Highland NHS Board 5 October 2010 Item 4.8 LOOKED AFTER CHILDREN IMPLEMENTATION OF CEL (2009) 16 AND THE LOOKED AFTER CHILDREN (SCOTLAND) REGULATIONS 2009 Report by Jan Baird, Director of Community Care on behalf of Roger Gibbins, Chief Executive The Board is asked to: Note progress across Health Boards to ensure the health needs of young people placed out of authority are considered as they are in Highland. Note the ongoing work to improve quality of service to Looked After Children (LAC) and Looked After and Accommodated Children (LAAC) and continually improve outcomes. 1 Background and Summary Implementation of CEL (2009)16 was the subject of a report to NHS Highland in January 2009 and since then steady progress has been made. This report provides an update and sense check of our position against the agreed targets as well as information on outstanding risks and other parallel work on improving outcomes. 2 Update The attached summaries provide an at-a-glance update of progress to date against agreed expectations and targets in CEL 16 and outstanding actions. More detailed action plans are maintained within the Partnership areas and are regularly maintained through the Children s Services Network. a) Implementation of CEL 16 Implementation of delivering on 2, (assessing general health needs of all LAC) within CEL 16, is progressing towards the 1 st target of Jan 2011. A LAC Health Reference Group has been formed to move this forward and ensure a standard approach, taking account of local issues, across Highland. Challenges: LAC Health services emerged across the UK in response to the evidence that outcomes for children were poor as core health services were not flexible enough to cope with the disjointed health care which came from multiple placement moves. Attempting to deliver on CEL 16 requirements and improve outcomes within mainstream services is therefore a bold move. Highland are in a unique position to already have a semi mainstream LAC Health model, the GIRFEC framework and a multi agency Child s Plan this may support ease of implementation. It is acknowledged across agencies that there does need to be considerable tightening up on both the plan and the process. GIRFEC is still a work in progress however we have an opportunity with CEL 16 and the new Looked After Children (Scotland) Regulations 2009, to move forward with the GIRFEC LAC agenda and to improve quality of care and outcomes for the regions 480 LAC. The key areas of work in implementation are: Establishing key points in a child's journey with agencies, when a direct health review should happen. The absence of guidance in HALL4 has fostered the position that direct health reviews are now reactive rather than proactive. Establishing key points for direct review especially for vulnerable children would allow practitioners to effectively build up an accurate picture of the childs health need and would negate
the need for a standalone assessment at point of entry to care. decision making across the board. It would support Ensuring a quality standard of practice. It is anticipated that multi agency, best practice guidance for the health of LAC would define and secure a standard of practice for NHS Highland and partner agencies. This standard would be monitored through the Childs Plan and delivered within the GIRFEC framework and the multi agency process. Ensure that the multi agency process is robust enough to support meeting requirements and improving on care. Specific actions are outlined in Appendix 2. Ensure that the multi agency Child s Plan is robust enough to be held as a QA reference document for meeting requirements. See appendix 2 for detail. Ensure, there is an effective monitoring system in place to evidence that the shift in service model has been effective. This will be reflected in a review of current LAC Health Service in line with CEL 16. CEL 16/ Mental Health Framework The Mental Health Framework outlines a recommendation for services to provide training to residential care staff. A successful pilot to this work has been undertaken in a number of residential units by CAMHS staff and a conference training day is to be offered as a result. CEL16 has outlined a need for children to have their mental health assessed. This is a pertinent requirement as it is believed that around 45% of foster children and 95% of children in residential care, suffer from a diagnosable mental health condition. It has been agreed that mental health should be viewed in its widest context hence a multi agency LAC Mental Health Group has been established with the initial remit of Defining what constitutes a mental health assessment Identifying what that assessment should look like and developing and piloting the model b) Commissioning services for children. There continues to be a gap in commissioning of general, specialist and mental health services for children who are placed out with Highland region Allocation of out of region placements Highland region has a multi agency allocation panel to review cases and oversee the procurement of places out with the region. Whilst every attempt is made to identify the most suitable place for the child and the detail of service level agreements at time of identification of the place, placements are frequently made upon only available bed basis. Notification Children moving from Highland: There is currently no agreed notification process in place to NHS boards, when children move from region to region. There is therefore a grey area around responsibility and accountability. Highland have attempted to bridge this gap by ensuring that the receiving LAC Health service is notified and provided with up to date health information, when a child is placed in another area. The extent to which these LAC services are known to respond, is variable. The NHSH LAC health service retains oversight of children out of authority due to the gap in service provision in other regions. The difficulties created by distance however make any oversight/intervention reactive rather than proactive. Clear service level agreements between residential schools and local NHS services, would help tighten up on this gap and allow procurement of places to be open and transparent and based on known availability and access to services. 2
