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Healthy Care Programme Handbook


NCB promotes the voices, interests and well-being of all children and young people across every aspect of their lives. As an umbrella body for the children’s sector in England and Northern Ireland, NCB provides essential information on policy, research and best practice for members and other partners.

DH INFORMATION READER BOX Policy HR/Workforce Management Planning Clinical

Estates Performance IM & T Finance Partnership Working

Document Purpose ROCR Ref: Title

Best Practice Guidance Gateway Ref: 4450 Healthy Care Programme Handbook DfES/Looked After Children Division 15 Mar 2005 PCT CEs, NHS Trust CEs, SHA CEs, Directors of PH, Directors of Nursing, GPs Local Authority CEs, Ds of Social Services The Healthy Care Programme aims to improve the health outcomes and life chances for children and young people who are looked after. The programme provides an audit tool for local authorities against which to benchmark their services. Implementing the programme will ensure that care settings provide a healthy, caring environment, quality provision of health assessments, health care and treatment. Promoting the Health of Looked After Children guidance n/a n/a n/a DfES Health of Looked After Children Team 4th Floor Caxton House SW1H 9NA 020 7273 5006 ncb.org.uk/healthycare

NCB aims to: ■ challenge disadvantage in childhood ■ work with children and young people to ensure they are involved in all matters that affect their lives ■ promote multidisciplinary cross-agency partnerships and good practice ■ influence government policy through policy development and advocacy ■ undertake high quality research and work from an evidence-based perspective ■ disseminate information to all those working with children and young people, and to children and young people themselves.

Author Publication Date Target Audience

Circulation List Description

NCB has adopted and works within the UN Convention on the Rights of the Child.

Published by the National Children’s Bureau, 8 Wakley Street, London EC1V 7QE Tel: 020 7843 6000 Website: www.ncb.org.uk Registered charity number: 258825 © National Children’s Bureau 2005

Cross Ref

ISBN 1 904787 41 X British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library All rights reserved. Apart from reprographic reproduction for not-for-profit use by a healthy care partnership, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form by any person without the written permission of the publisher.

Superseded Docs Action Required Timing Contact Details

For Recipient’s Use


Contents Foreword Voices Acknowledgements Terminology About this handbook

v vi vii viii ix

1. 2. 3. 4. 5. 6. 7. 8.

1 3 5 9 19 21 31 37

Introduction Why focus on Healthy Care? The National Healthy Care Standard The Healthy Care Partnership Children and young people’s participation and involvement Audit and action planning cycle Examples of Healthy Care Programme Work Support and further resources for Healthy Care Partnerships

Appendix 1: The National Healthy Care Standard: entitlements and outcomes Appendix 2: Healthy Care Audit Tool Appendix 3: Healthy Care Action Planning Tool

39 41 65

References

67


Figures Figure 3.1 The National Healthy Care Standard

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Figure 4.1 Summary of the stages of developing a Healthy Care Partnership

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Figure 4.2 Case study from Portsmouth Healthy Care Partnership

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Figure 4.3 Example of a Healthy Care Partnership and task groups

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Figure 4.4 Potential partners for Healthy Care Partnerships

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Figure 4.5 Case study from Telford and Wrekin Healthy Care Partnership

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Figure 5.1 Case study from Telford and Wrekin Healthy Care Partnership

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Figure 6.1 The Healthy Care action planning cycle

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Figure 6.2 Key stages of Healthy Care audit and action planning

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Figure 6.3 Case study from Portsmouth Healthy Care Partnership

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Figure 6.4 Case study from Eastmoor, Leeds Healthy Care Partnership

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Figure 6.5 Case study from North Tyneside Healthy Care Partnership

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Figure 6.6 Case study from Lincolnshire Healthy Care Partnership

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Foreword Improving the life chances for looked after children and young people, ensuring their safety and promoting their well-being is an essential strand of delivering the government’s Every Child Matters: Change for Children Programme. Promoting the mental and emotional well-being as well as the physical health of this small, but very vulnerable group of children and young people is a priority to help them achieve the five outcomes which we have set out for all children. The Government has funded the National Children’s Bureau to develop the Healthy Care Programme over four years. It provides a practical tool to help implement the Promoting Health of Looked After Children Guidance, assist implementation of the National Service Framework for Children, Young People and Maternity Services, and deliver the agenda set out in Choosing Health: making healthy choices easier – the Public Health White Paper. This Handbook provides a clear framework for developing partnership arrangements as part of a children’s trust; auditing current practice including the participation of children, young people and their carers; and setting and evaluating an action plan to ensure a culture of continuous improvement, based on the needs of children. The Healthy Care Programme Handbook, Healthy Care Briefings and Carer Training Programme together provide a set of resources for local services, including children’s trusts, to help promote stable placements, improve education outcomes, and ensure that children and young people can care for their health now and enjoy and contribute in their future lives. In addition the handbook shows how successful multi-agency partnerships were established in pilot areas to ensure effective collaborative working and strategic commissioning of services to support looked after children. The value of the work has been shown by over 40 partnerships currently involved in Healthy Care. The longer term success of the Healthy Care Programme will be demonstrated through its contribution to making a real change in the lives of looked after children and young people.

Lord Filkin Parliamentary Under Secretary of State for Children and Families


Voices This poem by three young people aged 12 to 15 years formed the basis of a sound loop for a slideshow of images created by looked after young people. It was part of an exhibition of art work by looked after young people displayed at the Museum of Lincolnshire Life in 2004. They tell me to listen Sometimes I understand Sometimes I don’t understand I just shut up They think I’m boring Am I boring? It doesn’t matter I get used to it Moving around That’s when I make new friends Then everything changes Then I make new friends again At school They think I’m different But I’m not They get used to me But it takes a lot of time Then they stop telling me I’m different I just wait Wait until they stop What makes me happy? I like jokes And calls on our mobile But if you laugh all the time It gets boring Some things are hard Sometimes I think everything is hard And then it isn’t I don’t think I’m sad Other people can be sad I’ve seen people very sad and angry Do you know what makes people sad? I don’t like some food Spaghetti Tomatoes Lettuce I hate liver

What can I use this for? I am making a pool over there I don’t think I’ll be here to see it finished When it rains I like to go out I don’t go out all the times I want When I go out That’s when I call Tom I’d like it to rain lots more I do dream a bit But I can’t remember everything Well bits Maybe I’m not right Can you remember anything when you dream? Then something different happens Then everything changes again I don’t know I just go on Everyone tries to help Most of my families have been good Two I didn’t like But that was me That was my fault My favourite things are games What games have you got on your mobile? I like Eddie Stobart I go paint balling Not as often as I like Just a few times when we can all go out together Words I find hard Tomorrow Dinosaur names Things like that When I am doing this I don’t mind you watching And talking Is that enough? Did I do alright? I like to be alright Maybe you’ll be back again


Acknowledgements This document was written by Helen Chambers, Principal Officer, NCB. The Healthy Care Programme is funded by the Department for Education and Skills (DfES), and developed by the National Children’s Bureau (NCB). It has been informed by the experiences of Healthy Care Partnerships that took place in 13 local authorities in England from January 2001 to April 2004. Regional Healthy Care Partnerships were also developed in the East Midlands, North East, South East and South West, to support local Healthy Care Partnerships and share learning. The initial five pilot sites and eight shadow sites tested how to set up and implement Healthy Care Partnerships. They have shared their successes and learning in order to support others to develop Healthy Care Partnerships. The pilot and shadow sites are: ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Barnsley Healthy Care Partnership Derby Healthy Care Partnership East Kent Healthy Care Partnership Leeds Healthy Care Partnership Leicester Healthy Care Partnership Lincolnshire Healthy Care Partnership London Borough of Harrow Healthy Care Partnership Nottinghamshire Healthy Care Partnership Portsmouth Healthy Care Partnership Salford Healthy Care Partnership Telford and Wrekin Healthy Care Partnership Trafford Healthy Care Partnership Wandsworth Healthy Care Partnership.

Thanks are given to all the participating partnerships, staff, carers, children and young people, and to all of those who have participated regionally and nationally. Particular thanks are given to colleagues in DfES and NCB for their expertise, time, determination and creativity, which have enabled this programme to happen. Special thanks to Sarah Heathcote and Nigel Shipley, Healthy Care consultants, who worked with local Healthy Care Partnerships, and used that experience to advise this document. A final thanks to the document’s editor Mary Ryan for her patience and forbearance.


Terminology Throughout this document the term ‘carer’ is used to refer to residential social workers and foster carers. The term ‘looked after children and young people’ refers to children and young people who may be: ■ accommodated under a voluntary agreement with their parent(s) consent, or their own consent if aged 16 or 17 ■ in care on a Care Order or Interim Care Order under Section 31 of the Children Act 1989 ■ accommodated under section 21 (2) (C) (i) of the Children Act 1989 (remanded to local authority care) ■ on an Emergency Protection Order under Section 44 of the Children Act 1989.


About this handbook The Healthy Care Programme Handbook provides information about: ■ The Healthy Care Programme – an overarching programme to promote the health and well-being of looked after children and young people. ■ The National Healthy Care Standard that describes the entitlements of looked after children and young people and outcomes that will help to measure progress towards providing a healthy care environment. ■ How Healthy Care can help to provide evidence for inspection processes and other reviews. ■ How the pilot Healthy Care Partnerships were set up. ■ How to carry out healthy care audits and develop and implement healthy care action plans. Tools and resources are also available to support this (available to download from: www.ncb.org.uk/healthycare and some are included as appendices in this handbook). This handbook will be useful to all involved in and concerned with the care of looked after children and young people – from elected members and strategic managers to carers.


Introduction The Healthy Care Programme provides a multi-agency framework to improve the health of looked after children and young people in England. The framework coordinates the key policies and addresses the issues that affect the health and well-being of children and young people. Better outcomes depend on the integration of universal services to address the needs of the child and family. The Healthy Care Programme promotes local healthy care services across agencies and makes the five outcomes of Every Child Matters (HM Treasury 2003) the driving force for the development and delivery of services to looked after children. The Healthy Care Programme has been developed in response to the Department of Health guidance Promoting the Health of Looked After Children (Department of Health 2002). A key principle identified in the guidance is the direct involvement of children, young people and carers: To be successful in improving health outcomes for this vulnerable population any guidance, structures or plans must have as its central focus a partnership process which builds on the views and priorities of the children and young people themselves. (Department of Health 2002) Children’s participation is a cornerstone of the Healthy Care Programme.

