20 (if applicable) is scanned and uploaded onto Livelink in the Legal & Statutory Documents & Advice folder;
  3. Within 2 days of CLA --
    Brokerage generates the relevant form, IHA- C Under 10 or IHA - YP 10 and over. Brokerage completes Part A of the form ensuring the relevant health information has been provided by the Social Worker;
  4. Within 3 days of a planned CLA Placement -
    Brokerage email the following documents to the CLA Health Team (cla.healthadmin@hct.nhs.uk):
    • Completed BAAF Form;
    • BAAF Consent Form for those placed “Out of Area”;
    • Section 20 / Interim Care Order / Emergency Protection Order /Police Protection;
    • C&F Assessment which includes the current background health history.
  5. Within 7 days of an emergency CLA Placement -
    Brokerage email the following documents to the CLA Health Team (cla.healthadmin@hct.nhs.uk):
    • Completed BAAF Form;
    • BAAF Consent Form for those placed “Out of Area”;
    • Section 20 / Interim Care Order / Emergency Protection Order /Police Protection;
    • C&F Assessment which includes the current background health history.
  6. Brokerage monitors and will chase outstanding information on a daily basis, escalating where necessary to ensure deadlines are met;
  7. The CLA Health Team identifies appropriate GP or Paediatrician;
  8. IHA takes place and any non-attendees to be notified to social worker;
  9. Immediately on receipt of completed paperwork - CLA Health Team Admin puts Health Assessment date on LCS demographics;
  10. CLA Health Team scans the fully completed IHA form and full immunisation form when adoptions are planned (otherwise only Part C plus the Immunisation Summary) and uploads the saved document & copy of immunisation history held on health electronic client system into forms on child or young person’s LCS record;
  11. The CLA Health Team monitors completion of health assessment process on a weekly basis;
  12. By first Statutory Review (within 28 days of becoming CLA and subsequent reviews) - SW puts the Health Plan in Part C of the Form IHA-C or YP into the LCS Child or Young Person’s Plan in the Health section. The Health Plan should be part of the CLA Review process.

2.4 Review Health Assessments (RHA)

The review health assessments may be completed by a registered nurse or registered midwife under the supervision of a registered medical practitioner. Health visitors and School nurses undertake the majority of the review assessments.

Once notice of an appointment has been received, the social worker will inform the child, parents and staff/carer of the purpose of and arrangements for the health care assessment, and either accompany the child and parents or arrange for staff/carers to accompany the child, as appropriate.

Where the child refuses a health care assessment, this must be recorded. If this should occur an email notification should be sent to Health via cla.healthadmin@hct.nhs.uk. The child should be encouraged to take advantage of the opportunity of the health care assessment to discuss health issues. Even if they initially refuse to go to their RHA appointment they may be willing to see a Specialist Nurse from the Children Looked After and Care Leavers Health Team or have their health assessed by a Health Professional who they already know and trust.

8 weeks before due date:

The SW/Designated Social Care Team Support Officer (SO) starts health review process. Check Placement address, telephone number, school and GP are correct on LCS demographics.

The Social Worker:

  • Completes the Social Care Section re Review Health Assessment (print and sign copy on LCS), include copy of the Care Plan (including specific timescales for tasks to be completed) and send via email to cla.healthadmin@hct.nhs.uk;
  • Visits the child/young person and informs them of their pending RHA and gives the child (age appropriate)/young person health assessment letter CS0264F1;
  • On receipt of Social Care Section re: RHA Form from Social Worker, the CLA Health Admin Team checks paperwork and will return to Sender if any information is missing;
  • Immediately On Receipt of completed paperwork the LAC and Care Leaver Health Team Administrator adds the date of the Health Assessment and Dental date, also records Immunisation status to LCS and scans the Health Assessment Summary and Action Plan onto LCS (in forms) Within 2 days (full copy attached in the case of Adoption).

2.5 Dental and Optician Checks

Dental Checks

The primary carer for the child is expected to arrange for children and young people in their care to attend a dentist as soon as possible after becoming Looked After and annually thereafter. Dental appointment dates are taken from previous Health Assessments and uploaded on LCS. Dates of examinations should be notified to the relevant Supervising Social Worker in Fostering, Adoption, or Brokerage for IP Placements, child’s Social Worker for semi- independent, who enters the date on LCS in the dental section (Their Team Support Officers can assist with this if asked).

