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Contents

1. Health Needs Assessments (HNA)
2. Individual Health Plans (IHP)

1. Health Needs Assessments (HNA)

The purpose of Health Needs Assessments is to promote children's physical and mental health and to inform the child's Individual Health Plan.

1.1 Frequency of Health Needs Assessments

Wherever possible, each child who becomes Looked After must have his or her first Health Needs Assessment completed within 28 days of first becoming Looked After - in time for the first Looked After Reviews (Procedure).

For children under five years, further Health Needs Assessments should occur at least once every six months.

For children aged five and over, further Health Needs Assessments should occur at least annually.

These are a statutory requirement for all Looked After Children and Young People up to the age of 18 years.

1.2 Arranging Health Needs Assessments

The social worker is responsible for ensuring that health needs assessments are undertaken.  They will be arranged by the child's social worker making a referral to the Administrator for the Health Team for LAC/YP.

In order for the health needs assessment to be conducted, the social worker must ensure that the consents section of the child's Placement Information Record has been completed and signed by the parent .  A copy of the health related section  must be sent with the first request for an HNA.  For all HNAs section A of the relevant BAAF HNA form should be completed by the social worker and sent to the LAC Team Administrator.

Once notice of an appointment has been received, the social worker will inform the child, parents and staff/carer of the purpose of and arrangements for the health needs assessment, and either accompany the child and parents or arrange for staff/carers to accompany the child, as appropriate.  Carers have a responsibility to encourage and assist the child/young person to attend their assessment.   Carers will be requested to complete a Strengths and Difficulties Questionnaire (SDQ; a  STATUTORY assessment of the childs emotional health and well-being). 

The child should be encouraged to take advantage of the opportunity of the health needs assessment to discuss health issues.  Where the child/young person refuses a health needs assessment, this must be recorded. There is DNA/Refusal Guidance in place. This states that a request for HNA should still be sent to the LAC Team Administrator  when due indicating the young person's wishes.  A Specialist LAC Nurse will then contact the young person to discuss this to ensure that an informed decision has been made.  They will also have a discussion with he carer/social worker to ensure any unmet health needs or opportunities for health promotion are made available despite refusal

1.3 Merging Health Needs Assessments/Health Checks

Some looked after children receive a great deal of health intervention; it may therefore be appropriate to combine review health care assessments with other necessary health checks.  For example, if a child has disabilities or a Statement of Special Educational Need (SEN) or when children are known to have complex medical needs and regularly attend hospital.   Request for HNA should still be made for the Health Assessment in the usual way.  The Health Team for LAC will endeavour to avoid duplication of assessments and ensure that an Individual Health Plan is produced

1.4 Black and minority ethnic children

Black and minority ethnic children can suffer considerable health disadvantage

They can be vulnerable to certain hereditary illnesses (e.g. sickle cell anaemia), can be predisposed to certain forms of diabetes, and there is evidence of high levels of depression amongst certain ethnic groups. It is important that:

• an accurate family history is taken;
• the emotional and behavioural development of black and minority ethnic children is accurately and fully assessed
• prior discussion with the child takes place in order to enable choice (e.g. in the gender of the doctor that a child may see)
• arrangements are made for children undergoing health assessments to use the language in which they feel most confident

1.5 Children in secure settings and/or on remand

The health needs of children in secure accommodation and/or on remand should not become secondary to issues of keeping them secure or on remand, nor should health expectations be any lower than for other groups of children.

For further information the Child Health Team can be contacted.

1.6 UASC and Refugees

Unaccompanied asylum seeking children/refugee children are unlikely to have medical records from their country of origin, and any medical history they themselves give is likely to be incomplete. Their immunisation status may be unknown, and they may have had no previous health surveillance.

2. Individual Health Plans (IHP)

Each looked after child must have an Individual  Health Plan in time for the first Looked After Review, with arrangements as necessary incorporated into the child's Placement Information Record.

The Health Practitioner will draw up the child's Individual Health Plan based on the information in the health needs assessment, in conjunction with the child, staff/carer (as appropriate), GP and any other relevant professional.  The plan will then be passed to the child's social worker who will update the child's electronic records and arrange for copies to be sent to the child (depending on age), the parents and the staff/carers.  A copy will also be sent by the LAC Team to GP and School Nurse/Health Visitor as appropriate. 

Where the child expresses a wish not to disclose the contents of the Plan to his or her parents and this is accepted by the social worker (having regard to the child's age and understanding and after consultation with his or her manager), the parents will not receive a copy.

The child's social worker is responsible for ensuring that the actions from the Individual Health Plan are carried out and will do this with the assistance of the health professionals identified in the plan.  The specific responsibilities of the staff/carers/others will also be identified in the Plan.

The Individual Health Plan will set out how the health care needs of the child will be addressed, including the following matters:

1. Whether it is necessary for any immunisations to be carried out and if so, when.
2. When it is necessary for a dental check to be carried out
3. When it is necessary for any hearing or vision checks to be carried out
4. Whether there are any specific health care needs - and how they will be met, including future hospital appointments, referrals to specialist services ( including CAMHS) and/or any specific treatment, strategies or remedial programmes required.
5. Whether there are any health or education issues to be addressed, for example, nutrition, sexual health and relationships, substance misuse, personal hygiene.
6. Whether there are any activities which it is known or suspected the child is engaged in which may be harmful to the child's health and well-being, and the interventions/strategies to be adopted in reducing or preventing the behaviour.(This includes safeguarding issues, specifically Child sexual exploitation which LA children are at an increased risk of. This is assessed and recorded on the Individual health plan. Other examples include substance /alcohol misuse, sexual activity,)
7. Whether there are any mental health/emotional wellbeing issues.  Include the Strengths and Difficulties Questionnaire score, outcomes and any therapeutic support required for both the child and their carers.
8. Identify any needs the carer may have in respect of their own professional development/awareness and/or to enable them to best support the child in their care

This Individual Health  Plan must be reviewed after each subsequent Health Needs Assessment or as circumstances change.

For advice regarding Health Needs Assessments or other health related issues contact the Health Team for Looked After Children via the Team Secretary on Tel. No. 0113 3055156.

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