What is in the Healthy Care Handbook? The Healthy Care Programme Handbook provides a set of tools and resources to assist partnerships to carry out audits of services, devise action plans and evidence their progress. It includes case studies and examples of healthy care work from 13 pilot local authorities. It is accompanied by a series of briefing papers on key health topics (see www.ncb.org.uk/healthycare). Every area will develop its healthy care services to meet local needs and build on good practice. The pilot Healthy Care Partnerships, or Multi Agency Looked After Partnerships (MALAPs) as they are called in some regions, have been supported by the Quality Protects Programme regional development workers, regional public health leads for children, and other staff based in government offices in the regions. Healthy Care Partnerships lead a process of continuous development to enable real and measurable changes to the physical and emotional well-being of looked after children and young people.

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Who is it for? This handbook is for managers of services and Healthy Care Programme lead officers as well as other relevant staff from partner agencies. It will be of interest to multi-agency staff who provide services for looked after children and young people. It will also be useful to staff in regional government offices, strategic health authorities and other regional organisations.

Relationship of the National Healthy Care Standard to performance management The National Healthy Care Standard forms part of the Healthy Care Programme which reflects best operational practice as identified by the work of Healthy Care Partnerships based in 13 pilot local authorities. Those involved in the provision of health services for looked after children and young people will find it helpful in ensuring that health outcomes for looked after children and young people are improved and that services are responsive to their needs, and in evidencing the achievement of parts of the National Service Framework for Children, Young People and Maternity Services (Department of Health 2004). It is however for local partners to decide how and whether to use the standard. It does not form part of the Department of Health’s Standards for Better Healthcare or the criteria which underpin those standards, and will not, in itself, be a requirement of the Healthcare Commission inspection regime.


Why focus on Healthy Care? Children and young people who are looked after are amongst the most socially excluded groups in England and Wales. They have profoundly increased health needs in comparison with children and young people from comparable socioeconomic backgrounds who have not needed to be taken into care. These greater needs, however, often remain unmet. As a result, many children and young people who are looked after experience significant health inequalities and on leaving care experience very poor health, educational and social outcomes. (Department of Health 2002) Commitment to improving the health and emotional well-being of looked after children and young people is high on central government and local agendas. The focus on health inequalities and the impact of social exclusion has identified this group of children and young people as highly vulnerable, and improving their health is a key priority. The physical and mental health of looked after children and young people is often poor when compared with their peers, and this may affect their ability to benefit from education and other life enhancing opportunities and have serious implications for their health and well-being in adulthood. National and international research has indicated: â–  Children may come into care with significant physical and mental health problems (Skuse and others 2001, Skuse and Ward 1999, Dimigen and others 1999). â–  Two-thirds of all looked after children were reported to have at least one physical complaint. The most commonly reported physical complaints were: eye and/or sight problems (16 per cent), speech or language problems (14 per cent), bed wetting (13 per cent), difficulty in coordination (10 per cent), and asthma (10 per cent) (Meltzer and others 2003, Williams and others 2001). A longitudinal study showed 52 per cent of looked after children had a physical or health condition that required outpatient treatment (Skuse and others 2001). â–  Looked after children and young people have a high rate of mental health problems (Richardson and Joughin 2000, Buchanan 1999, Arcelus and others 1999, Broad 1999, McCann and others 1996, Bamford and Wolkind 1988). Of looked after children and young people aged 5 to 17, 45 per cent were assessed as having at least one psychiatric disorder and two-thirds of those living in residential care were assessed as having a mental disorder (Meltzer and others 2003).

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■ There are high rates of self-harm and high-risk behaviour among looked after children and young people, particularly in secure accommodation (Richardson and Joughin 2000, Shaw 1998). ■ Some studies show that there is a higher level of substance misuse, including smoking tobacco, among looked after children and young people, than among the non-care population (Meltzer and others 2003, Williams and others 2001, Department of Health 1997). ■ There is a significantly higher rate of teenage conception among looked after young people than among the non-care population, and looked after young women are more likely to become young mothers than young women in the general population (Corlyon and McGuire 1997, Brodie and others 1997, Biehal and others 1992 and 1995). ■ Fewer looked after children visited a dentist regularly, and they were significantly more likely to need treatment in comparison with their non-care peers (Williams and others 2001). ■ Educational achievement is lower among looked after children and young people than among their non-care peers, with only 56 per cent of looked after young people sitting at least one GCSE compared with 96 per cent of the general population. Also a higher percentage are permanently excluded from school and a higher percentage are reported absent from school (DfES 2004). Disrupted education leads to missing out on health promotion work in schools. ■ Children from minority ethnic backgrounds may suffer discrimination within the care system leading to health needs being unmet. Training on the particular health needs of minority groups has been described as ‘woefully inadequate’ (Mather 2000). ■ Children with disabilities who are in care may experience unmet health and social needs (often due to confusion over funding and provision), services often ignore disabled children’s right to a say in their care, and transition to adult services and/or independence is often unsatisfactory (Morris 1995 and 1999). ■ There are significant gaps in health records for looked after children and young people (Butler and Payne 1997, Mather and others 1997). ■ Standards and indicators for looked after children tend to focus on ‘illness’ rather than ‘health’ (Howell 2001).


The National Healthy Care Standard The development and implementation of the National Healthy Care Standard is founded on a belief that all children are entitled to excellent, consistent care and health care, and a care environment that will equip them with the knowledge, skills and values for life now and in the future. (Chambers and others 2002)

The National Service Framework for Children, Young People and Maternity Services (Department of Health 2004) reinforces this view that services should be designed and delivered around the needs of the child, and sets standards for children’s health and social care: Services are child-centred and look at the whole child – not just the illness or the problem, but rather the best way to pick up any problems early, take preventative action and ensure children have the best possible chance to realise their full potential. And if and when these children grow up to be parents themselves they will be better equipped to bring up their own children. (Department of Health 2004) Looked after children and young people have contributed to the development of the National Healthy Care Standard and have voiced their thoughts and opinions about what healthy care should be and what is most important to them: They can support us by getting to know us, really knowing us. The things that we feel strongly about, that we believe in. Children in care just want someone to take an interest in them. It should be somewhere you feel supported and encouraged both emotionally and physically. You shouldn’t feel that you are responsible for everything as if you are alone. I would not have been able to cope if it had not been for the team. Whether it was helping me find a flat or popping around to see if I was OK. I never felt alone. There was always someone to turn to, they were really supportive. They look at you as an individual and you decide together what your needs are – they don’t decide everything for you. (Looked after young people participating in the National Health Care Standard consultation, 2002) The National Healthy Care Standard is based on a child’s entitlement to: ■ feel safe, protected and valued in a strong, sustained and committed relationship with at least one carer

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■ live in a caring, healthy and learning environment ■ feel respected and supported in his/her cultural beliefs and personal identity ■ have access to effective healthcare, assessment, treatment and support ■ have opportunities to develop social skills, talents and abilities and to spend time in freely chosen play, cultural and leisure activies ■ be prepared for leaving care by being supported to care and provide for him/herself in the future. The National Healthy Care Standard is summarised in Figure 3.1 on page 7. The relevant outcomes that provide evidence of meeting the NHCS are listed in Appendix 1 (page 39). The pilot Healthy Care Partnerships have undertaken a range of work focusing on key health topics across the four NHCS areas for action. This is summarised in Chapter 7.


The National Healthy Care Standard 7

Figure 3.1

The National Healthy Care Standard The National Healthy Care Standard helps looked after children and young people achieve the five outcomes described in Every Child Matters (HM Treasury 2003): ■ ■ ■ ■ ■

be healthy; stay safe; enjoy and achieve; make a positive contribution; and achieve economic well-being.

Children and young people in a healthy care environment will: ■ experience a genuinely caring, consistent, stable and secure relationship with at least one committed, trained, experienced and supported carer; ■ live in an environment that promotes health and well-being within the wider community; ■ have opportunities to develop the personal and social skills to care for their health and wellbeing now and in the future; and ■ receive effective healthcare, assessment, treatment and support.

A child or young person living in a healthy care environment is entitled to: 1. feel safe, protected and valued in a strong, sustained and committed relationship with at least one carer; 2. live in a caring, healthy and learning environment; 3. feel respected and supported in his/her cultural beliefs and personal identity; 4. have access to effective healthcare, assessment, treatment and support; 5. have opportunities to develop personal and social skills, talents and abilities and to spend time in freely chosen play, cultural and leisure activities; and 6. be prepared for leaving care by being supported to care and provide for him/herself in the future.

The National Healthy Care Standard focuses on four key areas for action: Policy

Partnership

Policies ensure services meet the needs of looked after children and young people.

Effective multi agency planning delivers services which meet the needs of looked after children and young people.

Participation Practice The involvement and participation of looked after children, young people and their carers with respect for their rights and responsibilities.

Carers and staff are committed to the well-being of children and young people, and are well trained and supported.


The Healthy Care Partnership Good health goes beyond having access to health services. Improved health outcomes for looked after children require the focus of health care planning to be on health promotion and attention to environmental factors as well as physical, emotional and mental health needs. Children and young people need to understand their right to good health and to be able to access services. They need the knowledge and skills to communicate and relate to others and to take responsibility for themselves. (Department of Health 2002) This section provides details of the lessons learnt by the pilot areas where Healthy Care Partnerships have been established. The Healthy Care Partnership supports local children’s services and children’s trusts including health, social care, education, leisure, the voluntary sector and other services to work together to fulfil their responsibilities to promote the health and well-being of looked after children and young people. The Healthy Care Partnership can be developed by building on existing local partnerships and sit within the local children’s strategic partnership or children’s trust. It provides a specific focus on looked after children and young people. It provides a framework to develop a healthy care environment through healthy policies, promoting good practice and the active participation of the children and young people and their carers. A Healthy Care Partnership brings together and enhances a range of activities to improve the health and well-being of children and young people in and leaving care. The Healthy Care Programme provides: ■ a structure for the development of local Healthy Care Partnerships to drive work on healthy care ■ a framework for implementing a range of local, regional and national initiatives including the National Healthy Care Standard ■ opportunities to raise the profile of health and well-being and health promotion in the care setting ■ opportunities to raise children and young people’s issues within planning and commissioning structures in health and other services ■ opportunities to raise awareness and gain recognition for current and future achievements locally, regionally and nationally ■ opportunities for sharing ideas and good practice ■ access to expertise, resources and support through national, regional and local networks.

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Developing a Healthy Care Partnership A Healthy Care Partnership is the driver for leading and coordinating local work on healthy care. In some areas work on healthy care is delivered through multi-agency looked after partnerships, sometimes known as MALAPs. A strong multi-agency partnership is able to promote and effect change for looked after children and young people. Where a specific Healthy Care Partnership is developed there are four key stages to be undertaken before work begins on auditing services and planning action. These are summarised in Figure 4.1.