The Social Worker must present the updated Health Assessment at the next review and ensure actions within the care plan have been completed.

Optician Checks

The primary carer for the child is expected to arrange for children and young people in their care to attend an optician every 2 years, unless directed more frequently by optician. Dates of examinations should be notified to the relevant Supervising Social Worker in Fostering, Adoption, or Brokerage for IP Placements, child’s Social Worker for semi- independent, who enters the date on LCS in significant health events (Their Team Support Officers can assist with this if asked).

The Social Worker must present the updated Health Assessment at the next review and ensure actions within the care plan have been completed.

2.6 Immunisations Up to Date

The CLA Health team scan onto LCS forms the immunisation data held by the Clinical Commissioning Group (CCG) at the same time as the Health Assessment form is scanned into forms and the Health tab is updated by the Health Team (authorised users).

The Social Worker takes an Immunisation History from the parent and completes on the Placement Plan. The immunisation data provided with the Health Assessments needs to be checked by the Social Worker.

Where immunisations are outstanding this must be reflected in the health section of the care plan with clear actions to address it. For many refugee children their immunisation status will be unknown and a course of primary immunisation will need to be undertaken. Social Workers should seek advice from the CLA Health Team. For every immunisation required, consent must be obtained for each one individually.

2.7 Adoption

Where adoption is part of the parallel plan for a child the IHA/RHA form should still be sent to the CLA Health Team clearly stating this. See all BAAF Forms and Medical Paperwork Required for Panel Procedure.

2.8 Emotional Health of Children Looked After and Care Leavers including Strengths and Difficulties Questionnaire Guidance

The National Service Framework for Children, Young People and Maternity Services (the Children's NSF) Standard 9 covers the mental health and psychological wellbeing of children and young people. It states:

Some children in special circumstances have greater needs regarding their mental health. Looked after children are five times more likely than their peers to have a mental health disorder. Children and young people with significant learning disabilities are three to four times more likely to have a mental disorder and at least forty per cent of young offenders have been found to have a diagnosable mental health disorder.

Experiences of abuse and neglect which are not treated continue to affect a child or young person’s sense of self even after they are physically safe. Research shows that living in an environment of serious emotional neglect or fear in early infancy can impair the growth and physical development of the baby’s brain as well as impacting on the emotional development of their relationships and impair their ability to learn.

It is also well documented that experiences of loss, delays and uncertainty, changes of placement and longer term instability of care are also major contributors to emotional problems in children and young people who are looked after and leaving care.

So clear care planning which minimizes delay and early identification and appropriate service provision for emotional difficulties are very important for children and young people who are looked after.

A screening tool called the Strengths and Difficulties Questionnaire has been introduced nationally with the intention of identifying children and young people who may need additional emotional support.

Strengths and Difficulties Questionnaire (SDQ) Guidance

The Department for Education “measures” emotional well-being of Children Looked After (CLA) as one part of an effort to increase children’s emotional well-being. To do so it uses Strengths and Difficulties Questionnaire (SDQ) (R Goodman’s 1997) Local Authorities are only required to use the SDQ (P4-16) for a child aged between 4 and 16 (inclusive). There are SDQ's for other age groups and there are also follow-up SDQ's. The additional scales and questionnaires may be used, but please remember that these tools are copyrighted. The additional information  must be used to inform child’s care planning.

The SDQ  screens behaviour. It measures five core psychological attributes, (a) emotional symptoms, (b) conduct problems, (c) hyperactivity/inattention, (d) peer relationship problems, and (e) pro social behaviour. Also, “the SDQ will provide predictions about how likely it is that a child or young person has significant mental health problems (unlikely, possible or probable).”

It is designed to flag up a limited range of emotional difficulties, which in turn may form the basis for therapeutic or other intervention.

