Health and Emotional Well-being Assessments and Plans

Contents

1. Health Issues for Children Looked After in a Residential Setting
2. Health and Emotional Well-being Assessments
3. Health Care Plans
4. Role of Linkworker

1. Health Issues for Children Looked After in a Residential Setting

In a residential setting, staff will not only need to take on the responsibility of a good parent, but will also need to take into account the following:

• The period of residential care for a child or young person could be fairly brief and this may be one of the only opportunities to provide appropriate healthcare;
• While staff may know some of the history of a child or young person, they may not know the full story. Good health assessment is crucial to identify areas of need;
• Because of previous influences children / young people may have already established patterns of behaviour which are placing them at risk. They may be unaware of risk issues or choosing to ignore the risk issues, either way appropriate information is very important;
• Children or some young people may be too immature or emotionally harmed to deal sensibly with risk issues. It can be difficult in some circumstances to help a child or young person to disengage from patterns of behaviour that place them at risk, particularly if other members of the residential group are exhibiting these behaviours.  

In view of these points, residential staff will need to have a planned pro-active approach for helping children and young people with health issues and work in partnership with health professionals.

Humber Teaching NHS Foundation Trust (HTFT) has close links with East Riding Local Authority Children’s Services in order to provide a Looked After Children’s Child and Adolescent Mental Health Service for children and young people, and care leavers aged 0-25 years, under the care of East Riding Local Authority. The East Riding Child and Adolescent Mental Health Service (CAMHS) Looked After Children (LAC) team, also known as the Emotional Health and Wellbeing Service offers support to East Riding Children Looked After (CLA) aged 0-16 years, and care leavers under the care of the Pathway Leaving Care Team aged 16-25 years. Similarly, support is also provided to the networks around them (Social Care, Education, Foster Carers, Residential Care Teams, Connected Carers, East Riding Local Authority Residential Homes and support is also limited support is offered to East Riding Post Adoption Support Team). The team is trauma-Informed and follows the Attachment, Resilience, Competency (ARC) Framework in all aspects of thinking around the child’s need and support offered. Interventions are highly influenced by Dyadic Developmental Psychotherapy (DDP) and PACE (Playful, Accepting, Curious & Empathic approach to care). The team consists of Clinical Psychologists, Advanced Practitioners, and a Team Lead. The service offers consultations for Social Workers and Personal Assistants (working in the Pathway Leaving Care Service), residential care staff, and young person’s professional network, to discuss concerns/queries relating to cared for children and care leavers. Requests for consultations can be made by completing a consultation request form (see attached). Consultations provide a ‘space’ for workers to think about, for example, psychological formulation, complex systemic/relational dynamics, appropriate service/s and therapeutic interventions. If appropriate follow up consultations may be offered to referrer in order to provide continued support. Following consultation, therapeutic intervention/s may be provided to the young person, their carers or professional network, informed by a thorough assessment and individualised therapeutic care plan.

At present, all East Riding Local Authority children’s residential homes receive support from a clinician within the East Riding Looked After Children CAMHS service. Amount of support varies depending on the individual needs of the staff team and young people in residence but is usually provided on a weekly or fortnightly basis. Clinicians offer regular reflective discussions to the team of staff, provide a link to East Riding Core CAMHS- facilitating any referrals needed into the service, build rapport with the young people in order to offer regular emotional well-being check-ins, and attend meetings as required in respect of the children and young people residing in residence.

Clinicians within the team offer consultation and reflective practice sessions, on a weekly to monthly basis, to all areas of Corporate Parenting within East Riding Local Authority, which includes Children Looked After Team, Pathway Leaving Care Team, and Fostering Teams (2 Mainstream Teams and a Connected Persons Team). Limited support is provided to the Post Adoption Support Team via discussion of requests for externally commissioned therapeutic intervention at the Emotional Mental Health Decision Making Forum.

Two clinicians from the East Riding CAMHS Looked After Children Team (Clinical Psychologists) take part in fortnightly Emotional Mental Health (EMH) Decision Making Forum meetings whereby any requests for externally commissioned therapeutic input are discussed. Representatives from East Riding Local Authority senior management, commissioners, and allied health professionals such as Looked After Children Health Nurse and East Riding Core CAMHS Team Leader also sit on this multidisciplinary forum and ensure that any externally commissioned therapies adhere to clinical governance standards and are monitored with regards to efficacy and value for money.