Figure 4.1

Summary of the stages of developing a Healthy Care Partnership Stage 1: Identify a lead for the multi-agency Healthy Care Partnership (a senior manager from health, social services or children’s services) and a senior-level champion, usually the assistant director for social services or children and families or equivalent within children’s trusts. Stage 2a: Involve and secure formal commitment from strategic leads across all key agencies through a formal agreement with sign-up and endorsement from relevant directors, including social services/children and families, children’s trusts, health, education and leisure/community services. Include elected members as corporate parents. Stage 2b: Identify the formal arrangements for the strategic accountability of the Healthy Care Partnership with the children and young people’s strategic partnership, children’s trust or equivalent. Stage 3: Appoint a lead officer for Healthy Care. This need not be a full-time post – it could be part of an existing post. This role undertakes some of the coordination of the partnership – crucial in the early stages. Some administrative support is also needed. Stage 4: Develop partnership structures, such as a strategic steering group, working groups and lines of communication. Consider who can be involved in the partnership and how. Operational as well as strategic staff must be included and there may be many different ways of involving staff and services. They will want to be kept informed of progress and to contribute. Ensure the active involvement of looked after children, young people and their families and carers.


The Healthy Care Partnership 11

Stage 1 – A senior champion for Healthy Care Identify a lead person who can act as a senior-level champion; he or she needs to be someone who can ensure the involvement of strategic leads from all key agencies. In the pilot Healthy Care Partnerships this has usually been the assistant director for social services, social care or for children and families.

Stage 2a – Involve strategic leads from key agencies Involve strategic leads from all the key agencies. Depending on local arrangements this is likely to include: ■ ■ ■ ■ ■ ■ ■

director of children’s services or social services and education lead officer for looked after children director of the children’s trust chief executive of the PCTs or child health lead director of public health director of leisure services a corporate parenting officer.

Secure their commitment to the partnership with a written agreement. This confirms their involvement in the partnership and their commitment to the involvement of looked after children and young people in the process. It is also important to secure the commitment of elected members as corporate parents.

Stage 2b – Secure a locally appropriate strategic mandate The Healthy Care Partnership must secure a locally appropriate strategic mandate. The lead person will negotiate this with the relevant group for children and young people’s services within the local strategic partnership, usually the local children and young people’s strategic partnership.

Stage 3 – Develop partnership arrangements The membership and working practice of each Healthy Care Partnership will largely depend on the local context but will reflect the key agencies active locally. Consideration will be given to diversity and inclusion issues to ensure that the partnership reflects the local communities, priorities and circumstances. Carers have much to contribute to healthy care, and should be provided with opportunities to share their views and help shape service


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developments. Working with the local group from Fostering Network or carer’s support groups and residential social workers in children’s homes including those provided by the independent sector, ensures there are opportunities for carers to participate in the local Healthy Care Partnership. Similarly the families of looked after children and young people may wish to be involved and contribute. Training and support for carers is an essential part of providing a healthy care environment and the early involvement of training managers for fostering and residential care services is also important. The involvement of children and young people in and leaving care is crucial. The meaningful involvement of children and young people within the partnership provides the opportunity to check that changes in services are impacting favourably on them. Portsmouth Healthy Care Partnership held a conference with looked after young people and carers to help to identify priorities for their Healthy Care action plan. The conference tackled issues that were very important to looked after children and young people and produced tangible results (See Figure 4.2).

Figure 4.2

Case study from Portsmouth Health Care Partnership A one-day multi-agency conference was held to seek evidence about the current healthy care situation and to identify priorities for the action plan. The morning session of the conference was presented by looked after young people and foster carers giving their views and opinions about what needed to happen. The afternoon saw the members of the partnership group devising an action plan based on the issues and priorities presented in the morning session. This draft action plan was presented to the children, young people and carers for their comments and approval. As a result the Portsmouth Healthy Care Action Plan included the development of passports for both looked after children and young people, and foster carers. The children and young people’s passports contain information about themselves that they want the carers to know as they come to live with them. The foster carers’ passports include information about the household. Young people have helped to identify what information is necessary. Together, both passports should help communication and help to make moves to new placements less stressful for children, young people and carers.


The Healthy Care Partnership 13

Healthy Care Partnerships develop different groups functioning at different levels, for example an over-arching steering group to strategically drive the partnership and one or more implementation/task groups to take forward different elements of the action plan (see Figure 4.3). This develops over time as the work of the Healthy Care Partnerships grows. Figure 4.3

Example of a Healthy Care Partnership and task groups Local Children and Young People’s Strategic Partnership or Children’s Trust

Healthy Care Partnership Steering group

Healthy Care Workforce Development

Leisure activities for children and young people

Residential care

16 plus and leaving care

Stage 4 – Identify a Healthy Care lead officer A Healthy Care lead officer is essential – this role can take forward much of the organisational development and administration of the Healthy Care Partnership. This can be an allocation of time from within an existing post. Administrative support for this role is also necessary for efficient working. The role of the Healthy Care lead officer usually includes: ■ supporting the development of the Healthy Care Partnership including convening stakeholder meetings and ensuring relevant paperwork is available ■ collating and analysing evidence for the Healthy Care audit ■ coordinating the action plan ■ monitoring and reviewing the action plan


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■ setting up a communication strategy ■ reporting progress to the Healthy Care Partnership ■ linking with the national Healthy Care Partnership, attending regional and national seminars ■ ensuring feedback to the children’s strategic partnership ■ ensuring evidence is available to support inspection of services ■ ensuring the action plan is implemented.

Who to involve However a Healthy Care Partnership may be organised, it is essential to engage and secure commitment from both operational and strategic staff across as wide a range of partner agencies as possible. A list of possible partners is provided in Figure 4.4 (page 16).

Making the partnership work ■ Local Healthy Care Partnerships must engage and secure commitment from both operational and strategic staff across as wide a range of partner agencies as possible. ■ The formal sign-up of agencies to the partnership has been identified as critical to the success of pilot Healthy Care Partnerships. ■ Keep elected members as corporate parents informed of and involved in progress. ■ Existing partnerships may be used or built on. The partnership does not have to be huge and can start with a small committed group. Pilot Healthy Care Partnerships have shown that a small group can produce good outcomes for children, contribute evidence to inspections and reviews, and gain commitment to and increased membership of the partnership. ■ Engaging stakeholders can vary with local circumstances. Meetings with key individuals or groups may be needed to provide information, clarify roles, agency structures, avoid gaps and duplication and encourage active involvement. Early groundwork will develop trust, common understanding and purpose, and clarify the different roles of partners. ■ Local coordinators of Healthy Schools will be useful partners – the two initiatives have issues in common, such as multi-agency working, involving children and young people, and addressing inequalities, promoting social inclusion and achievement.


The Healthy Care Partnership 15

■ Use innovative and different ways to involve different stakeholders, for example, seminars, fun days, training for foster carers, one-day events. ■ Good partnership working, led and monitored by a Healthy Care lead officer, with tasks allocated to task groups will help to ensure effective outcomes. ■ Celebrate successes.


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Figure 4.4

Potential partners for Healthy Care Partnerships The pool of potential partners includes: ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

children and young people child and adolescent mental health services lead (CAMHS) children and families leads within social services children’s fund projects children’s rights worker/looked after children’s participation officer children’s trusts representative community paediatrician community safety partnership Connexions representative corporate parenting group representative designated doctor for looked after children or GPs designated teacher/education strategic lead for looked after children drugs action team (DAT) representative early years/Sure Start projects lead carers and foster carers, including independent providers and local fostering networks health visitors/school health nurses independent visitor/advocate leisure services lead officer local authority officers (from housing, health, leisure) looked after children’s nurse looked after children’s psychologists – clinical and/or educational psychologists healthy schools’ coordinator parents, family carers primary care trusts and acute hospital trusts (children’s lead/commissioner and public health/health promotion lead) respite care service representative local authority secure children’s home representative social inclusion officer (education) social workers (looked after children teams, children with disabilities teams, leaving care teams, therapeutic teams, family placement) teenage pregnancy coordinator voluntary sector youth offending service youth service – youth workers/mentors.


The Healthy Care Partnership 17

Figure 4.5

Case study from Telford and Wrekin Health Care Partnership Healthy Care work has been driven from within the local partnership development unit, which has secondees from key agencies taking forward work on behalf of the local strategic partnership. The lead officer for Healthy Care is employed by the primary care trust, which has benefits in terms of accessing and making sense of the health system. Initially a great deal of time and energy was invested in engaging stakeholders to build a strong partnership – this proved to be very worthwhile. The one-to-one contact made by the lead officer in the very early stages helped to ensure the commitment and involvement of managers, practitioners, foster carers and young people for the pilot phase. A seminar was held at which multi-agency senior management support for the Healthy Care Partnership was reinforced and the National Healthy Care Standard explained. Sub-groups were formed to take forward specific elements of the local programme, these were: ■ assessment ■ consulting with children and young people ■ a cooking club. Four areas of the service were chosen for healthy care audits and groups set up to oversee this: 1. 2. 3. 4.

respite care independent sector residential care foster care.

Each audit group examined performance against the National Healthy Care Standard and developed healthy care action plans. Results included: ■ enthusiasm and energy from children, young people, carers and service managers was quickly generated – they could all see the benefits ■ creative thinking about how to do things differently ■ an agenda for change in respite care and disabled children and young people were less marginalised ■ some ‘quick wins’ – the cooking club was easy to set up and very popular with the young people who managed it themselves with some support ■ identification of where deeper practice developments were required (for example, the quality of care plans) ■ the audit tool helped to analyse practice in detail and identify where work was needed. The focus on positive health and well-being was important so that we were not just screening for poor health. The audit has given us pointers rather than solutions which we can now take forward together. (Member of the Telford and Wrekin Healthy Care Partnership)


Children and young people’s participation and involvement To be successful, health improvement programmes need more than the reluctant consent of the young people, they require their active participation and empowerment, as the primary custodians of their own health. (Chambers and others 2002) The National Healthy Care Standard identifies participation as having two key outcomes: ■ involvement and participation of looked after children and their carers ■ a respect for the rights and responsibilities of looked after children. Children and young people should participate in the entire healthy care process, from initial audit and review through to monitoring and evaluating progress. To fully involve children, young people and carers requires a culture that builds respect and trust between children and adults, and a commitment from adults to listen. The process of involving children and young people includes: ■ informing children and young people of the issues ■ encouraging them to form an opinion ■ giving them opportunities to express their opinions to people who make decisions ■ giving them feedback on how their opinions have shaped service developments ■ making sure that appropriate and different ways are found to listen to children of different ages, with different abilities, from diverse cultures and backgrounds. Children and young people taking part in local Healthy Care Partnership meetings need to be part of a wider reference group that links to the larger community of looked after children and young people. There may be an existing participation structure for looked after children and young people that can be used to consult on healthy care issues. Some areas have a children’s rights worker or equivalent, who will be a valuable link and be able to support children and young people to participate in and contribute their views to the Healthy Care Partnership. The pilot Healthy Care Partnerships have found that consulting with and involving children and young people has been critical to the success of their action plans and has resulted in changes that have made a huge difference to children and young people – often changes that adults would not have thought about. Consultations have also brought great energy and enthusiasm to partnerships: as one carer commented ‘This is what I came to the job to do’.

