Health Care Assessments and Plans

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

This section should be read in conjunction with the Derbyshire Children’s Services Procedures, Decision to Look After and Care Planning Procedure.

Every Looked After Child should have a Health Assessment soon after being placed and then at specified intervals; as set out below.

The purpose of a Health Assessments is promote the child’s physical, emotional and mental health. The Health Assessment will inform the child’s Health Care Plan, and ensure that the placement meets the child's holistic health needs. As a minimum the child’s main carer will be required to complete the carer’s two-page version of the Strengths and Difficulties Questionnaire (SDQ) for the child in time to inform their health assessment.

(See Annex B of the ‘DfE Promoting the Health and Well-being of Looked-after Children’, Strengths and Difficulties Questionnaire).

Health Assessments must be conducted by a suitably qualified medical practitioner, who should provide the social worker with a written report.

• The first assessment must be conducted before the child’s first placement, or if this is not reasonably practicable, before the child’s first Looked After Review – unless one has been conducted in the previous 3 months;
• For children aged between 2 and 5 years, further assessments should occur at least every six months;
• For children aged over 5 years, further assessments should be at least annually;
• Health Assessments must be conducted more frequently where the child’s health needs dictate.

Health Assessments should not be seen as an isolated event but rather be seen as part of the continuous cycle of care planning (assessment, planning, intervention and review) and build on information already known from health professionals, parents and previous carers, and the child himself or herself.

The Social Worker is normally responsible for ensuring that Health Assessments are undertaken, but this responsibility may be undertaken by the home.

In order for the assessment to be conducted it will be necessary to ensure the Consents section of the child's Placement Plan has been completed and signed by the parent or a person with Parental Responsibility.

Each child's Individual Care and Placement Plan drawn up by the home should include a section on health care needs and set out how these will be promoted by the home ensuring the child’s holistic needs are met.

Additionally, each child must have a Health Care Plan (which may be part of the child’s Individual Care and Placement Plan or may be a separate Plan) drawn up by the social worker.

The initial Health Care Plan should be produced before the first Looked After Review. The Health Care Plan should then be updated after each Health Assessment or as circumstances change.

Strengths and Difficulty Questionnaires:

The SDQ Questionnaire, along with any other tool which may be used to assist, can be used to identify the needs and be part of the child’s Health Plan (see Annex B of the ‘DfE Promoting the Health and Well-being of Looked-after Children’, Strengths and Difficulties Questionnaire).

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

The matters that should be considered in drawing up the Health Care Plan (and addressed in the home’s Individual Care and Placement Plan) are as follows:

1. Whether there are any specific health physical, emotional or mental healthcare needs - and how the home will meet them;
2. If it is agreed that Paracetamol or other painkillers can be used to provide relief for headaches, menstrual or other pain; also whether there are any restrictions;
3. Agreements for the use of non-prescribed medicines, Home Remedies or use of first aid;
4. The involvement of the child’s parents or significant others in health issues during the placement;
5. Any specific medical or other health interventions which may be required, including whether it is necessary for any invasive procedures and how they will be undertaken;
6. The extent to which the child is able to retain or administer medication, or requires support to do so; A risk assessment and lockable cabinet in the young person’s bedroom must be in place if this is the case;
7. Whether it is necessary for any immunisations to be carried out;
8. Any specific treatment or therapeutic interventions, strategies or remedial programmes required;
9. Any necessary preventative measures to be adopted;
10. If the child is a risk of suicide or self harm or if the child has engaged in other behaviour which is potentially detrimental to their health and well being, the interventions/strategies to be adopted in reducing or preventing such behaviour;
11. Whether the placement will contribute to any other health related assessments;
12. How the home will contribute to any health monitoring.

Information should also be given about any allergies. See also First Aid, Household Remedies and Medication Procedure and Provision and Preparation of Meals Procedure.

One of the responsibilities of the child's Key Carer will be promoting his/her health and educational achievement, liaising with key professionals, including the Clinical Nurse Specialists for Looked After Children, the child’s GP and dental practitioner.

The Key Carer will also ensure that up to date records are kept on the child in relation to his/her health needs, development, illnesses, operations, immunisations, allergies, medications, administered, dates of appointments with GP's and specialists.

The Key Carer must also ensure the child is registered with a GP and other health care professionals as set out in Health and Wellbeing, Health Notifications and Access to Services Procedure.

Also see: Key Carer Guidance.

The Key Carer must also ensure the child is registered with a GP and other health care professionals as set out in Health and Wellbeing, Health Notifications and Access to Services Procedure.