The SDQ Process

In Hertfordshire, we aim to:

  • Ensure that every child over the age of 4 who becomes looked after has an SDQ completed by their second CLA Review;
  • Ensure that all children looked after who are identified as needing a therapeutic input (Score of 15 or over) are offered the right support in a timely way. Consideration should be given to making a CAMHS referral at this point;
  • Ensure that the SDQ scores are not only collected from the parent/carer, but also from the young person themselves and the designated teacher within the child’s education setting;
  • Ensure that an accurate up to date measurement of emotional and behavioural health is considered when care planning, (i.e. at every Review Health Assessment (RHA); CLA Review and Personal Education Planning (PEP) meeting);
  • Ensure SDQ Scores are actively used as one form of measuring outcomes for children looked after.

SDQ Process for Children at the Point of Becoming CLA

  1. The Supervising Social Worker will bring the Strengths and Difficulties Questionnaire (SDQ) to the Placement Planning Meeting and will support the carer to complete this prior to the second CLA Review;
  2. Brokerage will collect and input the completed SDQ information onto LCS.

See SDQ Process for First Time Entrance to Care Flowchart.

SDQ Process for Children who are Long Term CLA

  1. The IRO will send out the Strengths and Difficulties Questionnaire to the parent / carer and young person (11 years and above) 12 weeks prior to the Review Health Assessment. The Virtual School will also send out the SDQ questionnaire to the designated teacher for all school aged children at this time;
  2. Brokerage will collect and input the completed SDQ information onto LCS.

See Process for Subsequent SDQs Flowchart.

All three SDQ Scores (Child / Young Person; Parent/Carer and Designated Teacher) and past scores will be available to view in the SDQ Questionnaire form on LCS.

Any emotional health needs identified should be entered into the child’s plan with actions to address the issues.

The SDQ can be downloaded from the SDQ info website. The youthinmind's website is helpful in that it allows you to use the SDQ online. Bear in mind that no-one except youthinmind is authorised to create or distribute electronic versions for any purpose. 

See also:

2.9 Merging Health Care/Health Checks

Some looked after children 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 Education, Health and Care Plan 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 manager and the Designated Nurse for CLA can decide to record the dates of medical assessments as the dates of the child's health care assessments. The reasons for this must also be recorded.

2.10 Disabled Children

Particular care will need to be taken to ensure that health assessments and treatment take account of any communication difficulties and that the child’s wishes and feelings, including consent, are represented and respected wherever possible. Health assessments should recognise the importance of identifying any disabling barriers in the child’s environment that may exacerbate the effect of their disability. The Social Worker needs to clearly inform health of any disabilities.

2.11 Black and Minority Ethnic Children

Research evidence has shown that black and minority ethnic children can suffer considerable health disadvantage. They can be vulnerable to certain hereditary illnesses (e.g. sickle cell anaemia, thalassemia), 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.

Interpreters

Health must be informed if there are any interpreting needs (language, communication). For children placed in Hertfordshire, the Health Team arranges the interpreter. For any child placed at a distance, the social worker is responsible for arranging the interpreter.

2.12 Children in Secure Settings and/or on Remand

Children in secure accommodation and/or on remand are considered Children Looked After and their health 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.

2.13 Refugees/Asylum Seeking Young People

Unaccompanied asylum seeking or refugee children are unlikely to have medical records from their country of origin, and may not be able to give a full individual or family medical history. Their immunisation status may be unknown, so a course of primary immunisation may need to be undertaken, and they may have had no previous health surveillance. Depending on the child’s country of origin the young people may have been at increased risk of exposure to some specific medical conditions may need to be considered including:

  • Tuberculosis;
  • Hepatitis B and C;
  • Malaria;
  • Schistosomiasis;
  • HIV/AIDS.


3. Health Care Plans

Each looked after child must have a health care plan, as part of their overall Care Plan, in time for the first CLA Review with arrangements as necessary incorporated into the child's Placement Plan. This should be updated after each CLA Review. The health section of the Care Plan should reflect the current health needs, desired outcomes and the actions and services agreed to address the needs. In addition to promoting the child’s health needs carers should be encouraged to adopt a healthy lifestyle (as set out in S6 of the Fostering National Minimum Standards 2011 (FNMS 2011) and the Children’s Homes Regulations 2015.

Social Workers should work in partnership with parents and carers to contribute to the health plan. All carers will have a copy of the child’s health plan. It is the Health Team’s responsibility to ensure that an up to date copy of the child’s health plan is provided to the child’s carer in a timely manner. Teams / services will have in place suitable arrangements for Business Support Officers to support the Social Worker in ensuring that health plans are sent to carers in timely manner.