5


20 Healthy Care Programme Handbook

A young person in Telford and Wrekin co-chaired the local Healthy Care conference and found the experience worthwhile. She describes it in Figure 5.1. Figure 5.1

Case study from Telford and Wrekin Healthy Care Partnership I was very nervous about doing this because I had never really done much speaking in front of large groups of people so co-chairing the conference was a little scary and a totally new experience. There were a few other people sitting at the table with Carol and me, which was nice because I felt that I had support from them. Looking at all of the people in front of us was very nerve-racking. The one thing that I was worried about was that the conference was going to be boring. I would hate to have seen people yawning and falling asleep right in front of me. Also, I have been to some very boring meetings and it is not very nice for the people who attend and the people who are holding them. Quite often the meetings are very valuable and the information given is important but because of the way that they are run people just don’t listen. Luckily for us though, everyone seemed to be enjoying themselves! The conference set up some task groups to tackle different areas of the standard. I was part of the task group that looked at foster care to see whether the young people were getting a fair deal according to the standard.

There are many resources available with ideas and tool kits for consulting with and involving children and young people. Total Respect (Children’s Rights Officers and Advocates 2000) is a training pack developed with 200 looked after children and young people and aims to get carers, social workers, managers and elected members thinking about how children and young people experience being looked after. It includes a training manual, video and audio cassette of messages from looked after children and young people and other resources. There are also two briefings about using creative participation and using drama to consult with children and young people available at www.ncb.org.uk/healthycare (NCB 2004a and 2004b).


Audit and action planning cycle

6

The first action of the Healthy Care Partnership is an audit of services in order to acknowledge current good practice and identify what needs to change and/or be developed. This leads to the development and implementation of the Healthy Care action plan followed by monitoring and evaluation of progress and updating the action plan. This cycle creates a process of continuous improvement focusing on the health and well-being of looked after children and young people.

Figure 6.1

The Healthy Care action planning cycle Record improvement and celebrate success

Audit services

Healthy Care Partnership

Monitor and evaluate

Implement action plan

Identify priorities

Agree action plan


22 Healthy Care Programme Handbook

Figure 6.2

Key stages of Healthy Care audit and action planning Stage 1a: Gather evidence Use the Healthy Care Audit Tool (see Appendix 2) to help identify current good practice in Healthy Care as well as areas for development and gaps in provision. Include current national priority targets and those addressing public health inequalities. Stage 1b: Gather evidence Children and young people and carers are consulted about what changes are important to them, and how they can be included in the local Healthy Care Partnership. Stage 1c: Gather evidence Review and include evidence from inspection reports and other relevant local reviews and consultations. Stage 2: Summarise the findings and prioritise Identify priority areas for action, for example fostering services, local authority secure children’s home, young people leaving care or children from birth to five years old. One or two action areas would be considered good practice. Healthy Care Partnerships must ask ‘What difference will the children see if we carry out this piece of work?’ The Healthy Care: Policy Framework (see www.ncb.org.uk/healthycare) may be used to help identify priorities. Stage 3: Action planning Use the Healthy Care Action Planning Tool (see Appendix 3) to review each priority area. This involves examining the four action areas of policy, partnership, participation and practice for each priority area and identifying required action. The Healthy Care Partnership may decide to set up task/action groups to focus on each priority area. These groups will report regularly on progress. Stage 4: Accountability and dissemination Once the action plan is agreed it is taken forward by the Healthy Care Partnership to the children and young people’s local strategic partnership, children’s trust board or other accountable body. Healthy Care partners disseminate the action plan within their agencies. Stage 5: Resource the identified work programme This is considered by the partnership. Consideration is given to the sharing and pooling of resources, connecting up of initiatives, and creative use of targeted budgets to provide resources for the work of the partnership. Stage 6: Monitoring and evaluation The work is monitored and evaluated and progress reported to the Healthy Care Partnership and the accountable body. The action plan is reviewed and updated regularly. New and revised targets are set as required, and usually include an annual review. Stage 7: Record improvement and celebrate success The Healthy Care action plan and record of improvements and impacts provide evidence for service inspections and reviews. Success and improvement is acknowledged and celebrated in newsletters, annual celebratory events, etc.


Audit and action planning cycle 23

How to get started with audits and action plans The Healthy Care audit is informed by: ■ the views of children and young people and their families and carers ■ evidence from multi-agency partners ■ evidence from recent inspection reports and other reviews. Using the audit tool will: ■ enable the participation of key stakeholders, including children and young people, their families and carers ■ ensure services are involved in advising on strategic and operational development ■ support inspection processes ■ clarify which parts of the National Healthy Care Standard to focus on first ■ produce some immediate results and benefits for children ■ give partnerships a ‘way in’ to Healthy Care, and produce some ‘quick wins’ which will increase motivation to develop the work further.

The Healthy Care Audit Tool The Healthy Care Audit Tool (see Appendix 2) provides a framework for Healthy Care Partnerships to assess their current position for delivery of healthy care outcomes in the context of the national outcomes for all children. It provides a framework to audit service provision within each entitlement and outcome considering policy, partnership, participation and practice. It is recommended that the audit is used on one or two service areas for looked after children and young people, for example children in foster or residential care, or specific age bands or groups of children. The audit tool is intended to act as a guide and can be amended to suit local situations where appropriate.

Developing an action plan When the audit is completed, it is important that the Healthy Care Partnership has the opportunity to discuss and share views on the current position locally and to consider additional evidence, gaps and priority areas for development in the Healthy Care action plan. The Healthy Care lead officer will collate and summarise information from the local sources and prioritise these in the Healthy Care action plan.


24 Healthy Care Programme Handbook

Deciding what is to be included in the action plan will be based on consideration of the following: ■ Priorities identified by the audit. ■ Children and young people’s priorities for action. ■ What is achievable? ■ What will secure the biggest gains for all, taking into account external drivers (for example, achievement of national and local targets)? ■ Are there pieces of work already started which need added impetus? ■ Will senior managers, chief executives and elected members agree to actions signed-up to, particularly taking resource implications, including time, into account? ■ Are there specific inequalities or social inclusion issues within the care setting that need addressing? The Healthy Care lead officer also considers links with cross-cutting agendas and other complementary national/local targets and plans such as the Teenage Pregnancy Strategy, young people’s substance misuse plans, youth justice plan, education development plan, behaviour support plan, and child and adolescent mental health development strategy. The pilot Healthy Care Partnerships have identified key learning during their development and implementation of Healthy Care action plans: ■ Be realistic about resource implications, including time, from the outset. ■ Include some easily achievable goals for children and young people – this helps to motivate the Healthy Care Partnership. ■ Be as specific as possible in defining objectives and the necessary actions to achieve these – this helps effective implementation and assists evaluation. Keep objectives SMART (specific, measurable, achievable, realistic, time-related). ■ Be explicit and clear about the intended outcomes, and how you can demonstrate these have been achieved. ■ An activity (the Clouds activity) has been included in the Healthy Care health promotion training programme for carers because it proved to


Audit and action planning cycle 25

be a useful way of identifying changes needed and focused on the NHCS child/young persons entitlements. This has also been useful for consulting with children and young people and carers. ■ Ensure a range of people are responsible for moving targets forward. The Healthy Care Action Planning Tool (see Appendix 3) is helpful in providing a template for constructing the local action plan. The action plan should be agreed by the Healthy Care Partnership, senior champion and the children and young people’s local strategic partnership or children’s trust board (or equivalent). Key learning from the pilot Healthy Care Partnerships has been that the focus of the work must result in outcomes that are important to children and young people. Healthy Care Partnerships should ask: ‘What difference will the children and young people see if we carry out this piece of work? How will it impact on them?’

Figure 6.3

Case study from Portsmouth Healthy Care Partnership Looked after children and young people were asked as part of the consultation on Healthy Care for practical suggestions that they thought would improve their physical and emotional well-being. Along with other issues the children identified two things that they thought would really make a difference: 1. Children and young people were very upset that when they moved to a new placement their belongings were usually taken in a black plastic bin bag. They found this very distressing and demeaning – as if they and their belongings were not important. They wanted to have suitcases or holdalls instead. As the young people said, ‘We are not rubbish, so don’t treat us like rubbish’. 2. They found moves between foster homes very stressful and asked if all foster carers could have a booklet about their home and themselves with photographs so that they would know something about their new placement and carers before they went there.


26 Healthy Care Programme Handbook

Monitoring and evaluation Evaluation is critical to determining if practice is indeed improving children and young people’s health and well-being. Once the activity identified in the action plan is under way it is important to monitor progress and get feedback from those involved. Revisiting the action plan can help to address regular changes in the external environment and local circumstances. It identifies progress and flags up problems that have emerged and require attention. The Healthy Care Partnership reports annually on progress and identifies evidence of positive outcomes in the four National Healthy Care Standard action areas (policy, partnership, practice and participation). This enables the partnership to: ■ ■ ■ ■ ■ ■ ■ ■

set new or revised targets consider setting new priorities based on identified needs build on good practice strengthen the Healthy Care Partnership respond and contribute to inspections identify achievement towards local and national targets celebrate success listen to how children and young people have experienced healthy care.

Examples of how to measure Healthy Care Some impacts are immediate and tangible and will increase confidence in the Healthy Care Partnership. Others are longer term, and are hard to evidence as being directly attributable to specific initiatives, such as lowering the rate of teenage pregnancy. It is important to track work undertaken to contribute towards targets wherever possible – this can be used in reporting on targets and as evidence for inspections. Be as specific as possible in defining objectives and the necessary actions to achieve these – this helps effective implementation and assists evaluation. Be explicit and clear about the intended outcomes, and how to demonstrate they have been achieved. It is essential that children and young people are included in the evaluation process. The aim of Healthy Care is to improve the health and well-being of looked after children and young people. Therefore the evaluation will examine the impact of the Healthy Care work on the


Audit and action planning cycle 27

children and young people – what difference has it made to them? Their opinions form an important part of the evaluation of effectiveness. The following examples describe some of the measurable targets that have been set by Healthy Care Partnerships: ■ To increase satisfactory completion of annual health assessments for looked after young people aged 14 to 18 years from the current 60 per cent to 80 per cent. ■ Carers to be involved in delivering a health promotion training programme for foster carers and residential social workers that has been developed and piloted as part of the Healthy Care Programme. ■ A Healthy Care health promotion training course for foster carers on healthy eating and nutrition for families, to be delivered locally by multi-agency partners. ■ Public service agreements for placement stability cover education and health and form part of the local delivery plan. ■ All looked after children, young people and foster families to be issued with local leisure services cards providing access to sports and leisure facilities at a reduced rate. ■ Sex and relationship training for foster carers of teenagers to be organised and delivered by health promotion, the youth service and the designated nurse for looked after children. ■ The leaving care group and Connexions to establish a young parents’ support group for care leavers who have children or who are pregnant (this could be separate groups for young mums or young dads). More examples of work focusing on healthy care can be found in Chapter 7. These relate to specific themes including substance misuse, healthy eating and physical activity, play and creativity, mental health and sexual health. The following three case studies describe how Healthy Care Partnerships have focused on particular services or aspects of them – a local authority secure children’s home and training for carers.


