Numbers of Children Placed in Care in Poole

HEALTH OF CHILDREN IN CARE

IN POOLE

ANNUAL REPORT

April 2013 –March 2014

SECTION

CONTENT

1 Introduction

2 Numbers of Children Placed in Care in Poole

3 Destination of LAC Leaving Care

4 Initial Health Assessments

Adoption

/ Key performance indicators
· Review Health Assessments
· LAC placed out of Borough
· Service Level Agreement (SLA)
· Dental Health

· Immunisations

/ Supporting Children and Young People with Disabilities /

/ Diet and Obesity /

/ Sexual Health & Relationships /

/ Alcohol /Substance Misuse and Smoking /

/ Referrals /

/ Emotional Health & Well-being /

/ Strengths & Difficulties Questionnaires (SDQs) /

/ Accessing Emotional Health Support /

/ Listening to Young People: Satisfaction Survey /

/ Summary of Key Areas of Development 2013/14 /

/ Key Areas for Development During 2014/15 /

/ References /

1. introduction

The annual report for 2013-2014 aims to review the service provided by the Poole Children in Care Health Team and set priorities for the coming year. The information is reported in line with the agreed Service Specification for Children & Families for the care of Looked After Children & Young People. The aims of the Children in Care Specialist Health Team Service in Poole are:

· To co-ordinate and develop health services for children who are ‘Looked After’ or ‘in care’ through the Borough of Poole.

· To have a commitment to improving the holistic health outcomes for all children and young people in care so that they are able to reach their full potential in achieving the 5 outcomes of ‘Every Child Matters’; be healthy, stay safe, enjoy and achieve, make a positive contribution and to achieve economic wellbeing.

· To ensure the health and wellbeing of children in care is identified as a local priority and that all structures are in place to manage and monitor the delivery of health care for children and young people in care.

· To work in partnership with statutory and voluntary services in co-ordinating additional health services to address identified complex health needs for children in care, whilst supporting access to universal health services where appropriate.

· To be an advocate to improve the health care and service given to individual children and young people and to the ‘population’ of children in care as a whole.

· To provide support, advice and training to the ‘Team Around the Child’ on holistic health issues and to be a driver for positive change regarding health issues.

The team adheres to the ‘Promoting the Health of Looked after Children’ guidance (2009) and the NICE Guideline ‘Health and Well-Being of Looked After Children and Young People’ (2010) in its approach and ethos in practice.

The following abbreviations are used throughout the report:

· CiC Children in Care

· CiCHT Children in Care Health Team

· IHA Initial Health Assessment

· RHA Review Health Assessment

· CYPSC Children and Young People’s Social Care

· SW Social Worker

· CAMHS Child & Adolescent Mental Health Service

· TAC Team around the child

2. Number of CHILDREN IN Care IN Poole

Table 1 Number of children in care in Poole
Year / 2006/7 / 2007/8 / 2008/9 / 2009/10 / 2010/11 / 2011/12 / 2012/13 / 2013/14
Poole / 108 / 104 / 116 / 119 / 133 / 164 / 146 / 161

There has once again been a rise in the total number of children in care this year. There have been 92 new admissions to care this year. This is an increase of 22 new admissions from the previous year. Of these, 46 were still in care at the end of March. This number has included large family groups of 6, 5 and 4 children. These children all remain in care and are now subject to care orders which will secure their long term permanence in care.

The impact of long term neglect and domestic violence on many of the new admissions to care has been clearly evident in their presentation and holistic social, emotional and physical health needs.

There has also been a significant increase in the number of young people aged 16-18 becoming looked after under section 20 as a result of estrangement from their families under the Southwark judgement criteria.

This group of young people have generally presented with a high level of need and difficulty across all areas of their lives and proved extremely challenging for the Team to engage with effectively to make a difference to their outcomes.

It is evident that the numbers of children entering and leaving care fluctuates greatly from month to month. This has a direct influence on the efficiency of the initial health assessment process and the workload of the health team generally.

The number of under 5’s is consistent year to year. There has been a notable increase in the number of children in care in the 6-12 age range (+ 16) this year. The number of boys in this age range has increased by almost 50% (+14) on last year’s total. The older age range remains consistent with last year’s total.

There continues to be a significantly higher proportion of boys to girls in care (94/66). It is interesting to note that there are a significant number of children in the 6+ year’s age range, who if unable to return to their birth family are less likely to achieve permanence through adoption. They are therefore likely to spend the rest of their childhood in care. It is vital to engage with this age group to promote key health messages and to support the foster carers in the delivery of health care. There has been an increasing emphasis on supporting the emotional needs of this age group through either direct referral to CAMHS (7) or through support to their carers through the psychology service in the fostering team (23 ). By accessing psychological support for carers a number of placements have been sustained and this has prevented a placement breakdown. It has also alleviated stress for a number of carers.

A significant number of the new children in care this year have presented with extreme emotionally driven behaviour difficulties both at home and especially in their education setting. A number of these children have experienced chronic neglect and exposure to domestic violence. Poor parental mental health and substance use including alcohol abuse have been recurrent features of the children’s lives before coming into care. There has been close liaison between all agencies including the CiCHT within the TAC to support the children’s well being within the school environment. The Specialist Nurse has attended a number of multi agency meetings and has contributed to the overall planning to prevent a breakdown or exclusion from the education setting.

