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Contents

1. Health Care Assessments
2. Health Care 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 Care Plan.

1.1 Frequency of Health Care Assessments

Wherever possible, each child who becomes Looked After must have his or her first Health Care Assessment completed within 20 days of first becoming Looked After - in time for the first Case Review unless one has been done within the previous 3 months.

The first assessment must be by a registered medical practitioner. Subsequent assessments may be carried out by a registered nurse or registered midwife under the supervision of a registered medical practitioner.

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. The Placement Agreement Record, giving medical consent by parents must be signed on the child coming into care. For the Initial Health Assessment, the social worker must open the BAAF IHA form on the Team's template and completing pages 1 and 2: IHA-C for children from birth to the age of 9 years and IHA-YP for young people over the age of 10 years. The IHA form and the signed consent form Placement Agreement Record must be sent to the Child Protection Coordinator at Bexley Care Trust.

By email - kirsty.rainey@bexley.nhs.uk
By fax - 020 8308 3157
By post - Kirsty Rainey South London Health Care Trust, Admin Corridor, Maternity Wing, Queen Mary’s Hospital, Frognal Avenue, Sidcup, Kent, DA14 6LT

For further advice phone 020 8302 2678 Extension 3085.

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. Health Assessments might be delayed or not carried out if the signed consent is not provided.

The legal issues surrounding consent to medical treatment are complex, particularly where the child may be of an age to give informed consent, where there are disputes about the need for treatment, and where the condition for which treatment is thought to be required my be life-threatening, or the treatment irreversible. In cases of doubt and complexity seek legal advice.

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 Looked After Children's Nurse 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 by the Social Worker.

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 can be 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 must have a Health Care Plan which will be part of the Care Plan. The Care Plan should be available for the first Looked After Review,

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 should 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 it is necessary for any immunisations to be carried out and if so, when.
2. When it is necessary for a dental check to be carried out
3. When it is necessary for any hearing or vision checks to be carried out
4. 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 programme's required.
5. Whether there are any health or education issues to be addressed, for example, nutrition, sexual health and relationships, 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.
7. The completion of a substance misuse SMART assessment
8. The completion of the Strengths and Difficulties Questionnaire: assessing the child's emotional well being. 
9. Whether there is any involvement with CAMHS.

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

End