28 Healthy Care Programme Handbook

Figure 6.4

Case study from Eastmoor, Leeds Healthy Care Partnership Eastmoor in Leeds is a 34-bed local authority secure children’s home for looked after young people from across England. It has approximately 200 admissions per year that include long and short stays. Despite local input from a general practitioner (GP), youth offending team (YOT), nurses and paediatricians, the young people’s often complex health needs were not being addressed adequately. Reasons included: ■ ■ ■ ■ ■ ■

health records for young people were not received from the placing authorities incomplete and poor health information was recorded on those received temporary registration with the GP prevented the transfer of health records no procedures for the transfer of health information when the young person was discharged little or no opportunity for health promotion health information was not shared in care reviews.

The framework of Healthy Care, alongside already established partnership working, has enabled new work to be taken forward. Funding has been agreed for a nurse to be based onsite at Eastmoor 15 hours per week. The role will include: ■ conducting holistic health needs assessments and producing individual health plans ■ responding to identified health needs including immunisations and administering medications ■ sharing health needs with relevant agencies and ensuring that they are met ■ facilitating/participating in the provision of health promotion to young people and their carers ■ establishing and maintaining strong links with a local GP and, in cooperation with the young people, using the GP services as appropriate ■ developing innovative approaches including the involvement of other agencies to improve the health experience of the young people ■ offering training and support to the staff.


Audit and action planning cycle 29

Figure 6.5

Case study from North Tyneside Healthy Care Partnership North Tyneside Primary Care Trust working within their Healthy Care Partnership, funded Healthy Care Health Promotion Training for all foster carers and residential social workers in North Tyneside. A train-the-trainers course was provided by the National Children’s Bureau’s Healthy Care Programme. A range of multidisciplinary professionals participated including a paediatrician, looked after children’s nurse, health visitor and health promotion specialist as well as carers and residential social workers. The two-day course focused on the training needs of foster carers and residential social workers and provided information, attitudes and skills training. It was co-facilitated with a foster carer/trainer from another region. Course participants commented the course was ‘thought provoking and useful’ and ‘interesting and practical’. Carers who participated on the course are now being supported to take up further education college training for adults without a teaching qualification, so developing their skills as trainers. The Healthy Care Partnership is now developing the programme to involve other social care and children’s services practitioners.

Figure 6.6

Case study from Lincolnshire Healthy Care Partnership Lincolnshire has reviewed its strategic training policy for foster carers and staff supporting young people in residential and foster care. Healthy Care is now embedded in training provision. A modular training programme has been developed by two healthcare workers who are part of the Healthy Care Partnership. The module covers: 1. 2. 3. 4. 5. 6. 7. 8.

Induction Looking after children for the local authority Health and safety Our needs and the needs of children and young people Child protection Disability Adolescent care Mental health and well-being.

Foster carers will soon be able to undertake modules using a CD-ROM. In addition a drama production by looked after young people that describes the life of a looked after child and young person through their eyes will be available as a DVD to be used as a training resource for foster carers and residential social workers.


30 Healthy Care Programme Handbook

Resources to help undertake audits and develop action plans The Healthy Care Audit Tool (see Appendix 2) provides a detailed breakdown of individual outcomes and potential evidence to support the National Healthy Care Standard outcomes. The Healthy Care: Policy Framework document (www.ncb.org.uk/healthycare) provides details of policies, initiatives, performance indicators and targets across a range of sectors. It will be useful for managers, strategic planners and Healthy Care lead officers. It identifies how work on healthy care can contribute to progress across a range of policy areas and places healthy care firmly within local policy frameworks. The Healthy Care Action Planning Tool (see Appendix 3) is an outline document of how to record and track healthy care action. Briefing papers on looked after children and young people and mental health and emotional well-being, sexual health, substance misuse, healthy eating and physical activity, and play and creativity are available on the Healthy Care Programme website (www.ncb.org.uk/healthycare). Examples of healthy care work on these themes can be found in Chapter 7 of this handbook. A forthcoming briefing paper for primary care trusts on how the National Healthy Care Standard contributes to the five outcomes of Every Child Matters (HM Treasury 2003) will be available on the Healthy Care Programme website. Also, leaflets about healthy care for children and young people, and a leaflet for carers are available from: www.dfes.gov.uk/qualityprotects (search under Work Programme then Health Issues).


Examples of Healthy Care Programme Work This section provides a summary of how Healthy Care Partnerships have used the Healthy Care Audit and Action Plan to demonstrate their work on the themes of: ■ ■ ■ ■ ■

mental health and emotional well-being (see page 32); sexual health (see page 33); substance misuse (see page 34); healthy eating and physical activity (see page 35); play and creativity (see page 36).

More information on these themes is provided in the Healthy Care briefings available from www.ncb.org.uk/healthycare. The following examples show the range of approaches to this work across National Healthy Care Standard areas for action of: ■ ■ ■ ■

policy partnership practice participation.

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32 Healthy Care Programme Handbook

Mental health and emotional well-being These examples show how Healthy Care Partnerships are promoting looked after children and young people’s mental health and emotional well-being across the National Healthy Care Standard action areas.

Policy

■ Local polices relating to mental health specifically include responding to the needs of looked after children and young people. ■ Relevant local policies about looked after children and young people include mental health and well-being. ■ A local policy decision resulted in all foster families, children and young people being given a card for reduced rate access to leisure, fitness and cultural activities. This is based on evidence that involvement in physical activity and other community activities enhances well-being and promotes social inclusion.

Partnership

■ A youth worker for looked after young people encourages and supports them to use mainstream youth, arts, sports and leisure provision. The project is a partnership between the youth service, the PCT and social services. ■ Preventive mental health teams are working with carers and professionals to train and support them in their understanding of looked after children’s mental and emotional well-being. ■ An ‘Arts in Health’ project is working with vulnerable young people in partnership with local organisations and includes a visual arts project for care leavers. Outcomes for the young people to date include: strengthening resilience, greater self-esteem, and better ability to make and sustain relationships, and it has stopped bullying.

Practice

■ A community therapist has been appointed under the CAMHS strategy to work

exclusively with the carers of looked after children. This includes running workshops around stress relief and anger management. All children who are being placed for adoption can be referred for play therapy to help them understand about being in care and the transition to a new, permanent home. A creative participatory music project for looked after young people in a residential home aims to improve low self-esteem. Feedback from the group has shown that members realised their musical potential, improved their self-confidence and ability to listen. A training resource for staff to promote emotional health and well-being in secure units was developed from good practice in five secure units. Training for foster carers and residential social workers includes mental health and emotional well-being.

Participation

■ Foster carers developed a folder about themselves and their home (including photographs) for children and young people to see before they came to the placement. Young people who took part in a Healthy Care consultation identified moves to new placements as distressing, said that they needed to know where they were going and suggested the folder. ■ Monitoring of a specialist CAMHS has been introduced and includes feedback from looked after children and young people using the service. This is informing the development and improvement of the service.


Examples of Healthy Care Programme Work 33

Sexual health These examples show how Healthy Care Partnerships are promoting looked after children and young people’s sexual health across the National Healthy Care Standard action areas.

Policy

■ The development of a local sexual health policy has included partnership working, consultation with young people, needs assessment, involving parents and carers, practice issues and outcomes. ■ Local polices relating to sexual health and sex and relationships education (SRE) specifically include looked after children and young people and acknowledge their right to SRE (for example the local teenage pregnancy strategy and the local preventive strategy).

Partnership

■ A youth worker for looked after young people has been trained in condom distribution. ■ A young mother’s supported housing unit includes young women leaving care or who have been looked after and links with leaving care teams and looked after children’s nurses. ■ A joint project has been developed between the youth service and link nurses for looked after children and young people to deliver SRE and involve young people as peer educators.

Practice

■ An outreach sexual health worker for looked after young people offers group work (such as a young women’s group) and individual work on sex and relationships. ■ Leaving care staff have been trained by a local sexual health project so that they can offer sexual health advice directly. Workers from the project attend young people’s Drop-ins to provide direct access to advice and free condoms. ■ Leaving care staff are preparing young people to care for themselves after they have left care and for example provide sensitive support to young people to use sexual health services independently. ■ Telephone numbers of helplines and details of local young people’s sexual health clinics are displayed in residential homes for young people. Staff explain how helplines work, and make sure that young people can obtain confidential help.

Participation

■ Support services have been developed for young parents who are looked after and care leavers. They aim to enable them to develop parenting skills and encourage them to return to education. ■ A leaflet on sexual health and local services for looked after young people was produced by a sexual health task group of looked after young people aged 13 to 18 years.


34 Healthy Care Programme Handbook

Substance misuse These examples show how Healthy Care Partnerships are promoting substance misuse education for looked after children and young people across the National Healthy Care Standard action areas.

Policy

Practice

Partnership

Participation

■ A drug education and support policy was developed for the looked after children’s service. Carers and children contributed to its development and dissemination. A young people’s version was also produced and distributed. ■ Alcohol and drug education for looked after children and young people is specifically included in the local young people’s substance misuse plans. ■ Local protocols are in place to introduce screening tools to assess looked after young people’s vulnerability and substance misuse. ■ Drug and alcohol action teams are part of Healthy Care Partnerships. ■ Youth workers and care staff work together to provide alcohol and drug education in residential children’s homes. ■ A substance misuse policy for all children and young people was produced by a partnership of all agencies delivering children’s services. Training about the policy was provided for staff across all services.

■ Training in alcohol and drug education is provided for foster carers, residential care staff, mentors, social workers and looked after children’s nurses. ■ A drug education and support worker has been appointed to work with looked after young people with problematic substance misuse. ■ Health assessments for some young people are carried out by the looked after children’s nurse and include sensitive discussions of alcohol, smoking and other drugs and whether there is a need for informal education or other support. ■ A survey into volatile substance abuse was carried out by looked after young people that identified levels of knowledge and ideas about improving education and support. ■ Looked after young people took part in drama workshops, devised a play about what can happen to young people leaving home and included problems with alcohol and substance misuse for young people. ■ A music recording and training project is working with looked after young people, and produced a CD for young people that used music to educate about alcohol and substance misuse. The young people gained professional recording skills and knowledge about drugs.


