Health and wellbeing of children looked after

‘Looked After Child’ is a generic term introduced in the Children act 1989. This describes children and young people subject to care orders (placed into care of Local Authorities by order of a court) and children accommodated under Section 20 (voluntary) of the Children Act 1989. Looked After Children may live within foster homes, residential placements or with family members (connected carers). In Calderdale, children and young people who are in care have told us that they prefer the term children looked after (CLA), so that is the term we use locally.

Under the Children Act 1989, a child is legally defined as ‘looked after’ by a local authority if he or she:

  • is provided with accommodation continuously for a period of 24 hours;
  • is subject to a care order; or
  • is subject to a placement order.

Most children become looked after as a result of abuse and neglect. Although they have many of the same health issues as their peers, the extent of these is often greater because of their past experiences. For example, almost half of children in care have a diagnosable mental health disorder and two-thirds have special educational needs. Delays in identifying and meeting their emotional wellbeing and mental health needs can have far reaching effects on all aspects of their lives, including their chances of reaching their potential and leading happy and healthy lives as adults (Department of Health and Department for Education, 2016).

CLA are more likely to go missing than children and young people who are not in a care setting. This can be both an indicator of need (eg a young people going missing from care because they are in distress in their care setting) and a cause of further risk (eg young people being more likely to be at risk of child sexual exploitation (CSE) when out at night, without carers).

The Department for Education publish annual statistics on the characteristics of CLA, both at national and local authority Level. These provide detailed information on trends and the current picture in terms of demographics, health, and the numbers of unaccompanied asylum seekers are who are looked after. These figures are available at  Looked after children statistics .

The local picture

Local picture of children looked after

Calderdale has a population of around 208,400 with around 61,600 children and young people up to the age of 24 years (Office for National Statistics (ONS), Mid year sub national population estimates 2015 ). Approximately 12% of children and young people in Calderdale are from an ethnic minority (ONS Census 2011 Ethnic group (table QS201EW) ). At September 2016, there were 303 children who are looked after (CLA) in the care of Calderdale Council. The number of children who are looked after in the local authority is showing a steady decline, and placement stability is good with only 7.6% having three placement moves in the year to September 2016. The majority of children looked after are cared for in fostering placements with an increasing number placed with in house foster carers.

Calderdale and Huddersfield NHS foundation trust (CHFT) is the provider organisation with responsibility under the Children act 1989 to comply with requests from local authorities to help them to provide support and services to children in need. As part of their role, CHFT produce an annual Children Looked After report.

The purpose of the report is to provide an annual review of the work undertaken by the Calderdale Children looked after health team. The report identifies challenges and gaps in health provision that exist, and makes recommendations on actions for future improvement and priorities. This is a summary of the report for 2014/15:

  • during 2014/15, the Health service for children and young people looked after, and care leavers in Calderdale, provided health interventions for 45 children looked after placed in Calderdale by external local authorities. Since this report was published, a further 142 CLA were placed within Calderdale between April and November 2016. Of these, 28 have received health assessments as they are undertaken if requested by the placing authority;
  • the age range of the 126 children who were new into care in 2014/15 is:
    • 0-5 years: 44%;
    • 6-9 years: 17%;
    • 10 and above years: 39%.
  • compared to 2013-14, this represents an increase in the proportion of children over the age of 15 entering the care system;
  • during the 12 month period of the report, 126 children and young people became CLA. Of these, 77.6% had their Initial Health Assessment (IHAs) completed within a 20 working day timescale;
  • health needs analysis data identifies the following top five health needs of children and young people entering the care system:
    • squint;
    • asthma;
    • eczema;
    • dental decay;
    • speech and language delay.
  • during the 12 month period of the report, 248 CLA were entitled to have a Review Health Assessment (RHA). Of these 97.2% received a review health assessment, 98% had their teeth checked, and 96% were up to date with their immunisations. This health performance is significantly better than the national average;

A snapshot analysis of the health needs of 45 CLA in external placements (March 2016), evidenced that 30% of the cohort were receiving services to address their emotional and mental health needs. Health needs analysis data collated from Review Health Assessment (RHA) undertaken in this reporting period identifies the following top five health needs of children and young people remaining in care:

  • dental  issues;
  • speech and language delay;
  • emotional health issues;
  • sleep problems;
  • behavioural issues.

The developing Strengths and difficulties questionnaire (SDQ) pathway will, in due course, inform the RHA process;

In the quarter July to September 2016 there were 10 children and young people from within Calderdale who had 36 “missing” incidents.

Local Challenges:

  1. There are challenges when identifying Child and Adolescent Mental Health Services (CAMHS) for children placed out of area, which include additional funding issues, waiting lists and quality assurance of the CAMHS service providers in other areas;
  2. Work will continue between the Clinical Commissioning Group (CCG) (the commissioners) and Calderdale and Huddersfield foundation trust (CHFT - contracting lead) to resolve resourcing and capacity issues within the Children looked after health service to progress the service for children looked after who remain one of our most vulnerable group of children in Calderdale. This is in accordance with statutory guidance, intercollegiate framework, and accountability and assurance framework recommendations;
  3. Refine the Health Needs Analysis (HNA) database to capture health information collated through the review health assessment process, in order to produce a comprehensive HNA of the children looked after;
  4. Work with Calderdale General Practitioners (GPs) to develop robust information sharing processes to promote collaborative working.

