3.2 Health Care Assessments and Plans

Contents

1. Health Care Assessments
2. Health Care Plans
3. Children Placed in Residential Care or Foster Care

1. Health Care Assessments

The purpose of Health Care Assessments is to promote children's physical and mental health and to inform the child's Health Care Plan (which may be a separate plan or may be incorporated in to the Child’s Care Plan).

1.1 Frequency of Health Care Assessments

The first assessment must be conducted before the child’s first placement, or if not reasonably practicable, before the child’s first Looked After Review - unless one has been conducted in the previous 3 months.

For children under five years, further Health Care Assessments should occur at least once every six months.

For children aged five and over, further Health Care Assessments should occur at least annually

1.2 Arranging Health Care Assessments

The social worker is responsible for ensuring that health care assessments are undertaken.  They will be arranged by the child's social worker making a referral to the Designated Nurse for LAC- details to follow.

In order for the health care 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 or person with Parental Responsibility.

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.  The child should be encouraged to take advantage of the opportunity of the health care assessment to discuss health issues.

1.3 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 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 manager and the Designated Nurse for LAC 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.

1.4 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

1.5 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.

1.6 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.

2. Health Care Plans

Each looked after child Placement Plan, drawn up by the home must include the health care needs for the child and how they will be promoted by the home.

Additionally, each child must have a Care Plan (which may be part of the Child’s Care Plan or may be a separate plan) drawn up the Placing Authority/Social worker.

The Initial Health Care Plan should be drawn up in time for the first Looked After Review, with arrangements as necessary incorporated into the child's Placement Information Record.

The Designated Nurse for LAC will draw up the child's Health Care Plan based on the information in the health care assessment, in conjunction with the child, staff/carer (as appropriate), GP and any other relevant professional. The plan will then be passed to the child's social worker who will update the child's electronic records and 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 and after consultation with his or her manager), the parents will not receive a copy.

The child's social worker is responsible for implementing the Health Care Plan 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.

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

1. Whether there are any specific health care 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. On 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.
7. Whether it is necessary for any immunisations to be carried out.
8. Any specific treatment or Therapeutic Interventions, strategies or remedial programme's required.
9. Any necessary preventative measures to be adopted.
10. Whether the child is allowed to smoke and any measures agreed to reduce the behaviour.
11. 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.
12. Whether the placement will contribute to any other health related assessments.
13. Whether the home will contribute to any health monitoring.

This Health Care Plan must be reviewed after each subsequent Health Care Assessment or as circumstances change.

3. Children Placed in Residential Care or Foster Care

If Children are placed in residential care or foster care, the designated Keyworker or carer is responsible for promoting their health, well being and educational needs, liaising with key professionals, including the Clinical Nurse Specialist, the child's GP and dental practitioner.

The Carer/Keyworker must also ensure that up to date with information is 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 Carer/Keyworker must also ensure the child is registered with a GP and other health care professionals.

End