Looked after Children Annual Report 2010 ‘Looked after Child’ is a generic term introduced in the Children Act 1989 to describe children and young people subject to care orders (placed into the care of local authorities by order of a court) and children accommodated under Section 20 of the Children Act 1989. Looked after children may live in foster homes, residential placements or with family members. Children and Young People who are ‘looked after’ may have experienced traumatic events including neglect, sexual, physical and/or emotional abuse. This may affect their understanding of personal relationships, sex and sexuality, and result in low self esteem and inappropriate sexual behaviour. Young people in care are less likely than other young people to receive consistent guidance and support about relationships and sexual health from their carers or parents or other significant adults. Young people in care may experience different placements, changes in schools and have more frequent exclusions from school, so are more likely therefore to have missed school based sex educations sessions. They may also have missed the opportunity to build long term relationships with their peers, leaving them vulnerable to unwanted sexual pressure. Both Young women and young men in and leaving care are more likely than their peers to be teenage parents. One study found almost half of young women leaving care become pregnant within 18-24 months and another reported that a quarter were pregnant or young parents within a year of leaving care. This increased vulnerability to pregnancy is due to care leavers, and young people in and on the edge of care, being disproportionately affected by key risk factors for teenage pregnancy: experience of abuse, poor mental health, low educational attainment, school absence, contact with the police and poverty. Unaccompanied asylum seeking children (UASC) may have additional negative experiences, including bereavement and sexual violence, which can impact on their sexual health. It is therefore critically important that children in care and care leavers are helped to gain self esteem and skills needed to develop loving, respectful and safe relationships. This will include having the confidence to delay early sex until they are ready to make safe and positive choices and, if and when they do become sexually active, to use effective contraception and condoms to prevent pregnancy and sexually transmitted infections. Support around teenage pregnancy and sexual health should be provided to all young people in and leaving care, regardless of their sexual orientation or preference and should not be affected by individual practitioner’s personal views. Team Information The current team are a relatively new team and have only been together since August 2009, when the designated nurse Karen Woodhead came into post and the Nurse for Children with Disabilities and Complex Needs came into post in September, joining the Nurse for Care Leavers who had been in post for several years. They are based at the Deighton Centre, and between them the posts are equal to 2.8 WTE. There is also 1 Designated Doctor 0.8 WTE.
The 3 nurses are all registered nurses who have specialised in School Nursing or Health Visiting. Currently as a team we have been asked to speak at several events, two of which are national conferences and the other a local event for the foster carers within Kirklees. We are also pleased to be offering ‘Enabling Sexual Wellbeing’ training, a relationship based sexual health education programme, to foster carers this year, along with other training around Health and Hygiene. The Designated Nurse has successfully completed first year of Masters Degree ‘Professional Leadership by Action Learning and Enquiry’. Brief Work Programme 1. Statutory Initial Health Assessments – reading notes and filling out BAAF forms prior to assessment and post assessment, completing Health recommendations, arranging follow up referrals etc as well as offering health promotion to foster carers and birth parents. The team also undertake Review Health assessments not done by KCHS Health Visitors and School Nurses, which may be out of area, or for children and young people living in residential units. For unaccompanied asylum seeking children who are looked after and young people open to the Leaving Care Team, Initial Health Assessments are mainly done by Stasia Brackenridge. This includes arranging an interpreter if required, follow up, referral to medical entry clinics, GP, Dentists etc. and liaising with Dr. Parry who supervises work undertaken. For children with complex needs and disabilities, Initial Health assessments are mainly done by Denise Hopkins which includes liaising with the Children with Disabilities teams, follow ups etc and liaising with Dr. Parry who supervises work undertaken. 2. The Designated Nurse checks all review health assessments undertaken by Health Visitors and School Nurses ensuring that all health assessments are concluded with a Health Recommendation Plan, contacting the relevant professional where more work is needed to fully complete the Review Health Assessment. 3. To answer questions/e-mail queries and provide guidance relating to health issues and health assessments for Looked after Children from the wide range of staff working with the child, i.e. Social workers in community teams, Residential staff, School Nurses, Health Visitors, Managers, Foster Carers, other Looked After Children’s Nurse teams etc. 4. To work very closely with other agencies including the community reams with case responsibility for looked after children and young people, the Family Placement Unit; Foster Carers approved by Kirklees and independent Fostering Agencies; Inhouse and external residential units; the Youth Offending Team, the Pupil Referral Unit, the