3. Destination of LAC Leaving Care

Number of CiC / Percentage
Within Bournemouth & Poole / 108 / 67%
Outside B&P but Within Dorset / 34 / 21%
Out of County / 19 / 12%

The vast majority of Poole CiC are placed within Dorset. Of the 19 who are placed outside Dorset 9 are in adoption placements and 10 are in ‘in care’ placements as in specialist residential therapeutic settings (7), remand institiutions (1) or residential settings offering schooling and care for children with complex disability needs (2).

Where there is a planned admission for care to an out of area placement there is usually close liaison between the placing team and the CiCHT to ensure that all health needs can be met within the setting. The Specialist Nurse has ensured that children moving out of the area have sufficient medication to take with them when they move. It also sometimes provides an opportunity to complete the IHA before the child moves out of the area which means that the child has an up to date health plan at time of placement. . The Specialist Nurse has liaised closely with Poole CAMHS to pass responsibility for prescribing medication to the receiving CAMHS team.

Number of Leavers / Percentage
Home / 37 / 45%
Adoption / 5 / 6%
Remand / 4 / 5%
Care Leaver / 24 / 29%
Other Family Member / 9 / 11%
SGO to Foster Carer / 3 / 4%
Total / 82 / 100%

A total of 82 children and young people have left care over the year. Their ‘destination’ is shown in the above chart. Whenever a child or young person has left care the CiCHT has liaised with the relevant health professionals to ensure continuity of health care and in some instances to ensure safegaurding concerns are monitored from a health perspective. There have been a number of concurrent ‘foster to adopt’ placements which have required extremely high levels of confidential information sharing across the health professionals. The specialist nurse has on occasions visited birth parents with their child during a contact session to offer a health update. This has been when for reasons of confidentiality it has not been possible for the birth parents to meet with the named Health Visitor. This has ensured that birth parents are given every opportunity to be involved in their child’s health and devlopment.

A child’s ‘permanence’ is decided through a clear pathway of decision making (Public Law Outline 2008) . A number of formal, multi-agency meetings take place and the CiCHT are regularly invited to attend and contribute to these decision making forums. This has ensured that all health professionals involved in a child’s health care can be kept informed of permanency plans. For pre-school children the relevant health visitor for the child usually attends these meetings. It has also ensured that adoption medicals can be arranged in time for the agency decision maker to make their recommendations.

4. INITIAL HEALTH ASSESSMENTS

IHAs have continued to be the responsibility of the Dr Clark ,Medical Advisor for CiC. (Please see her report in the appendix section).

The improvement in the timing and quality of the IHA has been sustained over the year. The benefits of the assessment being completed by the Medical Advisor reported last year are still relevant;

· Closer involvement of birth parents and the gathering of important health information for both the health assessment but also for the child’s life story.

· Access to GP/school nurse and child health information which again gives a clearer history for planning and life story

· Health plans have generally been available at time of child’s first in care review. This has ensured that relevant health care has been initiated from an early stage and helped to prevent gaps in health care.

· IHAs have been undertaken by Specialist Medical Advisor for CiC who may then complete the adoption medical at a later date. This has ensured continuity of assessment for the children. There have been some significant improvements in children’s developmental and emotional well-being, clearly evident and documented between IHA and adoption medicals this year.

A CiCHT leaflet is now sent to all carers when a child is placed with them. This gives important information about the team and how we can support them as carers. It also clearly explains their role in the provision of health care and how to keep us updated with their child’s health needs.

The Specialist Nurse has attended a number of initial CiC reviews to present the initial health plan to ensure it is embedded in the child’s overall care plan. The reviewing officers have been consistently supportive in ensuring that health needs are considered at each review in a sensitive and age appropriate format. The new style review document and care plan lends itself to ensuring there is a clear focus on a child’s holistic health needs. This has ensured that holistic health care has been a priority in a child’s overall care.

5. Adoption

Dr Clark has completed 20 adoption medicals during the year. With the rapidity of the time frame within the Public Law Outline (2008) the adoption medical has sometimes been completed within a very short time after the Initial Health Assessment. Over the past year the initial health consent form has been modified to gain permission to request the pregnancy and birth details at an early stage rather than to wait for the adoption medical. This has provided vital information to inform the initial and any subsequent health assessments. It has also provided prospective adopters with clear and informed health information.

The CiCHT have ensured that a health assessment is completed prior to the child leaving their foster placement to move to their adoptive family. This has ensured that current health information is available to the adoptive family and receiving health professionals. The CiCHT has ensured that there is close liaison between the health professionals involved when children are placed for adoption. The CiCHT has had direct contact with a number of adoptive families both prior to and post adoption to offer advice and support. The Specialist Nurse has attended an adoption support group and training for prospective adopters to offer specialist advice and support re health issues for children who are in the adoption arena.

Each child being placed for adoption has been issued with a replacement Red Book to ensure continuity of health information and to give the child an accurate health life story.

The RHA for a child in an adoption placement has been completed through a ‘triangulated’ health assessment pro forma. The responsible SW has been asked for any updating health/developmental information. The adoptive parents have been sent a health questionnaire for their child. If there have been significant issues during the review period then more formal contact has been made with relevant health professionals and on occasions the Specialist Nurse has travelled with the SW to complete a more in depth assessment. This has meant that health issues have continued to be monitored and addressed.

6. KEY PERFORMANCE INDICATORS

Review Health Assessments

OVERALL; 98%of RHAS have been completed (KPI 90%)

Numbers of Children Placed in Care in Poole

SECTION

CONTENT

PAGE

1

Introduction

2