Following the Initial or Review Health Assessment, the child’s Health Plan is loaded to Livelink by the CLA Health team. The child’s social worker receives a case note notification of the same.

The business support officer is responsible, once notified that the child’s health plan is on Livelink, for sending a copy of the Health Plan to be shared with the child’s carer.

The IRO must check, within the CLA Review that the carer has been provided with the child’s current Health Plan in a timely manner.

To support and further embed this practice, the child’s social workers will include the child’s Health Plan and relevant actions taken, in the C&F Assessment and provide a hard copy of the child’s Health Plan for the CLAR.

The child's social worker is responsible for keeping the child’s Care Plan up to date, and will do implement the Plan with the assistance of the health professionals identified in the plan. The specific responsibilities of the staff/carers will also be identified in the health care plan, which should also address:

Whether it is necessary for any immunisations to be carried out and if so, where immunisations are outstanding this must be reflected in the health section of the care plan with clear actions to address it:

  1. When it is necessary for a dental check to be carried out;
  2. When it is necessary for any hearing or vision checks to be carried out;
  3. 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 programmes required;
  4. Whether there are specific emotional and mental health needs which may indicate that a Strengths and Difficulties Questionnaire should be completed to measure the child’s emotional well being. Advice should also be sought from CAMHS where relevant (see the Young People with Mental Health Difficulties Procedure);
  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.

Further details regarding the issue of consent to assessments and treatment is covered in Consent to Medical Examination and Treatment Procedure.


4. Sexual Health, Education and Related Issues

The importance of sex and relationships education is recognised in the Children Act (1989) and is part of the responsibility of corporate parenting for all looked after children, including lesbians, gay young men, trans-gender young people, disabled young people, questioning young people and young people who have experienced abuse. Children’s Services will support a young person in making informed decisions, in the context of his/her cultural background and religious beliefs, in the legal context and with due regard to his or her safeguarding, health and welfare needs. Children’s Services will be sensitive, respectful and supportive to him/her regarding their sexual maturation.

Safeguarding procedures should be followed if concerns are that a young person is being groomed for prostitution or exploited, or his or her behaviour presents a risk to another young person. For further guidance please see Hertfordshire Safeguarding Children Board Procedures Manual, Safeguarding Children Abused Through Sexual Exploitation Policy.

The CLA review process should ensure that appropriate education /information/assessment and treatment on sexual matters is made available to young people in a sensitive way, as part of the review of his or her health care plan.

Young people's right to choice and confidentiality is respected, mindful of the local authority's duty

  • To act as a good parent in terms of the safeguarding, health and welfare issues of both the young person; and
  • Any other people, affected by the young person;
  • The duty to work in partnership with parents.

Where a young person's information might be shared with other professionals or parents the young person must be consulted. If s/he not sure about proposed actions, ensure the s/he has the opportunity of an advocate, before any decision to disregard his or her wishes and feelings is made. The allocated social worker must discuss the matter with the Team Manager and the decision and the reason for it must be recorded on the child's file.

Advocacy service is available for a young person whether or not they have a complaint to make and is at no cost to him or her. (For further details please see Advocacy for Children and Young People Making a Complaint Procedure).

Pornography and Internet Access

Young people may undertake any activity that is legal for them to do, but pornographic material should be stored so that it does not influence or offend others. The opportunity should be sought to discuss with him/her that accessing pornography may link to issues of loss of dignity, for both parties, and possible development of a distorted view of sexuality.

Encourage safe and careful use of internet and social networking sites, particularly in relation to young people giving personal details on line.

Sexual relationships between two young people in the same placement are not permitted.

The Forced Marriage Act (Civil Protection) Act 2007 protects people from being forced to enter into marriage without their full and free consent, and protects people who have already been forced into marriage.

The Sexual Offences Act (2003) states it is an offence for anyone over 18 years of age, who is in a position of trust to have any type of sexual activity with that child if they are under the age of 18.

The Female Genital Mutilation Act 2003 states that this is illegal and local authorities have a duty to respond to needs of children who are suffering or who are likely to suffer significant harm.

