Appendix 5 TAYSIDE LOOKED AFTER CHILDREN S NURSING SERVICE Service Specification
SECTION 1 2 Service Description Service Objectives CONTENTS 3 Background 3 4 Service Scope Service Recipients Hours of Service Operational Bases Service Access Service Delivery 5 LAC Health Needs Assessment 6 Consent Review Health Assessments Referrals Non Attendance at Health Review Consent Non Consent 7 Non Disclosure of Address 7 8 Registration with a GP 7 9 Attendance at LAC Reviews 7 10 Discharge from Accommodation 7 11 LAC Out of Area Transfers 7 12 LAC Who Reside in Tayside but are the Responsibility of another Local Authority PAGE 3 3 3 4 4 4 4 5 5 6 6 6 6 6 6 8 13 Working in Partnership and Engaging with Families 8 14 Working in Partnership with Others 8 15 Record Keeping 8 16 Management and Supervision 9 17 Child Protection Case Supervision 9 18 Child Protection 9 19 Requests for Reports 9 20 Information Sharing 10 Appendix 1 Letter from Local Authority 11 Appendix 2 LAC Health Assessment Outcome & Action Plan (under 12 years) 12 Appendix 3 LAC Health Assessment Outcome & Action Plan 13 (aged 12 years and over) References 14 Service specification for Tayside LAC Nursing Service Page 2
1 SERVICE DESCRIPTION The Looked after Children s Nursing service is a targeted health service which aims to promote the physical and mental health and social well being of Looked after Children and Young People This service provides professional advice and support to this defined client group, their families and carers to empower and enable achievement of healthy lifestyles by addressing concerns about health and wellbeing. The service is provided to all Looked After Children and young people including all children who are accommodated, children in Kinship Care and those looked after at home as directed by the Children s Hearing System. This service is delivered by a mixed model i.e universal services plus specialist services within each of the three CHP s It delivers a programme of core interventions in accordance with CEL16 (Implementation of Action 15 of the Looked after Children and Young People: We Can and Must do Better ) based on the principles of Looked After Children: We Can and Must Do Better (Scottish Government, 2007). 2 SERVICE OBJECTIVES i) To assess the health of all looked after children within four weeks of notification by the local authority. ii) To engage and involve families and carers as appropriate to promote optimum health and development of all looked after children. iii) To actively ensure that the young person s views, as appropriate are included in the health care plan. iv) To work in conjunction with local authority and other partners to promote the health and well-being of looked after children. v) To assess and review the health needs of the individual and to involve the carer/client (where appropriate) in the process of meeting the health needs. vi) To take appropriate action to protect vulnerable children and adults at risk. vii) To promote health for LAC/YP in the wider community by working with NHS colleagues and other agencies; statutory and voluntary, in order to reduce inequalities in health. viii) To identify and address barriers to accessing health services and make them accessible to LAC/YP. ix) To provide training for foster carers and residential workers in agreement, or jointly, with social work and health colleagues. x) To provide expert health advice and training for other health professionals, partner agencies and carers in the needs of this specific client group. xi) To provide or facilitate access to appropriate supports and services for health related issues for all those who care for this vulnerable group, including residential workers and foster carers 3 BACKGROUND It is well documented that children and young people who are looked after experience much poorer health outcomes than their peers of a similar socioeconomic background who are not looked after (SWIA (2006) and extraordinary lives). This coupled with the greater awareness of the impact of poor health on future life chances (Looked after children we can and must do better 2007) requires a targeted approach to support the health needs of this client group. Service specification for Tayside LAC Nursing Service Page 3
The principles of LAC Nursing Service The LAC Nursing Service is underpinned by a public health approach to tackle health inequalities through promotion of good health and prevention of ill-health for Looked after Children and Young People. 