Annual report for Children Looked After Health team April 2014 2015 - Dr Sandhya Kenyon, - Designated doctor for Children Looked After Team Borough of Kingston - Achieving For Children Mission Statement - Achieving for Children, the joint Children s Service for Kingston and Richmond, is passionate about ensuring the best possible outcomes for children and their families and will deliver the services they need to live safe, happy, healthy and successful lives. Collaborative authorship: NHS Kingston/RBK/Your Health Care/ Achieving for Children Designated Doctor for CLA- Dr Sandhya Kenyon Named Doctor for CLA- Dr Augusto Palombi Lead Nurse for CLA Kingston and Richmond Andrea Knock Named Nurse for CLA Jane Bradwell 1
Abbreviations BAAF British Association of Fostering and Adoption CAMHS Child and Adolescent Mental Health Service CCG Clinical Commissioning Group CICC Children in Care Council CLA- Children looked After DCSF Department of Children Schools and Families DfES Department for Education and Skills DoE Department of Education DoH Department of Health HV Health visitor IHA Initial Health Assessment IRO Independent Reviewing Officer LSCB Local Safeguarding Children s Board MAST- Multi Agency Safeguarding Team NEET Not in Education Training or Employment QA- Quality Assurance RHA Review Health Assessment UASC- Unaccompanied Asylum seeking Children YOT Youth Offending Team 2
Summary This is the first Annual for Achieving for Children, NHS Kingston and Your Healthcare CIC working together focusing on Children Looked After (CLA). The Children Looked After Health team was fully staffed until January 2015 and managed to achieve excellent health outcomes. Due to staff changes the Team had to resort to urgent short term strategies until May 2015 where the team had to depend on GPs, Out of Borough CLA Health Teams and school nurses to carry out Review Health Assessments. The Health Team is well staffed currently with 2 new members and are working well together with the Social Care team to deliver excellent care in a timely manner to all Children Looked After in the borough and also for children and Young People placed out of borough. The CLA team is working closely with the Leaving Care Team, focusing on the care leavers journey to achieving independence. NHS Kingston has a major role in ensuring the timely and effective delivery of health services to Looked After Children and Young People. Under the Children Act 2004 PCT s and CCGs have a duty to comply with requests from Local Authorities to help them to provide support and services to children in need. In the Royal Borough of Kingston there were 116 CLA (April 2015), currently there are 52 CLA (April 2015) placed within the Kingston boundaries (which equates to 43% of the CLA population) and 64 placed outside of the Kingston boundaries (which equates to 57%). NHS Kingston is responsible for meeting the health needs of all Kingston CLA irrespective of where they are placed. The CLA Health Team was formally established in 2010 and at that time it consisted of a Lead Nurse (1wte) and the Medical Advisor for Adoption and Fostering (0.3wte) along with the PA for the Medical Advisor (0.6wte). The service has since evolved and since May 2015 there are both a Designated Doctor and a Nurse who operate strategically and oversee the implementation of policies and guidelines within Kingston. Designated Doctor contributes to the Adoption and Permanency Planning panel currently. The Named Nurse ( newly appointed in May 2015) and Named Doctor oversees and respond to the clinical needs of children in care. The Designated Doctor will provide support and advice (also carry out clinical assessments of children with more complex needs). The team also have business support /coordinator who works 0.5wte. The team work closely with a range of other health and social care professionals and they are fully integrated within the MAST process (Multi- Agency Support Team). MAST and CLA team meetings are attended by the Named Nurse for CLA. CSE is high on the agenda and have a raised awareness among the team when they review children. Designated Doctor and Designated Nurse attend the Health Economy Board meeting quarterly chaired by Designated Doctor for Safeguarding to raise any issues around Governance including staffing issues, KPIs, training and audits. 3