2. Health and Emotional Well-being Assessments

Every Child in Care should have a Health and Emotional Well-being Assessment soon after being placed and then at specified intervals; as set out below.

The purpose of a Health and Emotional Well-being Assessment is to carry out an initial assessment of the child’s physical, emotional and mental health. The Health and Emotional Well-being 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 completed the carer’s two-page version of the Strengths and Difficulties Questionnaire (SDQ) for the child in time to inform their Health and Emotional Well-being Assessment.

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

Health and Emotional Well-being  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 6 months;
• For children aged over 5years, further assessments should be at least annually;
• Health Care Assessments must be conducted more frequently where the child’s health needs dictate.

Health and Emotional Well-being 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 themselves.

The social worker is normally responsible for ensuring that Health and Emotional Well-being Assessments are undertaken, but this responsibility may be undertaken by the home.

2.1 Consent

In order for the assessment to be conducted, the social worker should ensure that all the necessary consents and delegated authority permissions have been obtained so that decisions are not delayed. Young people (dependant on their age and understanding) can provide informed consent for the assessment.

Young people aged 16 or 17

Young people aged 16 or 17 with mental capacity are presumed to be capable of giving (or withholding) consent to their own medical assessment/treatment, provided the consent is given voluntarily and they are appropriately informed regarding the particular intervention. If the young person is capable of giving valid consent, then it is not legally necessary to obtain consent from a person with Parental Responsibility.

Children under 16 - ‘Gillick Competent’

A child of under 16 may be Gillick Competent to give (or withhold) consent to medical assessment and treatment, i.e. they have sufficient understanding to enable them to understand fully what is involved in a proposed medical intervention. 

In some cases, for example because of a mental health issue, a child’s mental state may fluctuate significantly, so that on some occasions the child appears Gillick Competent in respect of a particular decision and on other occasions does not.

If the child is Gillick Competent and is able to give voluntary consent after receiving appropriate information, that consent will be valid, and additional consent by a person with parental responsibility will not be required.

Children under 16 - Not 'Gillick' Competent

Where a child under the age of 16 lacks capacity to consent (i.e. is not Gillick Competent), consent can be given on their behalf by any one person with Parental Responsibility. Consent given by one person with Parental Responsibility is valid, even if another person with Parental Responsibility withholds consent. (However, legal advice may be necessary in such cases). Where the local authority, as corporate parent, is giving consent, the ability to give that consent may be delegated to a carer (or registered manager of the children’s home where the child resides) as a part of ‘day-to-day parenting’, which will be documented in the child’s Placement Plan. 

For further information on consent, see: Department of Health and Social Care Reference Guide to Consent for Examination or Treatment.

3. Health Care Plans

Each child's Placement Plan should identify the child’s health care needs (if any) and set out how these will be met by the home.

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 and Emotional Well-being Assessment or as circumstances change.

The Health Care Plan should describe how the child’s physical, emotional and mental health needs will be addressed to improve health outcomes.

The Health Care Plan (and the Placement Plan as necessary) should cover the following:

1. Whether there are any specific health physical, emotional or mental healthcare needs - and how the home will meet them;
2. Responsibilities of staff to make sure a child attends their Health and Emotional Well-being Assessment and all other medical, dental and optical appointments, and facilitate any required treatment regimes;
3. Agreements for the use of non-prescribed medicines, home remedies or use of first aid;
4. 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;
5. Whether it is necessary for any immunisations to be carried out;
6. Any specific treatment or therapeutic interventions, strategies or remedial programmes required;
7. Any necessary preventative measures to be adopted;
8. Clarify which health care decisions have been delegated to children’s home staff;
9. If the child is a risk of suicide or self harm, the interventions/strategies to be adopted in reducing or preventing such behaviour;
10. How the home will contribute to any health monitoring.

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

4. Role of Linkworker

One of the key responsibilities of the child's Linkworker is promoting their health and educational achievement, liaising with key professionals, including the Designated Nurse for Looked After Children, the child’s GP, optician and dental practitioner.

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

The Linkworker  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: Linkworker Guidance.