Supporting Families Teams (within Health), Drug Sense, Family Nurse Partnership, CASH and GUM services and Regional and National Looked after Children Services. 5. To attend Adoption and Fostering Panel. This is currently covered by Denise and Stasia but is to be picked up again by the Designated Nurse on completion of her studies. These panels generally sit monthly usually for a full day and there is usually at least 8 hours reading to be done prior to these panels sitting. 6. To provide mandatory training for foster carers relating to health and hygiene issues and health promotion. 7. To provide training around Sexual Health and Wellbeing training for foster carers, social workers and residential home staff. 8. To provide training to Supporting Families team members who undertake review health assessments of Looked after Children, with training around raising awareness of the problems and issues looked after children have and also to inform staff how to do a review health assessment. 9. To attend foster carer support groups, under 8â€™s and over 8â€™s groups. 10. Designated nurse attends various meetings relevant to looked after children/young people including Management Meetings, Lac Operational Group, Multi- Agency Lac Group, BAAF Regional Meetings and the Northern Forum for Looked after Children etc. Data on Looked after Children The total number of Looked after Children (LAC) currently stands at 563. Of this figure there are 208 placed out of area that are looked after by Kirklees. The LAC Nurses Team remain responsible for ensuring these children have their health needs met and receive statutory health assessments. There is a clear and consistent upward trend in numbers of Children &Young People (C&YP) looked after in Kirklees. Oct 06
May 10 566
The number of children and young people leaving care between 1/4/09 and 31/03/10 equals 154, 2 of these became looked after and left care again in the same period, (154 children with 156 instances of leaving care). The number of Unaccompanied Asylum Seeker Children (UASC) becoming Looked after between 1/4/09 and 31/03/10 = 12, at approx. 1 per month. The numbers of Care Leavers has significantly increased due to Unaccompanied Asylum Seeking Children (UASC), by effect of Southwark Judgement Ruling. The total number of Children with Disability (CWD) who are looked after is 26, only children with a Social Worker allocated from the Children with Disabilities Teams are categorised CWD. There are a significant number of children who are looked after with complex health needs and/or disability, children in need or child with a child protection plan, that have social workers allocated from the LAC team, these are not included in the official CWD LAC stats. The total number of Looked after children living in Kirklees, ‘Looked after’ by other authorities is 15 that are known. This information has only just started to be collected this year so we have no knowledge of children who may have moved into the area in previous years and are still here. The total number of Kirklees Looked after children at 31/3/10 placed out of the Kirklees area equals 208 Between the 1/4/09 and the 31/3/10 the number of Children becoming looked after equals 203, of these 5 left care and became looked after again in the same period, (203 children with 208 instances of becoming looked after). Movements in and out of Care show a dynamic population and each new Child or Young person coming into care has an Initial Health assessment undertaken by the LAC team within 28 days of them becoming looked after, following a request by the social worker.
Clinics Held between 1/4/09 – 31/3/10 Clinics Total number of clinics held No’s of Children seen
Total No. children seen for IHA’s and Adoption Medicals
IHA’s = 81 Adoption Medicals = 81 162
Total number of Initial health assessments carried out in clinic sessions 1st April 2009 to 31st March 2010 is 141. Health assessments are a statutory requirement for LAC/YP. Review health assessments are required twice a year for under 5s and annually for children over 5s. The main aim of the service is to ensure that the statutory health assessments are fully operational and effective. It is a statutory requirement that each child should have a holistic health assessment on entering care within 28 days. The first assessment should be undertaken by a registered medical practitioner in accordance with the Children Act Regulations 2002. Review assessments may be carried out by an appropriately qualified registered nurse. Initial Health Assessments for most children are done within the clinic setting by the Doctor and a LAC Nurse. This gives us a baseline audit of the child’s health needs on admission into care. Currently Stasia Brackenridge or Denise Hopkins carry out most of our young peoples Initial Health Assessments as it has been found that this is the most effective way of achieving a satisfactory health assessment within the statutory 28 days. Many adolescent young people refuse to come to clinic in these cases one of the LAC nurses will meet with the young person at a venue of their choice to undertake the health assessment. Dr Parry oversees Stasia’s and Denise’s work if an initial health assessment is undertaken. We can only undertake an initial or review health assessment on receipt of a request from the child’s Social Worker, which in some cases is delayed. Even with monthly reminders sent out to managers of Social Workers this does not always happen. A mainstream approach has been undertaken in Kirklees which means that Health Visitors or School Nurses undertake review health assessments. The LAC Nurses Team offer support for the development of good practice within the supporting families teams and supports working towards the reduction of health inequalities experienced by Looked after Children and Young people. It enables and empowers them to access mainstream/universal health services. By mainstreaming it also allows the Looked after Nurses to focus resources on Children and young people who do not have a named GP or Health Visitor. Main issues found relating to health at IHA’s include; •
High levels of decayed teeth
Developmental concerns-relating to pre-care neglect, in some cases complex health problems as a result of injuries sustained
Previous missed health appointments requiring re-referral into health services
Speech and language delay
For adolescents coming into care their health issues often can be found as a result of risk taking behaviours including substance misuse (including binge drinking and cigarette smoking) self harm and being victims of sexual exploitation. Most of these behaviours are underpinned by lack of self esteem and are an emotional cry for help. Teenage pregnancy rates are also higher among young women in care than in the general population. Currently there are 8 young teenage girls/mums within the Family Nurse Partnership Programme plus 1 teenage father.