Performance Indicators are collated monthly in partnership with Children s Social Care and this provides data for the Children s Annual Performance Assessment as required by Central Government. This activity based reporting identifies the number of health assessments (initial and reviews), dental checks, and developmental assessments completed for children who have been in care for more than one year. The national targets are 85%: currently these are about 80 % for Kingston due to recent staff changes. The performance indicators are affected due to difficulties gathering information for children placed out of borough, children in remand or prison, missed appointments and repeated non attending by young persons, cancellations and specific difficulties with timely data collection for 16-18 year old children not in education. The Team works closely with Leaving Care Team and virtual school head to try and engage with YP. There had been a great increase in children being adopted during the period of March 2014 May 2015. There was an increase from average of 6 adoptions/year to more than 10 adoptions in the first quarter of 2015. This is due to early identification of younger children who will benefit from adoption early by their social care teams and quicker processing through adoption and permanency planning process. The voice of CLA and Young People and their carers are considered a priority which is reflected in clinical notes ( voice of the child or YP is recorded) and continues to be at the forefront of commissioning decisions and service development. 4
INDEX Abbreviations...2 Summary...3 1. Introduction...6 2. Purpose of the report... 7 3. National policies and legislation..7 4. Local agreements and CLA Health Team...8 5. Profile of Looked after Children...9 6. Governance and leadership of LAC services.10 7. Training and supervision.12 8. Adoption and Fostering 12 9. Care Leavers 13 10. Progress 2014-2015.15 11. Vision for future.. 15 12. Appendix - Health needs of LAC - 2014/15 16 5
1. Introduction 1.1 Definition of Children Looked After The term Looked after refers to any child or young person, for whom the local authority has, or shares, parental responsibility or for whom the local authority provides care and accommodation to the child or young person on behalf of their parent. The majority of children and young people need alternative care and accommodation because they are not able to live at home with their parents. The term child can refer to any child or young person between 0-18 years. This definition includes the UASC under children s act 1989 ( 2004) 1.2 Responsibilities of the Local Authority to CLA The local authority has a duty and responsibility to those young people who leave their long term care after the age of 16 years until they reach the age of 21 or up to the age of 25 if they are in higher education. 1.3 Entering care Looked after children often enter care with a worse level of health than their peers due to experiences of poverty, abuse and neglect. They can face greater challenges than their peers and longer term health, social and educational outcomes remain poor compared to the general population. Narrowing the gap in outcomes for CLA compared to other children and young people is a major goal for NHS Kingston. Categories of placement under sections of the Children Act 1989; -Accommodated under a voluntary agreement with their parent/s - Section 20 -Subject to a care order - Section 31 -Interim care order Section 38 -Subject to an emergency care order Sections 44 and 46 -Compulsory accommodation Section 21 -UASC Unaccompanied Asylum Seeking Children - (Unaccompanied asylum-seeking children in the United Kingdom, often abbreviated to UASC, are children who are outside their country of origin to seek asylum in the United Kingdom, are separated from parents and relatives, and are not in the care of someone who is responsible for doing so.) 1.4 Responsibilities of Health to CLA Health services have a duty to comply with requests from the local authority to help them provide support and services to children in need. In order to discharge this duty the NHS is required to commission effective services, deliver services through provider organisations and provide practitioners to deliver individualised care for all. 6
1.5 Principles of reducing health inequalities of CLA Looked after Children have similar health risks as their peers however the majority of these children and young people come into care as a result of abuse and neglect. Health, educational and social outcomes for CLA remain poor with a high rate of teenage pregnancies, smoking, substance misuse, mental health problems, school dropout rates, poor education attainment and criminality. In conjunction with local authorities and other partner agencies health providers have a responsibility to try to improve the health and well- being of these children and young people. The intercollegiate role framework (2015) recommends specific education and training of staff who work with CLA to improve outcomes for these children and young people. Health care staff trained to a high