There is a separate JSNA chapter which considers the health and wellbeing needs of Care leavers .

Inequalities

Children and young people in the United Kingdom (UK) experience inequalities in health care as highlighted in the Royal College of Nursing (RCN) briefing document ‘ Inequalities experienced by children across the UK accessing the right care, at the right time, in the right place. ’, June 2016.

Young people face plenty of challenges when preparing for adult life. For children and young people with complex physical health needs, there are many additional hurdles. In many cases, the health needs of these young people will have been met by the same people who have looked after them for as long as they can remember. However, one of the changes as they reach adulthood is the transfer to an adult environment where they may need to consult several different health teams, therapy teams, and adult social care services (Care Quality Commission, 2014).

The majority of children and young people who are looked after experience conditions of poverty and social disadvantage which are closely linked with communication difficulties. In areas of high social deprivation, between 40% and 56% of children start school with language delay (Locke et al., 2002). 

Current provision

Children Looked After Health Service

There is a specialist Children Looked After health service provided by Calderdale and Huddersfield Foundation Trust (CHFT) and commissioned by the Clinical Commissioning Group (CCG) in collaboration with the local authority.

The service covers:

  • statutory health assessments for all children looked after, both when entering care and at statutory intervals during the child or young person’s care journey;
  • clinical advice on a consultancy basis to health and social care professionals and carers, including mainstream services to better meet the needs of children looked after;
  • advising commissioners on how the needs of children looked after can be met;
  • adoption medical reports.

Children looked after access mainstream services, including services such as Child and Adolescent Mental Health Services (CAMHS) where they are identified as a specific priority group within the overall service provision.

Calderdale Therapeutic Service (CTS)

The local authority provides a specific service to children looked after via the CTS. The CTS provides a service to children and young people who are looked after, adopted or on the edge of care. The service addresses the mental health and emotional wellbeing of children and young people.

Virtual School

Another important aspect of wellbeing support is through the Virtual School service, which provides a Virtual Head to focus on the needs of children looked after within school. As well as prioritising the educational needs of children looked after, the service also looks at the holistic support available to children looked after to achieve positive outcomes, through personal education plans developed in partnership with each child looked after.

Other Support

Other wider wellbeing support includes subsidised access to sports and leisure facilities through Calderdale Council’s Passport to Leisure scheme, which is given to all children looked after by the local authority. 

User support

The Calderdale Children Looked After Strategy 2015 was written with a group of young people who are looked after by Calderdale. On health, they told us:

  • "I think the health services in Calderdale are very good because when you need them they are there very quickly."

A process is in place to collate feedback from children who are looked after following their annual Review Health Assessment (RHA). An audit was undertaken of 20 random questionnaires returned in 2014. All 20 children and young people (aged 10-18) thought the health assessment was a good idea.  The feedback from the children and young people was supportive of their health assessment process and would recommend other young people attend their health assessments.

Through Right 2 Voice and UNO (Upwards n Onwards), children and young people attend the Corporate Parenting Panel on a bi-monthly basis where they inform the Panel of issues and views important to them.  The Panel take on board their comments and act on their recommendations.  The children and young people have produced a number of posters highlighting issues pertinent to them and have written “The Pledge” for all Children Looked After which is signed up to by the whole of the Council as their corporate parents.  Further collaborative work will take place with the Right 2 Voice worker and a group of 8 - 11 year old looked after children to develop an RHA evaluation questionnaire for younger children. This will ensure that younger children have an age appropriate mechanism for sharing their views about this service.

Unmet need

There is no unmet need at present.

Projected future need

There are increasing numbers of unaccompanied asylum seeking children (11 as of November 2015) who are becoming looked after by Calderdale Council. These children and young people can have complex health needs, as well as significant barriers to accessing services. Local authorities have a duty of care to ensure that the welfare of unaccompanied asylum seeking children is met.

Calderdale has a slightly higher reported rate of domestic abuse repeat victimisation than the West Yorkshire average. Domestic abuse has an impact both on the emotional health and wellbeing of children and young people and on the number of them coming into care. 

Key considerations linked to the known evidence base (what works?)

[links??]

Statutory guidance on ‘Promoting the health and well-being of looked after children’ requires local authorities, clinical commissioning groups and NHS England to ensure that there are effective plans in place to enable looked after children aged 16 or 17 to make a smooth transition to adulthood (Department of Health and Department for Education, 2015). In 2016, a cross government strategy was published to transform support for young people leaving care (Department for Education, 2016). This strategy contains explicit detail on meeting health needs (see page 43-46).

The National Institute for Clinical Excellence (NICE) publishes public health guidelines and evidence based recommendations around looked after children (see NICE, 2015).

The Chief Medical Officer’s Annual Report 2012 (Department of Health, 2013) outlines evidence on the risk factors associated with entering care and outcomes (see Chapter 11). 

References and further information

References

All these references were accessed on 22 December 2016.

All these references were accessed on 30 January 2017.

Further information

More information on children and young people can be found in the Further resources .

Authors

Designated Children looked after nurse, Calderdale and Huddersfield NHS foundation trust (CHFT);
Commissioning team, Calderdale Council;
Team manager, Calderdale therapeutic services, Calderdale Council.

Edited by Naomi Marquis, Public Health Intelligence Officer, Public Health, Calderdale Council.

December 2016.