National & Local Under 18 Conception Data •
England 41.1 per 1,000 population. This represents a 11.8 % decrease since 1999.
Yorkshire & Humber 47.7 per 1,000 population. This represents a 10.1% decrease.
Kirklees 43.3 per 1,000 population. This represents a 10.9 % decrease.
10 ‘Hotspot’ areas across Kirklees, which are those above 60 per 1,000 of population.
Deighton 89.1 per 1,000 population, highest ward in Kirklees.
Significant higher rate of teenage conception [therefore higher levels of unprotected intercourse]
Looked after young women are 6x more likely to become teenage parents
Sexual Health relations work (data from C Card Database) Since November 2009 the number registered onto the C Card Condom scheme by LAC nurses equals 27, with the number of Condoms given out being 288. There have been 27 Young people screened for Chlamydia since April 2009. There have been 5 pregnancy tests since April 2009.
The Emotional Health of Looked after Children The White Paper Care Matters: Time for Change highlighted the need to improve mental health of Children and young people who are looked after. Foster carers frequently report that there are problems associated with the emotional wellbeing and mental health of children and young people in their care. Evidence suggests that Looked after Children are nearly 5 times more likely to have a mental health disorder than all children.
The Strengths and Difficulty Questionnaire (SDQ) is a short behavioural screening questionnaire which covers emotional difficulties, conduct problems, hyperactivity or inattention, friendships and peer groups and also positive behaviour. It is to be used for each Looked after child between the ages of 4 – 16yrs inclusive. Within Kirklees there have been 161 completed questionnaires returned between 1/4/09 and the 31/3/10. Of those the average SDQ score is 14.1, the regional average SDQ score is 14.9. As can be seen from the table below there is a significant amount of emotional health problems within Looked after Children as over 63% returned scores of over 20. The total sum scored on the completed SDQ for each Looked after Child is sent to the Social Worker for that child who is required to take appropriate action if the score is 20 or over. The Social Worker can then refer for a Consultation with CAMHS service and take advice how to progress. Overtime records can show a child’s progress, whether difficulties remain or, if appropriate interventions have been put in place, whether they have eased. The SDQ may not be appropriate to all children and Young people e.g. severely disabled children, or children and young people who have already identified significant mental health problems. Scoring of those 157 completed returned questionnaires Score of 19 and under “Normal”
Score of 20 – 25, cause for concern
Score of 26 – 30
Score of 31+
24 = 38.7%
11 = 17.8%
4 = 6.5%
Unaccompanied Asylum Seeking Children and Young People Currently there are 21 UASC aged 17yrs and under, with another 30 who are now aged 18yrs or over, no longer Looked after but still within the care leaving service. Ethnicity of the current 21 children and Young people includes; 9 Afghan, 6 Iranian, 1 Turkish/Iraqi, 1 Kurdish/Iraqi, 3 Iraqi and 1 Eritrean. On average there is 1 UASC per month coming into the Looked after services.