standard has an important role to play in helping reducing the health inequalities of CLA. 2- Purpose of the Report Annual CLA Health Report complies with the reporting mechanism to LSCB and CCG and other partner agencies in demonstrating the work of the CLA Health team in assessing the health needs of CLA and improving their health outcomes. This report also : -Outlines achievements and challenges for CLA ( March 2014 April 2015) - highlights good working practices - Shows Profile and demography of CLA - Shows Service direction and ambition of AfC - Way forward for 2015 / 2016 3.0 National Policies and legislation related to CLA The CLA Health Team continues to work guided by a wide range of national and local policies and legislations. These include: -Every Child Matters (2003) -Looked After Children Strategy ( Kingston Borough of Kingston Upon Thames March-2014 March 2015) -Promoting health Of Looked After Children DOH 2009 -Delivering the Health reforms for Looked After Children : How the new NHS will work from April 2013 7
-NICE Guidance- Promoting the quality of life of Looked After Children and Young People - Oct 2010 - Updated Pathway 2014 - NICE website - Intercollegiate Role framework Royal College of Paediatrics and Child Health, Royal college of GPs and Royal College of Nursing March 2015 - Care matters: Time for change DfES (2007) -The Children s Act (1989) ( 2004)- (defines Looked after Children as where the child or young person is looked after by the local authority for more than 24 hours (section 22). The four main groups of accommodated children are; Accommodated under voluntary agreement with parents section 20 Subject to a care order Section 31, interim care order section 38 Subject to an emergency orders section 44 and 46. Compulsory accommodation including due to criminal justice supervision section 21. 4.0 CLA Health Team Local Agreement Initial health Assessment (IHA) : Undertaken by Named Doctor for CLA within 20 working days of being notified by social care team Review health Assessments (RHA) : Under 5 years 6 monthly by Named doctor for CLA 5-18+ years undertaken by the Named nurse for CLA 12 monthly 4.1 CLA Health Team Designated Doctor for CLA (Dr Sandhya Kenyon) 2.5 PA Named Doctor (Dr Augusto Palombi ) for CLA 3.0 PA Lead Nurse for CLA (Andrea Knock ) 1.0 WTE Named Nurse for CLA ( Jane Bradewell) _ 1.0 WTE (PA= 4hours) 8
4.2 Statutory Assessments As part of his role, the Named Doctor for CLA carries out all IHA of Children who become looked After and RHA on children under 5 years and where appropriate UASC. The named nurse under takes RHA of all 6-18+ and some of out of borough review assessments of children and YP. This ensures continuity of care as she has a good rapport with this cohort who are quite vulnerable. The newly appointed named Nurse also has experience and training in carrying out family planning clinics and sexual health matters of young people which is an asset for her role which she can develop further. 5.0 Kingston Borough Profile 2014-2015 This information is taken from CLA data for Corporate parenting 31/10/15 Age Range No: % Stat- neighbour National Under 1 year 7 6% 5% 6% 1-4 years 9 8% 13% 17% 5-9 years 21 18% 17% 20% 10-15years 48 40% 38% 36% 16+ 34 29% 27% 21% TOTAL 119 100% 100% 100% Placement locality No % Stat- neighbour National In borough 40 34% 44% 59% Out of borough 78 66% 48% 36% Other( incl place for adoption) 1 1% 8% 5% TOTAL 119 100% 100% 100% Legal Status No: % Stat- neighbour National Interim Care order 13 11% 12% 12% Full care order 41 34% 37% 47% Placement order granted 11 9% 14% 13% On remand, on trial, sentenced or 01 1% 0% 0%% 9
accommodated by LA Police protection order 0 0% 0% 0% Emergency protection order 0 0% 0% 0% Under child assessment order in LA 0 0% 0% 0% accommodation Single period of accommodation under section 20 53 43% 37% 28% TOTAL 119 100% 100% 100% This information is taken from CLA data for Corporate parenting 31/10/15 Note: 1- statistical neighbours are Bracknell Forest, Hertfordshire,Merton,Oxfordshire,Reading,Richmond,Surrey, Sutton, Windsor 2- Statistical neighbour and National comparator data is taken from the SSDA903 and relates to data as at 31/03/14 6.0 Governance and Leadership of CLA services 6.1 Health Economy Group: Attended by Designated doctor for LAC To oversee the development, implementation and monitoring of the Kingston Clinical Commission Group (KCCG) Safeguarding Children and Looked after Children governance arrangements and practice across the health economy within KCCG. 6.2 LSCB Quality Assurance meeting Attended by Designated Doctor and Designated nurse for CLA. They will update concerns raised of matters concerning CLA and will disseminate information and reports to the team. 6.3- CSE Strategy meeting Attended by Designated Doctor and Designated Nurse for CLA quarterly. They will update needs and highlight special issues around CSE in CLA cohort. They will implement policies agreed by the Group. Last year issues around YP living in Independent Housing schemes which could be a potential focus of CSE was brought to attention to the CSE strategy group. The police, social care and health have taken steps to educate the YP and information provided about CSE and how it affects YP. This is ongoing teaching session and is well attended. 10
