• contents
• keywords and contacts
• quick guide
• values
• alerts and suggestions
• search
• minimum standards

Contents

1. Health Care Assessments
2. Personal Health Plans

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 Plan.

1.1 Frequency of Health Care Assessments

Also See: Department of Health Guidance: Promoting the Health of Looked After Children.

Each Looked After Child must have an Initial Health Care Assessment at specified intervals as set out below.

Initial Health Care Assessments must be conducted by a suitably qualified medical practitioner  (normally the child’s General Practitioner); who should provide the social worker with a written report (See Section 1.3, Arranging Health Care Assessments)

In the event of any difficulty being experienced in obtaining a Health Care Assessment, the child’s social worker should take advice from the CLA Nurse. If necessary the CLA Nurse will carry out the Health Care Assessment.

• The first Initial Assessment must be conducted before the first placement or, if not reasonably practicable, before the child’s first Looked After Review - (unless one has been done 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, review Health Care Assessments should occur at least annually
• For a child accommodated under Section 20 Children Act 1989, consideration should be given to the appropriateness of a copy of their Health Assessment being given to their parents, the Social Worker and their Team Manager will make this decision.

Exceptions

• Newborn babies: The discharged summary is counted as their Health Assessment
• For children who have had a recent medical such as a non accidental injury medical, there is not need to repeat, as this is counted as the health assessment
• If the child/young person's Care Plan is Permanency away from their parents, the social worker should arrange an appointment for the child to be seen by the Medical Advisor. (The Social Worker should complete the St. George's Hospital referral forma and send it to the Medical Advisor). The Medical Advisor will provide a detailed written report for the Adoption and Permanency Panel or the Fostering and Permanency Panel.
• If there are specific concerns about a child's health or development the social worker should complete the above referral form for the Medical Advisor to see the child/young person rather than the G.P.
• Young people who refuse to see their G.P. can be referred to the CLA Nurse
• A child with complex health needs who is already seeing a Paediatrician - there is no need to repeat the medical as this counted as the health assessment. The child's Social Worker should receive a written health report from the Paediatrician.
• The Social Worker should contact the Medical Advisor if there are any health queries.
• The Social Worker should contact the CLA Nurse where there are lifestyle issues for young people.

It is the responsibility of the Social Worker to provide a copy of the Child's Health Assessment to the child/young person's carer and ensure the Independent Reviewing Officer knows it is on Framework (i). The outcome of the health assessment should be shared with the child/young person as appropriate. Following discussion with the child/young person, the Social Worker should put a copy of the medical report in the child/young person's RED file.

Also see The Child's Personal Record File (Red File) Procedure.

Dentist

• The child/young person should have a dental check within a month of being accommodated. It is the responsibility of the Social Worker and Supervising Social Worker to ensure that the carer or care home arranges the appointment.
• A child/young person should be seen by a dentist by the age of two or earlier if there are concerns about oral hygiene.
• All children should have a dental check at least once a year.

Optician

• To be arranged by the child's foster carer or keyworker as part of the Placement Plan within a month.
• All children should have an eye test from the age of five by an Optician. If there are any concerns raised by the optician the foster carer/care home should discuss the outcome with the Social Worker who will contact the Medical Advisor.

Immunisation

Refer to schedules: See the Department of Health website (which are subject to change)

It is the responsibility of the social worker and the foster carer/care home to ensure that any outstanding immunisations that are identified by the GP, CLA Nurse or Medical Advisor on the AFU69 - Medical Assessment Form are completed immediately.

It is good practice to work in partnership with young people when arranging the appointment. If the young person has concerns the CLA Nurse should be contacted.

Sexual Health

• Information on sexual health and relationships is routinely provided by schools
• The school Nurse or CLA Nurse can be contacted where there are concerns about children who are out of school.
• All young people should be made aware of safe sex and sexual health clinics. Foster Carers/Care Homes and social workers should actively facilitate or accompany sexually active young people to these clinics.
• The actual details of the consultation will not be shared with the social worker or carer unless the young person chooses to give permission.
• The CLA Nurse or Drugs and Alcohol Worker can be contacted for individual advice and further information especially for those young people who are or will be sexually active and those who express a desire to become a parent.
• The following website's may be useful:
  
  Getting it on

Also see Your Guide to Local Health Services in Wandsworth and South West London

Teenage Pregnancy

• The CLA Nurse should be notified of any pregnancies or young men who become fathers to ensure the young person receives appropriate support. This information is used to assist the Council's quarterly statistical returns on teenage pregnancy.

DUST Screening

Dust screening is designed for use with young people where there may be concerns regarding drug/alcohol use.