Children moving to Highland: NHSH LAC service are not routinely notified of children placed in private fostering placement in Highland, from other regions. They are not encompassed in the Child Protection notification system and there is therefore risk to the child as information goes unshared. Given the high tariff of these children, securing high levels of service access and quality care is a priority area for the Scottish Government who are picking this up at strategic level with the LAC Board Directors and the LAC Health Services. Notification around children being placed in private residential care in Highland from other regions, rarely comes from the childs home region, rather the open links made between units and the NHSH LAC service have supported good service delivery and a healthy response to meeting need. There is no distinction made between Highland children and those from other regions, when/if children are placed in Highlands private residential units. These children receive equitable access to services/support as Highlands LAC. Private/Charitable Residential Schools Children from Highland who are placed in other regions have highest rate of placement moves. Whilst the Care Commission found that basic health needs were well met in the recent review (see link) www.carecommission.com/index.php?option=com_content&task=view&id=7683&itemid=152 in the current economic climate, LAC health services are being asked to move away from providing a health service to private/charitable schools and to focus on local schools/units. This is likely to significantly increase the already precarious position for children out with the region. Mental Health There continues to be issues around access to services, amongst children who need mental health support when they are staying out with the region. Children staying in residential school are frequently in crisis and in need of stability, consistency and a safe environment. Skilled and capable staff are a key part of achieving emotional and mental stability for these children in crisis. Staff need to be well supported to manage children with such a high level of need. This is the responsibility of all agencies and the mental health framework outlines CAMHS role in this. There is however a need for CAMHS services to be responsive to the level of need by way of increased risk of depression, suicidal behaviour, mental health diagnosis. Many CAMHS services across Scotland offer consultation to the professionals dealing with the child, however this is not a routine part of wider support discussion which happens when children are placed in residential schools. c) Improving health outcomes In moving forward the Getting it Right for Every LAC agenda in step with delivering on CEL16 requirements, we currently face the challenge of identifying a person/service and/or process to ensure continuously improving health outcomes for LAC via targeted health initiatives. These initiatives (immunisation and sexual health drives) previously proved successful prior to the service model change in 2008, when the Clinical Lead role moved to majority support and consultation. NHS Highland is currently looking at how we ensure these targeted initiatives are promoted. 3 Contribution to Board Objectives This piece of work improves the quality of care to LACs and LAACs ensuring best use of resources and development of appropriate skills and expertise. 3
4 Governance Implications Patient and Public Involvement Highland Children s Forum have been involved in ensuring that the experience of LAC and LAAC has been captured and continue to represent these groups within the Children s Services Network 5 Risk Assessment Risk assessment is integral to planning and commissioning of services for LAC and LAAC. Specific issues as outlined within the improving outcomes section require closer management in relation to the development of Public Health Nursing, implementation of Hall IV and continued roll-out of GIRFEC. 6 Impact Assessment Impact assessment will be completed by the LAC Health Reference Group and reported through the Children s Services Network. Jan Baird Director of Community Care 24 September 2010
CEL16:Looked After Children Progress: Aug 2010 APPENDIX 1 1. 2.. 2 Appoint NHSH Board Director Meet New LAC Regulations (2009) Be able to Identify LAAC update COG 7/10 LAC HRG 1 st Meet. 8/10 Action *** Outcomes Plan agreedpaper to CSM LAC HRG 2 nd Meet. 9/10 Update to CSN 10/10 Board update Target 1/11.3 Be able to Identify LAC 3. Implement WCAM Complete after CEL Is achieved 4. Health assessment For LAAC.2 Health assessment for LAC via 2 5. LAC Mental Health assessment by 2015 SCOT PHD Project Multi Agency Mental Final Paper Heath ref Group meet SCOT PHD 6. Health needs of LAAC to be identified 4/10 10/10.2 Health needs of LAC to be identified via 2.3 Co-ordination & follow up by assessor via 2 7. Performance Measurement via 2
APPENDIX 2 ACTION PLAN to deliver on: 2/4.2/6.2/6.3/7 Step TASK Current Action Who When RAG Next Steps Identify Core health information needed for Childs Plan Define key stages when a direct health review is required Review and consult with staff LHRG Move to CSN for signing off Target Date Single Agency Agree assessment tool Review & Decision on assessment tools against MWT LHRG Move to CSN for signing off Claim quality standard within writing of best practice guidance Multi- Agency Improving Outcomes Agree a staged approach to best practice & QA linked to single process Delivering on Mental Health requirements Summary to CS Management/discuss at LHG Review proposed mapping and edit Multi Agency discussion to agree response pathway around Quality Standards Organise detail of training event for residential care Establish multi agency m/h implementation sub group LHRG L Hill & Move to CSN for discussion Move to MA QA group