6.4 CSE working group ( MASE ) 2 monthly Attended by named nurse for CLA. She will disseminate and share information with the team if any concerns raised about any child or YP for further strategies and input at RHA. 6.5 Cooperate parenting Group monthly Attended by Named nurse for CLA. She will update health needs of CLA and also share with Health Team any other concerns for any CLA raised at the meeting for further interventions and follow up. 6.6 CLA Health Team - weekly Attended by Health team weekly. Updates on all new CLA entering care, discuss any other current issues for children or carers, review notes for all children booked for medical reviews for the week, check non attendance and rebook. Designated doctor to QA reports from named doctor and other reports from outer boroughs and school nurses. Ensure all reports have SMART action plans which are followed up. Named nurse to ensure timeliness of completion by telephone consultation with carers and Social worker. 6.7 CLA Peer review meeting NW London CLA teams The CLA health team to attend this quarterly meeting Chaired by the Designated Doctor for CLA Kingston. These are held quarterly and CLA Health teams from other boroughs attend. Information shared, protocols and local guidelines are shared, case presentations by teams for lessons learned and changing practices. 6.8 Peer review audits to start from July/August 2016 when the new CLA staff had time to settle in, together with Richmond Team 6.9 Audits Audit of health issues in CLA cohort under taken by Dr Kenyon and Dr Palombi April 2015 see appendix A Audit of timeliness of IHA and RHA Named Nurse and Named doctor to start August 2015 ongoing monthly data Collate information from patient/ carer feed back forms Dr Kenyon September 2015 in process Collate SDQ s and summarise needs Dr Kenyon and Jane Bradwell October 2015 in progress 11
Audit - outcomes of advice given to YP regarding smoking cessation, sexual health Jane Bradwell- November 2015 Audit advice given and actions on healthy eating / healthy activities/ weight loss - Dr Sandhya Kenyon, Dr Augusto Palombi Named nurse for LAC will continue to collect data for teenage pregnancies in local cohort and recurrent pregnancies ensure support and follow up given appropriately in partnership with CAMHS, education and social care teams Jane Bradwell Named Nurse, November 2015 start 7.0 Training and supervision 7.1 Raising profile of CLA- CLA team attended and Away day (April 2015) work shop with community Paediatricians, therapists and the community nursing team at Moor Lane Child Developmental Centre to raise the profile of the team and raise awareness of health and social needs of CLA among the other therapists and Paediatricians who work with some of our looked After Children. The Health Team attended Health Visiting Teams and social care CPD session ( December 2014) to raise awareness of health needs and developmental needs among CLA and to highlight the importance of prioritising therapy input when referred. The Designated doctor and the Named Doctor attend mandatory Safeguarding training at Kingston hospital and BAAF training days relevant for CLA. The Designated Doctor for CLA supervises the Named Doctor on a weekly basis and a formal 6 monthly review and yearly appraisal by mentor (Consultant Paediatrician at Kingston Hospital) yearly. Both the Designated Doctor and Named Doctor have been Re validated by GMC in 2015. The Designated Doctor for Safeguarding supervises the Designated doctor for CLA yearly and also yearly appraisal with Consultant Paediatrician from Kingston hospital and has been Revalidated by GMC. Named Nurse for CLA is supervised by the Designated Nurse for safeguarding 3 monthly 8.0 Adoption and Fostering Adoption medical service Adoption is the legal process by which parental responsibility for a child or young person is vested in a new parent or parents. It is a permanent and lifelong commitment. Recent policy changes in the Adoption process (April 2013) require that the process takes a shorter period of time, this has been reduced to 26 weeks or 6 12
