Guidance on Health Assessments for Looked After Children in Scotland

Section 1: Strategic Context

Introduction

The Scottish Government has 5 objectives underpinning its core purpose - to create a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth.

The strategic objective for health is to help people to improve and sustain their health, especially in disadvantaged communities, ensuring better, local and faster access to health care. Of the 16 National Outcomes, a number are particularly relevant to looked after children's health and wellbeing:

• Our children have the best start in life and are ready to succeed
• Our young people are successful learners, confident individuals, effective contributors and responsible citizens
• We have improved the life chances for children, young people and families at risk
• We live longer, healthier lives
• We have tackled the significant inequalities in Scottish society

The Scottish Government's vision for children and young people is clear: we want Scotland to be the best place in the world for them to grow up; a place where rights are respected and where children can access all the opportunities and support they need; and a place where children have the best start in life, are ready to succeed and live longer, healthier lives.

The Scottish Government is also striving to improve the life chances for children, young people and families at risk. Looked after children have some of the poorest life outcomes of the child populations. The factors associated with the child becoming looked after are often associated with a range of health needs and higher vulnerability. An additional factor in poor health outcomes is disjointed and disrupted health care as a result of multiple placement moves.

Our aim is that the health outcomes of children and young people who are, or have been, looked after will be as good as those of their peers who have not.

'Getting it right for every child' (GIRFEC) is Scotland's overarching approach to improve outcomes for all children and young people. It is being threaded through all existing and new policy, practice, strategy and legislation affecting children, young people and their families. GIRFEC therefore provides the framework for all work with looked after children and young people including health assessments and planning.

The Children and Young People (Scotland) Act 2014 will require through regulation that the looked after child's plan is fully integrated with the holistic Child's Plan described in the Act and GIRFEC policy. NHS Scotland policy supported by legislation provides the framework for health boards, services and practitioners to assess, plan and deliver health services for all children and young people taking a GIRFEC approach. Health assessments and planning for Looked After Children should be carried out within the Values and Principles of the Getting it right approach and applying the core components of the approach.

Looked After Children in Scotland

In 2012/13 16,041 children were looked after by local authorities in Scotland.

The vast majority of looked after children have become looked after for care and protection reasons. Some will have experienced neglect or mental, physical or emotional abuse. Some parents are unable to look after their children because of their own health problems, substance misuse or poor parenting skills.

Children who are looked after can either be looked after at home (eg supervised by the local authority but living at home) or looked after away from home (eg living in residential accommodation or with family and friends in kinship placements). In 2012/13 this was broken down as follows:

Scottish Government Children's Social Work Statistics Scotland 2012/13 show that the majority of looked after children will have more than 3 placement moves during their time in care. These moves uproot the child or young person from their known support systems, their family, local community and - from a health service perspective - from their local school, GP, health visitor and/or school nurse.

Professionals working with looked after children should be aware of the negative impact on long-term outcomes of such disruption of children's attachments.

Looked after children often face a range of difficulties arising from their home circumstances, health or learning needs. The GIRFEC approach provides the framework to address these wellbeing needs. The approach requires different agencies to work together with children, young people and families to holistically assess and consider the wellbeing needs of the child in the context of their wider circumstances. Services and practitioners can then prioritise and plan action to address the identified needs.

Policy Context

In 2007, We Can and Must Do Better set out an action plan to improve the life outcomes of Looked After children and young people. Action 15 stated that:

'Each NHS Board will assess the physical, mental and emotional health needs of all Looked After children and young people for whom they have responsibility and put in place appropriate measures which take account of these assessments. They will ensure that all health service providers will work to make their services more accessible to Looked After and accommodated children and young people, and to those in the transition from care to independence.'

Recommendations designed to address this action were issued to health boards on 28 April 2009 in Chief Executives Letter (CEL 16 (2009)) - see para 59. CEL 16 instructs NHS Boards to implement the 7 recommendations applying to all looked after children and young people.

The Looked After Children (Scotland) Regulations 2009 reflect a child's journey through the looked after system. These Regulations set out the statutory requirements for every looked after child to have their needs assessed and a child's plan created setting out the child's immediate and long term needs and how they will be met.