Please see Safeguarding Children and Young People From Sexual Exploitation: Supplementary Guidance via the DfE offers guidance to local authorities.

and Hertfordshire Safeguarding Children Board Procedures Manual, Safeguarding Children Abused Through Sexual Exploitation Policy for further information.


5. Minor Accidents

Foster carers must report all accidents to the child’s social worker and the supervising social worker.

Supervising social workers must complete an Accident Report Record and ensure that the cause of the accident is investigated and measures are taken to prevent such an accident reoccurring.


6. Child and Adolescent Mental Health Service (CAMHS) for Children Looked After

Hertfordshire Partnership NHS Trust (HPFT) provides Specialist CAMHS (tier 3) and Targeted CAMHS (tier 2) for CLA.

CAMHS provides specific and specialised support to foster carers, children’s homes and professionals working with Children Looked After in Hertfordshire.

Hertfordshire County Council Staff member access to CAMHS Consultation Sessions (see Hertfordshire CAMHS Informal Consultation Details).

See also: Tools for Supporting Children and Young People’s Mental Health.

CAMHS Referral Process

Criteria for Referral:

Any social worker involved in the care of children within the looked after system can refer to CAMHS either in writing or by telephone to make a referral or request a consultation.

Referrals for Children and Young People Looked After by Hertfordshire County Council and are residing in Hertfordshire:

  • Referrals are made via the Single Point of Access (SPA) 0300 777 0707. Social Workers will need to complete the referral form along with the Strength and Difficulties Questionnaire’s (SDQ’s);
  • SDQ and Impact Supplement for Parents of 4-17 year olds;
  • SDQ and Impact Supplement for Teachers of 4-17 year olds;
  • SDQ and impact Supplement for Self-Completion by 11-17 year olds;
  • Children and Young People Looked After by Hertfordshire County Council but are residing “out of Area”;
  • The Social Worker needs to refer to the local CAMHS Service. It is advised that funding is requested before or at the same time the referral is made along with the details of the registered General Practitioner at the time the Child/Young Person came into care. If this is not possible, details of the originating District Council should be included in order to ensure the correct funding is allocated from the relevant CCG.

Please see: Out of Area CAMHS Funding Request Form.


7. LCS Recording of Health Information and Performance Indicators

Each child or young person who is looked after requires that their LCS record includes the following:

  • Health section of Child and Young Person’s Plan should reflect the current health needs, desired outcomes and the actions and services agreed to address the needs;
  • General Practitioner;
  • Other involved health professionals;
  • Immunisation record see above.

NHS Number

  • Dates of statutory Initial and Review Health Assessments (entered by CLA Health team);
  • Copies of the IHA and RHA in forms (entered by CLA Health team);
  • Registered dentist and date of last attendance;
  • Dates of other health appointments in significant health events e.g. Optician / ophthalmologist and date of attendance;
  • Forthcoming medical / health appointments;
  • Health conditions/ disability;
  • Current medication;
  • Substance misuse and help offered.

Performance Indicator Requirements:

It is important to have the information regarding health recorded so the following can be reported on an annual basis.

  • The health and dental checks are recorded separately on LCS;
  • The percentage of young people who have up-to-date dental and health assessments on time are generated separately;
  • The Key Performance Indicator is the average of the 2 separate percentages;
  • Immunisations are a separate indicator;
  • The annual reporting date is the 1st April each year;
  • New emotional and behavioural indicator from April 2008- Strengths and Difficulties Questionnaire SDQ completed by carers for all CLA who are aged between 4 and 16 years inclusive who have been looked after for 1 year or more on 31 March;
  • The reported indicator for Hertfordshire is the Mean score for all CLA in the cohort.


8. 17 and 18 Year Old LAC and Care Leavers Health Information Pack

For all young people aged 17 - 18 yrs that the LAC & Care Leaver Health Team are made aware of, the Team will collate a Personal Health Information pack. This pack will then be sent (via internal post system) to the Social Worker whose responsibility it is to hand direct to the young person at the next visit.

N.B. if for some reason the young person declines to receive this pack, the sealed envelope must be shredded and the Social Worker must inform the LAC & Care Leaver Health Team by email: CLA.healthadmin@hct.nhs.uk.

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