months to increase the speed of permanency for children and young people. Prior to these changes coming in to place in September 2013 the whole process could take up to 12 months. 8.1 Medical Advisor for Adoption: The Designated doctor /medical advisor advise the adoption panel and carries out the report writing for children waiting for adoption in time for the panel. Attends Adoption panels alternating with the Medical Advisor from Richmond borough as the panel is a joint Kingston and Richmond panel. The role of the Medical Adviser is to; carry out medical examinations as appropriate or discuss with the named doctor who carries out medical examination (pre adoption medical assessments ) of children moving to adoption and prepare statutory reports. In some cases reports can be completed from the initial health assessments (IHA) previously carried out by other doctors. Making referrals to Consultants and Therapists as required by the needs of the child or young person. Be the medical advisor for Adoption Teams advising on the present health needs of children and lifelong health needs. Counselling of prospective adoptive parents on the health needs of child/ren. To collate the medical information on prospective adoptive parents and to provide reports to the Adoption Team this is handed over to the named doctor who has had recent training in assessing adult HA reports with supervision. To be the Health Representative on Adoption Panels. Medical Advisers work closely with a range of other professionals from health - Nurses, Therapists and Paediatricians as well as Education and Social Care. Also liaise with tertiary centres for expert opinions. Ensure timescales are adhered to within the Adoption Framework. Update and train professionals on issues related to Adoption. 9.0 Care Leavers Looked after and leaving care team provides a specialist service to children and young people: who are under the care of the Council on a permanent or long term basis who have left care and require ongoing advice and/or assistance Most of these children and young people are either in foster care or residential accommodation, although some may be in young offender institutions or boarding schools. 13
The team work closely with social workers, education, mental health workers and an educational psychologist. The team liaise with GPs, health visitors and school health professionals for advice and support when making decisions and recommendations for the Young Person s future needs. All children up to 16 living in Kingston are given a named health visitor or school nurse. All children and YP have regular reviews of their care these are opportunities for them, their parents and carers to talk about how things are going as well as future care plans. The meetings are led by a professional not from the social work team involved so that an unbiased view of the services being provided is given. All care leavers aged 16-22 years of age who are at risk of becoming homeless or are in housing need are provided with a tailored support packages to assist them in their transition to independent living which may include support and advice on budgeting, rent payment, house-keeping, cooking and DIY. Profile of Care Leavers 2014/2015 Care Leavers 13/14 14/15 Care Leavers 19 th,20 th 21 st Birth Day 88 80 Suitable accommodation 63 60 % 72% 75% Engaged in EET 42 39 % 48% 49% 14
10.0 Progress 2014-2015: -All Action Plans Quality Assured by Designated Doctor ensuring a SMART plan -The Voice of the child Ensure this is recorded at each HA -Healthy Eating and Be Active Health promotion packs for Primary school children and for secondary school children given at the health assessment and discussed, audit of progress Dec 2015 -IHA- jointly with Named Doctor and Named Nurse when possible -Joint Health Policy - Jointly with Health and social care -Health Passport for care leavers to be piloted August/September 2015 11.0 Vision for Future and Improvements To ensure the best possible outcomes for children looked after by delivering the services they need to live safe, happy, healthy and successful lives. -Ensure all CLA Achieve >85% for timeliness for IHA ( to meet national standards) -Facilitate completing Health Passports starting from aged 14+ -Facilitate 6 monthly Joint Health, Education, Adoption and Foster care teams joint work shops - Ensure health input in Foster carer training days 15
Appendix A Health needs among CLA Kingston (Total CLA 119)- 2014/15 Psychological disorders 27/119 ( 22 %) - self harm - attachment disorder - depression - anxiety - aggression - eating disorder Obesity 6% Developmental delay 24/119 (20%) FASD (Fetal alcohol spectrum disorder) 2 SEN statements 10/119 (8%) Smoking > 12years -10/ 57 (17 %) Drugs/cannabis- >12years 2/57 (3%) 16