Examples of Healthy Care Programme Work 35

Healthy eating and physical activity These examples show how Healthy Care Partnerships are promoting healthy eating and physical activity for looked after children and young people across the National Healthy Care Standard action areas.

Policy

■ Outcomes about healthy diet and opportunities for physical activity are written into the local children and young people’s preventive plan. ■ A policy on healthy eating and drinking has been developed for residential children’s homes.

Partnership

■ Health assessments are held in local leisure centres. Young people can drop in to see the nurse or doctor as well as take part in arts and leisure activities including using the swimming pool and fitness centre. ■ A community dietician works with staff and young people in children’s homes. Young people’s involvement has included designing a new kitchen for their residential home and learning about budgeting, shopping and cooking.

Practice

■ A Healthy Care health promotion training course for foster carers on healthy eating and drinking and nutrition for families was delivered locally by multi-agency partners. ■ A leisure and fun coordinator was appointed to ensure looked after children could access leisure activities including physical activities. ■ Height and weight is discussed sensitively at health assessments plus healthy diet and physical activity. Rapid weight loss or gain is followed up. ■ Residential care staff have been trained in community sports award leadership to support and encourage more involvement in physical activity.

■ Fresh fruit and vegetables, water and healthy snacks are freely available in residential children’s homes. ■ Carers and staff ensure that meals reflect the heritage and cultural preferences of children and young people.

Participation

■ Looked after young people have helped to organise ‘Cook and Eat’ groups designed to develop cooking skills and knowledge about healthy eating and drinking. ■ A young mother’s group which includes young care leavers, supports and encourages breast-feeding and teaches how to budget and cook healthy meals. ■ Children and young people are supported and encouraged to participate in physical activities of their choice (for example by ensuring play/sports equipment is available, making sure they can attend regularly and carers showing pride in the child/young person’s efforts and achievements). ■ Young people were consulted on the contents of a draft health guidance file for staff and carers that included issues such as healthy eating and physical activity. A care leaver was employed to run the consultation and developed a questionnaire and quiz. This resulted in a relevant guidance file as well as young people being more interested in health topics.


36 Healthy Care Programme Handbook

Play and creativity These examples show how Healthy Care Partnerships are promoting play and creativity for looked after children and young people across the National Healthy Care Standard action areas.

Policy

■ Ensuring local polices relating to play, arts, culture and education specifically include looked after children and young people (for example the local cultural strategy). ■ A regional group has been established to focus on looked after children and young people and creativity. The group ensures strategic development, provides networking opportunities and shares learning across the region. ■ A DfES funded pilot project – Out of School Hours Learning – will identify what works in encouraging looked after children to get involved in out of school activities.

Partnership

■ A leisure and fun coordinator has been appointed to support and encourage looked after children and young people to engage in leisure activities of their choice and support foster carers to make this happen. ■ A youth worker and a Connexions advisor for looked after young people encourage and support young people to use mainstream leisure and youth provision. ■ A weekly leisure club for looked after children and young people has been organised by a partnership of education, social services, leisure and community services plus the local museums and arts services and many others. Looked after young people are supported to join mainstream provision but also remain in contact with the club.

Practice

■ A drama project for looked after young people is promoting well-being by helping children express themselves. This is leading to increased confidence and stronger communication skills. Some young people

have developed their interests further by joining mainstream activities. ■ Looked after children have access to play therapy services if required. ■ Permission for looked after children and young people to attend outings and visits is arranged at the beginning of a placement for all visits so that this does not stop children participating in school or other leisure activities. ■ A music project for looked after young people ended with a public performance. The young people developed skills in lyric writing, rapping, music mixing, video and other production skills, learned to work together and gained confidence and pride in their abilities and achievements.

Participation

■ Care plans for children include information about their interests and leisure time preferences. The children and young people are involved in updating this regularly. ■ ‘Make it happen’ – a range of creative activities were organised for looked after children who were considered to be most vulnerable and needing extra support. Professional assistants worked with artists and sports workers to help the children get the most out of it. ■ A ‘Quiz’ is used to audit the leisure and fun needs of all looked after children and young people aged 5 to 13. Individual plans are devised from the results. A regular evening activity session is provided for children who want to attend and where they can meet and play with siblings. ■ Carers Can! (a magazine for carers and staff) includes play and creative activities that have been tried and tested by carers. The activities are suitable for the whole family and for groups of children and young people.


Support and further resources for Healthy Care Partnerships The national Healthy Care network offers support and links to other Healthy Care Partnerships in the regions, sharing good practice, and facilitating cooperation and joint working between partnerships. More information about how to access the Healthy Care network can be found at: www.ncb.org.uk/healthycare Regional development staff at government offices in the regions have provided support to develop Healthy Care Partnerships and regional support structures. This work has been coordinated by the regional development worker and regional public health leads for children and young people. Further resources to support the Healthy Care Programme are also available: ■ www.dfes.gov.uk/qualityprotects (search under Work Programme then Health Issues) includes information about the programme and links to leaflets about healthy care for children and young people, and a leaflet for carers. ■ www.ncb.org.uk/healthycare includes briefing papers on key topics such as: substance misuse, healthy eating and physical activity, mental health, play and creativity, and sexual health; a briefing on healthy care for primary care trusts (forthcoming) and Carers Can!, a magazine for carers on play and creativity. ■ Healthy Care Training Manual: a health promotion training programme for foster carers and residential social workers (NCB 2005) has been developed. It includes background information, trainers notes and resources for a two-day course and is available from the National Children’s Bureau (8 Wakley Street, London EC1V 7QE; telephone 020 7843 6000). ■ Improving the emotional health and well-being of young people in secure care: training for staff in local authority secure children’s homes by J. Bird and L. Gerlach (2005) and is available from the National Children’s Bureau (8 Wakley Street, London EC1V 7QE; telephone 020 7843 6000). ■ Healthy care leaflets for children and young people (Staying Healthy, Feeling Good: A Young Person’s Guide, ref: DfES/0528/2004), and for foster carers and residential social workers (Healthy Care, ref:DfES/0850/2004) can be ordered from DfES Publications (PO Box 5050,Sherwood Park, Annesley, Nottingham NG15 0DJ; telephone 0845 6022260; fax 0845 6033360; email dfes@prolog.uk.com).

8


The National Healthy Care Standard: entitlements and outcomes

APPENDIX

1

The National Healthy Care Standard helps looked after children and young people achieve the five outcomes described in Every Child Matters (HM Treasury 2003): ■ ■ ■ ■ ■

be healthy; stay safe; enjoy and achieve; make a positive contribution; and achieve economic well-being.

The National Healthy Care Standard Children and young people in a healthy care environment will: ■ experience a genuinely caring, consistent, stable and secure relationship with at least one committed, trained, experienced and supported carer; ■ live in an environment that promotes health and well-being within the wider community; ■ have opportunities to develop the personal and social skills to care for their health and well-being now and in the future; and ■ receive effective healthcare, assessment, treatment and support.

The standard identifies the entitlements and outcomes required for a healthy care environment: 1. A child/young person will feel safe, protected and valued in a strong, sustained and committed relationship with at least one carer. Outcome 1(a): The child/young person is given an opportunity to make safe, protective, caring and continuing relationship(s) with his/her carer(s) and believes that there is at least one person who is interested in him/her and cares for and about his/her health and wellbeing. Outcome 1(b): The child/young person develops a sense of self-worth and is positive and self-directed in relation to the choices and challenges of everyday life. 2. A child/young person will live in a caring, healthy and learning environment. Outcome 2(a): The child/young person is provided with a safe, secure, caring and stimulating environment, where he/she can develop and achieve his/her physical, emotional, educational and spiritual potential.


40 Healthy Care Programme Handbook

The National Healthy Care Standard continued

Outcome 2(b): The child’s carers are supported, trained and adequately resourced to provide for the healthy development of children/young people who are in their care and protection. Outcome 2(c): The child/young person has a range of sustained positive relationships with family, friends and the community. 3. A child/young person will feel respected and supported in his/her cultural beliefs and personal identity. Outcome 3(a): The child/young person has a clear and positive understanding of his/her cultural beliefs and identity; these are respected and there are opportunities to celebrate them. Outcome 3(b): The child/young person will understand and have skills and confidence to develop appropriate personal and social boundaries and respect those of others. 4. A child/young person will have access to effective healthcare, assessment, treatment and support. Outcome 4: The child/young person is able to access effective healthcare to enable his/her health to be promoted, maintained and treated. 5. A child/young person will have opportunities to develop personal and social skills, talents and abilities and spend time in freely chosen play, culture and leisure activities. Outcome 5(a): The child/young person is knowledgeable, emotionally resourceful and is able to use his/her own emotions and thinking skills to guide and manage his/her positive behaviour using a variety of strategies. Outcome 5(b): The child/young person achieves his/her potential and is proud of his/her achievements. 6. A child/young person will be prepared for leaving care by being supported to care and provide for him/herself in the future. Outcome 6(a): The child/young person will develop understanding of his/her needs and responsibility for maintaining his/her health and well-being. Outcome 6(b): The child/young person has the knowledge, skills, values and attitudes to keep him/herself safe, to prepare for adult life and to play a part in creating a healthy, safe community. Outcome 6(c): The child/young person is supported adequately through childhood into adulthood.


APPENDIX

Healthy Care Audit Tool This audit tool accompanies the National Healthy Care Standard and provides a detailed breakdown of individual outcomes for each of the national Healthy Care Standard entitlements and outcomes. It identifies the evidence that will demonstrate achievement of these outcomes and the delivery of healthy care for looked after children and young people. It focuses on the four action areas of: ■ policy and partnership, which focus on the management, strategic and planning responsibilities of an agency ■ participation and practice, which focus on the work carried out to ensure children and young people’s ownership and participation in healthy care and the direct practice of carers and workers from all agencies involved. The audit tool assists Healthy Care Partnerships to audit their services thus identifying gaps, areas for development and good practice. It provides a basic template and Healthy Care Partnerships may add to it in the course of their audits as they identify progress, build on good practice and other local developments.

2


continued

2. The child/young person is able to express his/her own views and wishes concerning family relationships and contact, and these are taken into account.

Participation 1. Participation of parents and family and carer is promoted throughout all the systems and structures of the corporate parent.

2. Multi-agency partnerships, the local strategic partnership for children and young people, children’s trusts and other strategic partnerships should ensure polices are in place to enable the child/young person and his/her parent/carer to have a consistent and caring relationship.

Partnership 1. Multi-agency partnerships, the local strategic partnership for children and young people, children’s trusts and other strategic partnerships should ensure polices are in place to develop improved health and well-being for looked after children and young people.

Policy 1. Policies and practices are in place to encourage stable placements and care planning within his/her own family or in care placement.

