1. Looked After Children Dr Christine Arnold, Designated Doctor 22.05.2014

2. Gain knowledge of guidance and legislation framework for Looked After Children Gain an understanding of the Looked After Child’s journey Gain an understanding of the health needs of Looked After Children Gain an understanding of how health services can contribute to the overall care and planning for the child/young person Gain an understanding of the CQC LAC and Safeguarding Framework This training has been developed to meet the Level3 Safeguarding Intercollegiate Competencies 2014: To be able to know how to ensure the processes and legal requirements for looked after children, including after-care, are appropriately undertaken. Learning Outcomes

3. QUIZ

4. The Looked After Child’s Journey

5. Definition of Looked After Children Act (1989) defines a child as being “looked after” by a local authority if child in its care or is provided with accommodation for a continuous period of more than 24 hours 4 main groups: accommodated under voluntary agreement with parents (s17) or if unaccompanied asylum seeking child children subject to a care order or interim care order (s31) children subject of emergency orders for the protection of the child (s47) compulsorily accommodated/remanded (LASPO)

6. Abuse or neglect: 62% Family dysfunction: 14% Family in acute stress: 9% Absent parenting: 5% Parent’s illness or disability: 4% Child’s disability: 3% Socially unacceptable behaviour: 2% At 31st March 2012 67,050 looked after children in England Ref: National statistics: Children looked after by local authorities in England Gov.UK September 2012 Why does a child/young person become “Looked After” ?

7. Parental vulnerabilities Domestic Abuse Alcohol misuse Substance misuse Disadvantaged upbringing School failure and unemployment Unplanned pregnancy Mental health problems May have been ‘looked after’ themselves

8. In Surrey at 31 st March 2014 –798 Looked After Children –10% aged 1 year and under –56% aged between 10 and 18 years –9% asylum seekers –43% placed outside Surrey border 260 approx. from other Local Authorities 390 enter and leave care every year Surrey LAC Profile

9. Placements Majority are in Foster Care (including Mother and Baby foster placements) Family and Friends (‘kinship’) Residential Supported lodgings (Care leavers)

10. Key Legislation and Guidance

11. Types of Order- Children Act 1989 Section 20 or voluntarily accommodated – the Parent retains full Parental Responsibility Section 38 or Interim Care Order – PR is shared between the parent and Local Authority Section 31 or Full Care Order – the Local Authority has full PR, child remains ‘Looked After’ Adoption Order – adoptive parents hold PR and child is no longer ‘Looked After’ Special Guardianship Order – PR is transferred to SG and child no longer ‘Looked After’ ‘Delegated responsibility’ for Foster carers

12. Monitoring All Looked After Children have an Independent Reviewing Officer who is responsible for overseeing the Care Plan which includes the Health Plan developed by the Social Worker Reviews are held on a regular basis

13. HEALTH NEEDS OF LOOKED AFTER CHILDREN

14. Rocks blocking the path to successful outcomes Two thirds of all looked after children have at least one physical health complaint Looked after children are more likely than peers to experience problems including speech and language problems, bedwetting, co- ordination difficulties and eye or sight problems About 60% of those looked after in England have been reported to have emotional and mental health problems around four times the rate for children generally Nearly a quarter of looked after young people aged 11-17 report having experienced some kind of sexual abuse Looked after children are around 3 times more likely to drink regularly and more likely to smoke than their peers Nearly a quarter of looked after children and young people are more likely than their peers to have experienced the death of a parent or sibling Looked after children are around ten times more likely than their peers to have significant learning difficulties Increased risk taking behaviour – both looked after young women and men are more likely to become teenage parents than their peers

15. Removing the rocks Listen to the voices of children/young people and their families Deliver holistic care tailored to individual need Provide services that address health, wellbeing and promote high quality care Effective integrated professional working Competent, caring professionals Children & young people are helped to develop a strong sense of personal identity Young people are prepared for and supported in their transition to adulthood Child / young person is supported to participate in wider network of peer, school and community activities Warm and caring relationships between child/young person and carer Children & young people have a stable experience of education Effective joint commissioning

16. National Framework

17. Universal and Targeted Services GP services Enhanced Service from 0-19 Teams Camhs Children in Care Team Catch 22 Virtual School LAC Health Team (Specialist Nurses, Medical Advisers in Adoption and Fostering) Paediatricians

18. Initial and Review Health Assessments IHA is a comprehensive assessment of the child’s needs IHA should be carried out by a doctor resulting in a health plan within 4 weeks (Statutory) RHAs 6 monthly for under 5s and annually for over 5s (Statutory) Reviews may be completed by a doctor or nurse Intercollegiate Competencies defines skills and competencies expected from practitioners completing Health Assessments

19. What would you do? A ‘short term’ foster carer wants to register a child but is not sure how long the placement will be for An unaccompanied asylum seeking young person wants to register but does not have an NHS number A relative has just taken on the care of a child and wants to register the child with your practice as it is nearer than her own (but she does not want to change her GP) A foster carer asks for a copy of the child’s immunisation history An adoptive parent asks to see her adopted child’s records

20. Promoting health in Primary Care Full registration and request for fast track of records within 48 hours Alert on records Health Assessment reports should be readily identifiable Social Worker contact details should be known Ensure that all practitioners understand who can provide consent Identify a Practice Lead for LAC

21. CQC Safeguarding and LAC Inspection

22. Key objectives The experiences and views of children and their families. The quality and effectiveness of safeguarding arrangements in health. The quality of health services and outcomes for children who are looked after. Health leadership and assurance of local safeguarding and looked after children arrangements.

23. CQC Inspection area – the Local Authority area and Health Providers Case tracking of children and young people Out of County placements also considered. Published reports on CQC website http://www.cqc.org.uk/public/publications/the med-inspections/child-safeguarding-and-looked- after-children-inspection-progr

24. Any questions? Dr Christine Arnold Designated Doctor for Looked After Children c.arnold1@nhs.netc.arnold1@nhs.net Mrs Elizabeth Channing Designated Nurse for Looked After Children elizabeth.channing@nhs.net elizabeth.channing@nhs.net