Looked After Children by Ethnicity 31 March 2010 Ethnicity(LAC)
A2 White - Irish
A3 White - Other B1 Mixed White/Black Caribbean B2 Mixed White/Black African
A1 White - British
B3 Mixed White/ Asian
B4 Any other mixed background
C4 Asian - Other
D1 Black - Caribbean
D2 Black - African
D3 Black - Other
E2 Any other ethnic group
E4 Information not yet obtained
Looked After Children by Locality as at 31 March 2010 Matched on Placement Post Code Locality
Batley, Birstall and Birkenshaw
Denby Dale and Kirkburton Dewsbury and Mirfield
Outside Kirklees / Not Known
Children Looked After
Cheshire West & Chester City of Kingston Upon Hull
County of Herefordshire
Doncaster Durham East Riding of Yorkshire Hambleton Harrogate Leeds Lincoln Liverpool Macclesfield Manchester Newcastle Upon Tyne North East Lincolnshire North Lincolnshire North Warwickshire Oldham Powys Preston Rochdale Rossendale Rotherham Salford Selby Sheffield Shropshire South Lakeland South Ribble Stockton-on-Tees Stockport Sunderland Tamworth Wakefield Warrington Wigan Wiltshire Not Known
3 7 7 1 1 44 1 1 1 1 2 2 2 1 2 1 3 5 2 2 1 3 3 1 4 1 1 1 2 1 13 2 2 1 22 (Adopted)
Conclusion This report has given a general overview of the service. There are areas of concern within the service that the Local Authority, NHS Kirklees and KCHS are aware of. Steps are being taken to address these issues as quickly as possible. Attached is the Healthy Care Standard Audit Summary, along with the Action plan for the Health section. Summary of difficulties and issues •
Initial health assessments not completed within statutory 28 days
There are delays by School Nurses and Health Visitors on review assessments
Issues with social workers; not requesting initial and review health assessments in a timely manner, failing to attend IHA’s, failing to notify carers of appointments, not providing required consent documents, not altering legal status on system
Data collection, New Care First6 system – LA to be installed. System1 access. Discussion ongoing as to how to collect data required for both sides without wasting time duplicating input onto 2 systems
Out of area assessments not given equal priority. Also numbers of children placed within Kirklees from other authorities unknown
HEALTHY CARE PROGRAMME AUDIT TOOL LOCAL EVIDENCE GRID Developed in partnership with Government Office West Midlands
Location: Kirklees Completed by: Karen Woodhead, Linda Patterson
Organisation: KCHS, KMC Date Completed: 19/05/2010
SUMMARY LOCATION PROFILE Location:
National Healthy Care Standard, with the six entitlements 1. Living in safe, protected and stable care arrangements.
2. Living in a caring, healthy and learning (including educational) environment.
3. Having cultural beliefs and personal identity respected and supported
4. Having access to effective healthcare, assessment, treatment and support.
Participation of Children and Young People
Date Completed: Practices supporting the standard
Policies supporting the standard
Partnerships and Strategies supporting the standard
5. Having opportunities to develop personal and social skills, talents and abilities, and to spend time in freely chosen play, cultural and leisure activities. 6. Being prepared for leaving care by being supported to care and provide for themselves in the future.
4. Having access to effective healthcare, assessment, treatment and support. Practices supporting the standard – Red Initial health care assessments not being completed within 28 days of the child becoming Looked after, due to various issues that lie within the Local Authority. IHA’s, RHA’s not being requested, children not put onto Care First, legal status not updated. More clinic’s being held than are scheduled for raising issues of cover.
No training and awareness raising of LAC needs for staff within acute trusts currently being done.
Meetings with Managers of Social workers. Weekly reports to all managers re due/overdue assessments.
ChYPS – Unit managers
PCT - Designated LAC Nurse
Whole systems, processes and new ways of working being looked into.
ChYPS – Unit managers
Liaise with acute trusts re training/ information/ awareness raising
Designated LAC Nurse
PCT - Designated LAC Nurse
Review assessments completed by HV and SN, delays due to SW not requesting them, delays by HV, SN
Policies supporting the standard – Red / Amber
Partnerships and Strategies supporting the standard – Amber / Green
Work with S/W’s, team managers, Whole systems, processes and new ways of working being looked into.
Out of area Children’s assessments delays due to our children not being given equal priority.
Being raised on a regional/national basis at BAAF meetings
Camhs provide a limited service to meet the needs of CYP
Tier 2 consultation held. Service model to be developed looking at creative ways of working
Data collection limited
ChYPS – Unit managers PCT - Designated LAC Nurse
Designated LAC Nurse
ChYPS/PCT joint responsibility
ChYPS New Care first, access by LAC nurses, being rolled out by LA.