Evidence

Evidence to date

Action Points

Priority

Outcome 1a: The child/young person is given an opportunity to make a safe, protective, caring and continuing relationship(s) with his/her carer(s) and believes that there is at least one person who is interested in him/her and cares for and about his/her health and well-being.

National Healthy Care Standard Audit Tool

42 Healthy Care Programme Handbook


4. Each child/young person’s family and social relationships help to promote a sense of self, attachment, belonging and identity.

3. Moves are minimised to prevent disruption to these attachments and relationships.

2. The child/young person’s care plan reflects their need for stability, permanence and protection and the opportunity to make significant attachments and relationships.

Practice 1. The child/young person has a consistent, caring relationship with a named carer(s)/parent(s).

Evidence

Evidence to date

Action Points

Priority

Appendix 2: Healthy Care Audit Tool 43


3. The child/young person’s care, family and social relationships help to promote a positive sense of self, attachment, belonging and identity.

2. Carers show consistent care, love and respect for the child/young person.

Practice 1. Carers prepare the child/young person for increased responsibility and help them to gain skills in decision-making.

Participation 1. Learning and development opportunities assist the child/young person in developing resilience, self-efficacy, and self-esteem.

Partnership 1. Corporate parents must ensure that their policies and practice involves and empowers children and young people.

Policy 1. Policies ensure that the child/young person is involved and empowered through participation in decisions about his/her care.

Evidence

Evidence to date

Action Points

Priority

Outcome 1b: The child/young person develops a sense of self-worth and is positive and self-directed in relation to the choices and challenges of everyday life.

National Healthy Care Standard Audit Tool

44 Healthy Care Programme Handbook


continued

Participation 1. The care setting has sufficient diverse resources that engage the child/young person in understanding their health needs and to support them to take appropriate responsibility for their own health and well-being.

Partnership 1. Multi-agency partnerships, local strategic partnerships (and contributory plans and mechanisms) and children’s trusts demonstrate joint working and joint responsibility for the safe care and improved health and well-being of looked after children and young people.

2. Evidence that the chief executives and elected members of local authorities, children’s trusts safeguarding boards, and primary care trusts promote joint working and accept their statutory responsibilities as corporate parents.

Policy 1. Evidence of adherence to national minimum standards for children’s homes, and other residential services, adoption and fostering service regulations and standards.

Evidence

Evidence to date

Action Points

Priority

Outcome 2a: The child/young person is provided with a safe, secure, caring and stimulating environment, where she/he can develop and achieve his/her physical, emotional, educational and spiritual potential.

National Healthy Care Standard Audit Tool

Appendix 2: Healthy Care Audit Tool 45


5. Carer/parent provides a stimulating and supportive environment to enable the achievement of good outcomes.

4. The Personal Education Plan reflects the educational needs of the individual child/young person and puts a plan in place to meet those needs.

3. Carer/parent actively promotes the child/young person’s education and development.

2. Carer/parent provides a nurturing environment to enable the development of health and well-being.

Practice 1. The health plan identifies the needs of the individual child/young person and the services to be provided to meet those needs.

Evidence

Evidence to date

Action Points

Priority

46 Healthy Care Programme Handbook


continued

Participation 1. Carers and multi-agency staff are provided with good quality training, support and resources to enable them to understand the development needs of children and young people and the part they play in ensuring that these needs are recognised and met.

2. Multidisciplinary training, supervision and support are provided for all staff, carers and volunteers promoting the health and well-being of looked after children and young people.

Partnership 1. Corporate parents and agencies with responsibility for delivering improved outcomes to ensure that carers/volunteers and professional staff are provided with and take up training and development opportunities to understand, identify and promote health and well-being.

Policy 1. There is a training and staff development plan in place for carers, staff and managers, which links to a recruitment, reward, and retention policy and plan.

Evidence

Evidence to date

Action Points

Priority

Outcome 2b: The child/young person’s carers are supported, trained and adequately resourced to provide for the healthy development of children and young people who are in their care and protection.

National Healthy Care Standard Audit Tool

Appendix 2: Healthy Care Audit Tool 47


3. Carers have a comprehensive understanding of the emotional needs of looked after children/young people, and the skills and resources to address these.

2. All involved in the child/young person’s care understand the diverse needs of looked after children and young people, and have the skills and resources to meet them.

Practice 1. Carers have an understanding of child protection and child/adolescent development.

Evidence

Evidence to date

Action Points

Priority

48 Healthy Care Programme Handbook


continued

5. There are fora in place that enable children and young people to contribute and participate, and they are supported in this.

4. There are training and support schemes to enable young people to develop advocacy skills.

3. Confidential services are available and accessible.

2. Opportunities exist for children and young people to meet other looked after children/young people and their siblings.

Participation 1. Opportunities exist for children and young people to participate in community activities.

2. Community partnerships provide a safe environment and opportunities for the child/young person to grow and develop.

Partnership 1. Mentoring, independent visitor, advocacy schemes are available.

Policy 1. Local plans contain positive inclusion strategies and services for looked after children and young people.

Evidence

Evidence to date

Action Points

Outcome 2c: The child/young person has a range of sustained positive relationships with family, friends and community.

National Healthy Care Standard Audit Tool

Priority

Appendix 2: Healthy Care Audit Tool 49


4. Carers work to help the child/young person make positive relationships within the care setting and with peers.

3. Sibling relationships are supported and contact encouraged when in the child/young person’s best interests.

2. The care provided supports positive contact with significant family members, friends and community.

Practice 1. Referrals are made to independent visitor schemes, mentoring and advocacy schemes.

Evidence

Evidence to date

Action Points

Priority

50 Healthy Care Programme Handbook


2. The child/young person is helped to understand difference and diversity and is provided with strategies for managing their own and others’ discriminatory behaviour.

Practice 1. Direct work with the child/young person helps them to understand their history, identity (including gender and sexuality), culture and beliefs and promotes their self-esteem and self-efficacy.

Participation 1. The child/young person feels valued and is able to express his/her identity and this is welcomed and celebrated.

Partnership 1. Multi-agency partnerships, the local strategic partnership for children and young people, children’s trusts and other strategic partnerships ensure resources are identified and in place to meet the individual needs of children and young people.

2. Policies provide a framework for addressing and challenging discrimination and oppression.

Policy 1. Policies promote and support the child/young person’s developing sense of identity and celebrate diversity.

Evidence

Evidence to date

Action Points

Priority

Outcome 3a: The child/young person has a clear and positive understanding of his/her cultural beliefs and identity; these are respected and there are opportunities to celebrate them.

National Healthy Care Standard Audit Tool

Appendix 2: Healthy Care Audit Tool 51


2. The child/young person will know about sources of help and support and will be able to access them.

Practice 1. The child/young person is helped to understand what they are able to keep private and confidential.

Participation 1. The child/young person understands what information will be shared in meetings and conferences and that his/her views are taken into account.

Partnership 1. Information systems ensure that confidential records are kept, retained and follow the child/young person, and are accessible to those who need to see them.

Policy 1. All agencies have developed policies and protocols for sharing information that preserve the privacy and confidentiality of the child/young person within the legal framework.

Evidence

Evidence to date

Action Points

Priority

Outcome 3b: The child/young person will understand and have the skills and confidence to develop appropriate personal and social boundaries and respect those of others.

National Healthy Care Standard Audit Tool

52 Healthy Care Programme Handbook


continued

4. A strong link/advocate for looked after children is identified in the primary care trust.

3. Multidisciplinary planning, monitoring and evaluation of service delivery mechanisms are in place.

2. There is access to inclusive health services in the wider community and the development of specialist services responsive to need.

Partnership 1. All agencies participate in and develop health and health promotion policies.

2. Corporate parents ensure, through joint planning processes, that looked after children and young people have access to health services which promptly and effectively address inequalities and deficits in their earlier lives.

Policy 1. Corporate parents ensure that there is a mechanism for monitoring and aggregating the individual health needs of children and young people into the strategic plans and resource development of the individual agencies.

Evidence

Evidence to date

Action Points

Priority

Outcome 4: The child/young person is able to access effective healthcare to enable his/her health to be promoted, maintained and treated.

National Healthy Care Standard Audit Tool

Appendix 2: Healthy Care Audit Tool 53


continued

2. A holistic health assessment and plan is provided which is responsive to the child/young person’s own strengths, knowledge, wishes and interests, and encourages the child/young person to participate in and maintain his/her health and well-being.

Practice 1. Carers ensure all children and young people are registered with a GP.

4. Where a child/young person has specific treatment programmes they are given the required assistance to learn about these and take responsibility for them.

3. Health personnel listen to and value the child/young person’s views and opinions and ensure his/her informed consent.

2. The child/young person is helped to be aware of and take up universal service provision including confidential services.

Participation 1. The child/young person-held health passport includes identification of family health history.

6. All involved in the care and education of the child/young person are aware of the health and care plans, and support these in their interactions and work with the child/young person.

5. Designated health practitioners and a named social services person ensuring delivery of health promotion services.

Evidence

Evidence to date

Action Points

Priority

54 Healthy Care Programme Handbook


8. Carers, through good modelling, prepare the child/young person for increased responsibility and teach good health care, how to seek information (to inform their decisions) and how to make decisions.

7. Carers ensure that immunisations are up to date.

6. Carers ensure all children/young people attend sight, hearing and development checks.

5. Carers arrange for dental checks and support children/young people to attend.

4. These plans are reviewed regularly to ensure they complement each other and new actions are put in place as appropriate.

3. Each child/young person’s health plan links with their personal education plan, individual education plan and any other educational plans, including the plan for permanence and the review.

Evidence

Evidence to date

Action Points

Priority

Appendix 2: Healthy Care Audit Tool 55


continued

2. The educational setting promotes the emotional health and well-being of the child/young person through positive interactions and strategies.

Partnership 1. Multi-agency partnerships, the local strategic partnership for children and young people, children’s trusts and other strategic partnerships and CAMHS are responsive to the developing mental and emotional needs of looked after children and young people, and assist their carers, families and other workers in meeting these needs.

3. Clear strategic linkages and delivery plans exist across the dedicated looked after children services – such as CAMHS looked after children dedicated service, Education Protects team and health needs assessment team. This is coordinated through a multi-agency looked after partnership and linked to the children and young people’s strategic partnership, children’s trust or relevant multi-agency looked after partnership.

2. Behaviour support policy and plans are in place to support the needs of looked after children and young people.

Policy 1. Multi-agency CAMHS strategy is in place that meets the identified needs of looked after children and young people.

Evidence

Evidence to date

Action Points

Priority

Outcome 5a: The child/young person is knowledgeable, emotionally resourceful and is able to use his/her own emotions and thinking skills to guide and manage his/her positive behaviour using a variety of strategies.