• It will not provide a comprehensive substance use assessment
• It will indicate when specialist advice should be sought
• It will help identify risk factors

In Wandsworth Children Looked After from the age of 11 years have a DUST screening every year and more frequently if required.

The DUST form is available on Framework (i)

The social worker completes the questionnaire with the young person and it is then passed to the Drugs and Alcohol misuse worker to analyse. If there are issues raised by the Social Worker, Foster Carer, Care Home, young person or the Drugs and Alcohol worker this will be shared with the Team Around the Child and a plan agreed for the intervention, advice and support.

Also see: Children and Young People Drug Policy.

Strengths and Difficulties Questionnaire (SDQ)

The Strengths and Difficulties Questionnaire is used to assist workers in assessing the Emotional and behavioural development of a Looked After Child. It is the Local Authority's responsibility to ensure that each Looked After Child using the Strengths and Difficulties Questionnaire and the findings should be discussed with the Psychologist based in the Placement Support Team and other Health professionals and the carer/s, Emotional and behavioural development is not only about difficulties, but is also concerned with how the child's social and emotional development can be effectively promoted.

All Looked After Children between the ages of 4-16 are required to have a completed SDQ Questionnaire. The questionnaire will provide information on the emotional and behavioural health of Children Looked After in Wandsworth. The form will be completed by the child or young person's main carer. The child's social worker will download the form and give it to the carer. The social worker should calculate the child's score from the form and then pass to the Team Administrator to input on to Framework (i).

1.2 Placement Transfer

If a child moves placement the social worker should furnish the new carer/placement with a copy of the child’s Personal Health Plan (PHP).

If no plan exists, the social worker should arrange an assessment within a month of the placement beginning so that a (PHP) can be drawn up.

1.3 Arranging Health Care Assessments

The Team Administrator is responsible for sending the relevant medical forms out to the carer/care home with a covering letter requesting that they make an appointment for the child to be seen by their GP. A copy is also sent to the carer's supervising social worker or the key worker and team manager. The GP is also sent a claim form and a stamped addressed envelope so they can return the form to the Team Administrator along with the child's completed medical form. Most GP's will submit a claim form that is passed to the Medical Adviser (Dr Tina Sim) who will process the payment.

On receipt of the completed forms the Team Administrator will enter the data onto Framework along with the dates of the visit to the dentist and the immunisations.

The forms will then be sent to the Medical Adviser who will write her comments on the overall health and development of the child/young person and make recommendations. The Medical Adviser will make direct contact with the child's social worker if necessary.

The Medical Adviser will send copies of the child's medical assessment to the social worker and the Child Health Department who will then send copies to the relevant Health Visitor/ School Nurse and GP.

2. Health Plans

Each Child Looked After Care Plan must incorporate a Personal Health Plan (sometimes referred to as a ‘’PHP’’) in time for the first Looked After Review, with arrangements as necessary incorporated into the child’s Placement Plan recorded on the Placement Information Record. 

The Personal Health Plan should be the outcome of a meeting or meetings involving the child / young person (depending on age and level of understanding), the child’s foster carer or residential key worker, the child’s Health Visitor (if aged under 5), anyone holding parental responsibility, a representative from the child’s school if appropriate, the child’s social worker and the CLA Nurse.

The child's Personal Health Plan should be completed by the child's social worker using the agreed template. The Personal Health Plan is a Framework Episode and it should be reviewed after each Health Assessment and updated at least every 6 months.

The Personal Health Plan should contain a list of specific action points, with the timescale for completion of each action and the person responsible clearly stated.

In completing the Personal Health Plan the child’s social worker should always make sure that the following areas are covered

• Any significant health problems or conditions including allergies
• Any significant family history
• General health and development
• Hearing and vision including whether the child needs spectacles or hearing aids
• Immunisations and urgent action to deal with any that may be outstanding
• Dental health and dental care including any necessary dental hygiene work or orthodontics
• Any forthcoming health appointments and how the child will be supported
• Promotion of good physical health through good diet and regular physical exercise
• Any concerns about child’s height and weight with reference, if applicable, to centile charts
• Emotional and mental health including any psychotherapeutic needs or Child and Adolescent Mental Health Services (CAMHS) involvement
• Use of alcohol, tobacco or other illegal drugs and any actions needed to assist the young person in giving up smoking or dealing with any substance misuse problems

A copy of the plan should be sent by the child’s social worker to all parties.

The child’s social worker should discuss the plan with the child and give the child a hard copy of the plan to be placed in the child’s Red File. See The Child's Personal Record File (Red File) Procedure.

Also see: Department of Health Guidance: Promoting the Health of Looked After Children

End