Part II of the Regulations establishes the care planning process, including gathering information on the child; assessment of that information and the formation of the child's plan. Section 3(b) states that the local authority must obtain a written assessment of the child's health and their need for health care by a registered medical practitioner or a registered nurse. This requirement may not apply if a health assessment has been carried out in the 3 months before the child began to be looked after.

The Healthcare Quality Strategy for NHSScotland (May 2010) sets out 3 clearly articulated and widely accepted ambitions based on what people said they wanted from their NHS - care which is person-centred, safe and effective.

The strategic narrative Achieving Sustainable Quality in Scotland's Healthcare: A 20:20 Vision (September 2011) provides the context for taking forward the required actions to improve efficiency and achieve financial sustainability to meet the significant challenges that Scotland's health services face. This will involve planning sufficient universal health service to meet the needs of looked after children.

Service providers should ensure that services for young people reflect the Quality ambitions and the 2020 vision.

Child Centred Approach to Care Planning

Getting it right for every child (GIRFEC) is the national approach to supporting and working with all children and young people in Scotland. It affects all services for children and adult services where children are involved. It is designed to ensure all parents, carers and professionals work effectively together to give children and young people the best start we can and improve their life opportunities. The looked after child's assessment and plan is administered in this context.

It is Scottish Government and NHS Scotland policy that children and young people should benefit from a single planning process when they require assessment, planning and action to promote, support or safeguard their wellbeing. In many situations, as for children and young people who are looked after, the Child's Plan will include contributions from different services and agencies including needs identified through specialist assessments such as the Health Assessment and the actions to address these needs. To ensure that a consistent approach is taken by services and agencies the GIRFEC National Practice Model, should be utilised as the framework for any assessment and planning.

National Practice Model

The GIRFEC National Practice Model provides a framework for practitioners and agencies to structure and analyse information consistently to understand a child or young person's holistic needs and consider what support they might require. It is a dynamic and evolving process of assessment, analysis, action and review, and a way to identify outcomes and solutions for individual children or young people. It is not intended or designed to replace existing methodologies but should be used as a 'common tool' alongside and in conjunction with other processes and assessment tools. It is a way for all agencies and workers who support children, young people and their families to begin to develop a common language within a single framework, enabling more effective inter- and intra-agency working.

The Early Years Collaborative (EYC) is a good example of joint working between government, local authorities and health boards. It is an outcomes focussed, multi-agency, quality improvement programme, which aims to deliver nationally on the vision and priorities of the Early Years Taskforce and build on the Early Years Framework. It covers children pre-birth to 8 years old.

The EYC breaks traditional approaches, enabling professionals from all disciplines and agencies, including third sector, as well as children and families to test ideas for improvement that will lead to transformational change. Driven by those receiving or closest to the service delivery, changes are rigorously tested using rapid small scale tests of change before implementing and spreading across local and national areas.

Corporate Parenting

The Children and Young People (Scotland) Act includes provision that requires every corporate parent to:

• be alert to matters which, or which might, adversely affect the wellbeing of looked after children, young people and care leavers under the age of 26;
• assess the needs of those children and young people for the support and services it provides; places a duty on corporate parents to collaborate with each other when exercising their responsibilities in relation to looked after children and young people;
• promote the interests of those children and young people;
• seek to provide those children and young people with opportunities to participate in activities designed to advance their wellbeing;
• take action it considers appropriate to help those children and young people to access opportunities and support and make use of the services it provides; and
• take any other action as it considers appropriate for the purposes of improving the way in which it exercises its functions in relation to those children and young people.

There will also be a requirement for corporate parents to collaborate with each other when exercising their corporate parenting responsibilities. They will be required to prepare, consult on and publish a corporate parenting plan and keep this under review. They will also be required to report on how they are exercising their corporate parenting duties to Scottish Ministers.

Community Planning helps public agencies work with the community to deliver better services. Community Planning Partnerships (CPPs) have been established to drive children's integrated service plans to achieve better outcomes. As well as local authorities and health boards, CPPs comprise a diverse range of public, private, voluntary and community organisations within their membership - some of who will also have corporate parenting responsibilities.