National Healthy Care Standard Audit Tool

56 Healthy Care Programme Handbook


2. The child/young person experiences positive parenting, which includes praise and reward.

Practice 1. Carers encourage and provide different opportunities for the safe expression of emotions, and the child/young person receives comfort.

2. Personal and social education in the education and care settings supports the child/young person in learning how to develop positive peer relationships.

Participation 1. The child/young person is provided with opportunities to understand his/her behaviour and emotions, and those of others.

Evidence

Evidence to date

Action Points

Priority

Appendix 2: Healthy Care Audit Tool 57


continued

2. Funding and other resources are available to support hobbies and interests of looked after children and young people.

Partnership 1. Resources are in place to ensure that each child/young person continues to achieve their potential and develop new interests and skills.

4. Corporate parents have policies and systems in place for prioritising employment opportunities for looked after children, in their own organisations as well as other business sectors.

3. Corporate parenting policy guidance and training is in place for school governors and elected members.

2. Admission and exclusion policies prioritise the inclusion needs of looked after children and young people.

Policy 1. Education, arts, culture and leisure policies promote the needs of looked after children and young people and ensure access to appropriate universal and specialist services.

Evidence

Evidence to date

Outcome 5b: The child/young person achieves his/her potential and is proud of his/her achievements.

National Healthy Care Standard Audit Tool

Action Points

Priority

58 Healthy Care Programme Handbook


continued

4. Emotional well-being and educational achievement are perceived by carers/parents as linked issues, and resources are available to support both.

3. Carers/parents are supported and trained to assist children/young people’s educational development.

2. Carers promote and are involved in each child’s education and their progress, setting high, but realistic, expectations for them.

Practice 1. The child/young person is provided with opportunities for creative activities and play.

3. The child/young person is given opportunities to develop skills to express wishes and feelings.

2. The child/young person has choices and opportunities to explore a range of sports and leisure activities and develop her/his talents and potential.

Participation 1. The child/young person is supported to achieve her/his potential and has a record of achievements and qualifications.

3. Corporate parents ensure that a range of play, arts, sports, and leisure activities are made available for looked after children and young people. Corporate parents are aware that emotional well-being and educational achievement are linked issues, and resources are available to support both.

Evidence

Evidence to date

Action Points

Priority

Appendix 2: Healthy Care Audit Tool 59


8. Carers are proactive in providing stimulation for the child’s development.

7. Corporate parents and carers provide opportunities for celebrating children/young people’s achievements.

6. The carer knows about and takes an interest in the child/young person’s activities.

5. Carers provide opportunities for the child/young person to develop existing and new skills and talents in sport, culture and arts activities.

Evidence

Evidence to date

Action Points

Priority

60 Healthy Care Programme Handbook


continued

3. Personal and social education enables the child/young person to learn about positive and safe relationships and unsafe, abusive relationships.

2. Evidence of involvement in policy-making and provision of resources and information.

Participation 1. Young people are able to demonstrate that they have the knowledge, skills, attitudes and values to keep themselves safe and to care for their health and well-being.

Partnership 1. Children’s trusts, multi-agency partnerships, the local strategic partnership for children and young people, and other strategic partnerships demonstrate evidence of joint working and joint policies.

Policy 1. The policies of social services, education, health and leisure services are coordinated to enable the young person to develop and maintain good health and well-being including young people in out of authority placements.

Evidence

Evidence to date

Action Points

Priority

Outcome 6a: The young person will develop understanding of his/her needs and responsibility for maintaining his/her health and well-being.

National Healthy Care Standard Audit Tool

Appendix 2: Healthy Care Audit Tool 61


2. Relevant materials are provided for the health education of looked after children/young people.

Participation 1. Children and young people show an understanding of healthy lifestyles, and managing health risks and gains.

Evidence

Evidence to date

Action Points

Priority

62 Healthy Care Programme Handbook


2. Continuing assessment and review of the young person’s needs is carried out to ensure the pathway plan is met.

Practice 1. Carers, practitioners and corporate parents provide opportunities for developing skills for independent living throughout the child/young person’s life and identify suitable support during transition to independent living.

2. A care plan/pathway plan is drawn up which increasingly places responsibility on the child/young person for meeting her/his own health needs as appropriate to her/his development.

Participation 1. Preparation for leaving care is available to all care leavers.

Partnership 1. Multidisciplinary partnerships are in place to ensure access to housing resources, benefits and education and training.

Policy 1. Policies and resources are in place to meet the needs of care leavers in accordance with their pathway plans. This includes support while in further education, training or employment or at university.

Evidence

Evidence to date

Action Points

Priority

Outcome 6b: The child/young person has the knowledge, skills, values and attitudes to keep him/herself safe, to prepare for adult life and to play a part in creating a healthy, safe community.

National Healthy Care Standard Audit Tool

Appendix 2: Healthy Care Audit Tool 63


2. Support and resources are in place to enable young people to continue with education, training and employment.

Practice 1. Support is available for care leavers who become young parents.

Participation 1. All care leavers have a pathway plan that they have participated in compiling and which addresses their short and long term needs.

Partnership 1. Multi-agency partnerships are in place which enable access to support and other agency services for care leavers.

3. Corporate parents have policies in place that reflect their eventual role as corporate grandparents.

2. Policies and resources are in place to support further education and training, employment and university admissions. Ongoing support is available to those care leavers while living away at university or college.

Policy 1. Strategies covering leaving care and transition into adulthood exist, and these integrate children and adult services and provision ensuring a smooth pathway.

Evidence

Evidence to date

Outcome 6c: The child/young person is supported adequately through childhood into adulthood.

National Healthy Care Standard Audit Tool

Action Points

Priority

64 Healthy Care Programme Handbook


APPENDIX

Healthy Care Action Planning Tool Use the template on the next page to identify individual actions to include in the Action Plan. The template is also available electronically at www.ncb.org.uk/healthycare

3


What do you want to change?

Outcome:

Practice:

Participation:

Partnership:

Policy:

Action needed

By whom?

Healthy Care Action Planning Tool

By when?

How will children know when you have done it? What will be the difference for them?

66 Healthy Care Programme Handbook


References Arcelus, J and others (1999) ‘A mental health service for young people in the care of the local authority’, Clinical Child Psychology and Psychiatry, 4, 4, 233–45. Bamford, F and Wolkind, S (1988) The Physical and Mental Health of Children in Care. Swindon: Economic and Social Research Council. Biehal, N and others (1992) Prepared for Living? A survey of young people leaving the care of three local authorities. London: National Children’s Bureau. Biehal, N and others (1995) Moving On: Young people and leaving care schemes. The Stationery Office. Bird, J and Gerlach, L (2005) Improving the Emotional Health and Wellbeing of Young People in Secure Care: Training for staff in local authority secure children’s homes. London: National Children’s Bureau. Broad, B (1999) ‘Improving the health of children and young people leaving care’, Journal of Adoption and Fostering, 23, 1, 40–48. Broad, B (2005) Improving the health and well-being of young people leaving care. Dorset: Russell House Publishing. Brodie, I and others (1997) ‘The health of children looked after by local authorities’, British Journal of Nursing, 6, 7, 386–91. Buchanan, A (1999) ‘Are care leavers significantly dissatisfied and depressed in adult life?’, Journal of Adoption and Fostering, 23, 4, 35–40. Butler, I and Payne, H (1997) ‘The health of children looked after by local authorities’, Journal of Adoption and Fostering, 21, 2, 28–35. Chambers, H and others (2002) Healthy Care. London: National Children’s Bureau. Children’s Rights Officers and Advocates (2000) Total Respect: training pack. London: Children’s Right’s Officers and Advocates.

Choosing Health: making healthy choices easier (2004) The Stationery Office. Corlyon, J and McGuire, C (1997) Young Parents in Public Care: Pregnancy and parenthood among young people looked after by local authorities. London: National Children’s Bureau.


68 Healthy Care Programme Handbook

Department for Education and Skills/National Statistics (2004) Statistics of Education: outcome indicators for looked after children: Twelve months to 30 September 2003. England. The Stationery Office.

The Children Act (2004) The Stationery Office. Department of Health (1997) Substance Misuse and Young People. London: Department of Health. Department of Health (2002) Promoting the Health of Looked After Children. The Stationery Office. Department of Health (2004) National Service Framework for Children, Young People and Maternity Services. The Stationery Office. Dimigen, G and others (1999) ‘Psychiatric disorder among children at time of entering local authority care: Questionnaire survey’, British Medical Journal, 319, 675. HM Treasury (2003) Every Child Matters. The Stationery Office. Howell, S (2001) ‘The Health of Looked After Children’, Highlight, 184. London: National Children’s Bureau. Lincolnshire Healthy Care Partnership (2004) Voices. Unpublished. Mather, M (2000) ‘Health Issues for Black and Minority Ethnic Children’. Journal of Adoption and Fostering, 24, 1, 68-70. Mather, M and others (1997) ‘The statutory medical and health needs of looked after children: Time for a radical review?’ Journal of Adoption and Fostering, 21, 2 36–40. McCann, J and others (1996) ‘Prevalence of psychiatric disorders in young people in the care system’, British Medical Journal, 313, 7071, 1529–30. Meltzer and others (2003) The Mental Health of Young People Looked After by Local Authorities in England. Office of National Statistics. The Stationery Office. Morris, J (1995) Gone Missing: A research and policy review of disabled children living away from their families. London: Who Cares? Trust. Morris, J (1999) Hurtling into a void: Transition to adulthood for young disabled people with ‘complex health and support needs’. Brighton: Pavilion.


References 69

National Children’s Bureau (2004a) Learning from the Standard: Using creative participation with children and young people. http://www.ncb.org.uk/healthycare/docs.asp (accessed 12 November 2004). National Children’s Bureau (2004b) Learning from the Standard: Using drama to consult with children and young people. http://www.ncb.org.uk/healthycare/docs.asp (accessed 12 November 2004). National Children’s Bureau (2005) Healthy Care: a health promotion training programme for foster carers and residential social workers. London: National Children’s Bureau. Richardson, J and Joughin, C (2000) Mental Health Needs of Looked After Children. London: Gaskell. Shaw, C (1998) Remember My Messages. London: Who Cares? Trust. Skuse, T and Ward, H (1999) Current Research Findings About the Health of Looked After Children. Paper for Quality Protects seminar: Improving health outcomes for looked after children. Dartington Social Research Unit and Loughborough University. Skuse, T and others (2001) Looking After Children: Transforming data into management information. Report of a longitudinal study at 30/9/99, third interim report to the Department of Health. Loughborough: Loughborough University. Williams, J and others (2001) ‘Case-control study of the health of those looked after by local authorities’, Archives of Disease in Childhood, 85, 280–85.


Healthy Care Programme - Handbook  

The Healthy Care Programme Handbook provides information about the DfES funded National Children's Bureau (NCB) Healthy Care Programme - an...

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