4 SERVICE SCOPE Service Recipients All looked after children aged 0-18 placed from the three local authority areas Angus, Dundee and Perth and Kinross who are still in school and education. The Dundee service covers looked after children who are in transition as part of the Through Care System. Children who are in kinship care, ie looked after by relatives, eg grandparents, aunts Children looked after at home, as directed by Children s Hearing System. Children looked after away from home. This includes children/young people placed in foster care, independent foster care, local authority residential units and secure units and those placed by each of the three local authorities in family or residential placement out with Tayside. For children looked after in Tayside, but placed by other local authorities, the LAC service will facilitate access to local health services as appropriate. Hours of Service 09.00 17.00 hours Monday - Friday (excluding Public Holidays). Operational bases Angus - Whitehills Health and Community Care Centre, Station Road, Forfar, DD8 3DY. Telephone - 01307 475270 Dundee - Ryehill Health Centre, St Peter Street, Dundee, DD1 4JH. Telephone - 01382 647773 Perth and Kinross - Drumhar Health Centre, North Methven Street, Perth, PH1 5PD. Telephone: child health 01738 564273, LAC health 01738 564250 Service Access. For Children and Young People who become Looked after Angus The area local authority will notify the child health department without delay using LAC letter (see appendix 1) to a secure generic email. Admin staff will notify caseload holders, public health nurses or LAC Nurse that a child or young person has become looked after. Child health admin will record core forms (LAC letter) on MIDIS. Dundee The area local authority will notify LAC health without delay using the LAC Letter via a dedicated secure email address. The LAC health admin will notify caseload holders and copy this information to child health admin who will then record the LAC letter as a core form on MIDIS. Service specification for Tayside LAC Nursing Service Page 4
Perth & Kinross The area local authority will notify the child health department without delay using the LAC letter via a secure email with a copy to LAC Nurse. Child health admin will record this on MIDIS which will alert caseload holders that the child/young person is now looked after. LAC Nursing teams can be readily accessed by telephone All teams have direct telephone numbers at their base. Out with these hours an answering machine service (voicemail) is available. An open referral system operates for any looked after child, their parents, carers and workers who are looking for advice and support. Other professionals can access the service for advice and support as necessary. Service delivery The service is delivered by: Looked After Children s Nurses - Registered Nurses with experience of working in hospital and/or community settings, who have undertaken additional training at degree level, which specifically relates to the health needs of children. School Nurses and Health Visitors - Registered Nurses, with experience of working in hospital and/or community settings, who work within teams and are supported by Health Visiting and School Health Nursing Staff Nurses. The service can be delivered within clinics, child s home, residential homes, schools, residential units, and carers homes as appropriate to meet the individual needs of the looked after child/young person. Looked After Children s Nurses work closely with specialist doctors, paediatricians in regards to training and awareness raising of issues relating to looked after children and young people. This includes Medical Advisers for Adoption and Fostering, specialist paediatricians and training grade doctors who work under supervision. Looked After Children s Nurses also work alongside other members of the public health team and can liaise with e.g. GPs., practice nurses, pharmacist and also, at times, as part of a multi-agency team with colleagues from statutory and voluntary agencies. 5. LAC HEALTH NEEDS ASSESSMENT The aim of the LAC assessment is to enable a full assessment of the health needs of the looked after child. This assessment will be used to identify any outstanding health needs and ongoing referrals required and will inform the individual s health plan. This plan will identify need for review and ongoing advice and support. This face to face health assessment should be offered within four weeks of notification of the child/young person becoming looked after. In P&K and Angus the completed health assessment will be forwarded to the child s social worker and/or care and review officer (whoever is the Lead professional) to inform the individual s integrated plan. It is good practice that the GP receives a copy of the assessment. In Dundee a summary of the doc LAC2/3 (see appendix 2 &3 ) related to actions required (in relation to health outcomes ) and by whom will be sent. to child s individual social worker and or CARO. It is important that there is appropriate consent obtained and that families (where appropriate) are advised of and included at each stage of assessment. All nurses who undertake health assessment for looked after children should be aware of guidelines on how to complete a health assessment. Service specification for Tayside LAC Nursing Service Page 5
Communication between members of the primary health care and multi-agency team is essential to ensuring looked after children and young people receive appropriate levels of support and intervention. Review Health Assessments Each health assessment will identify the need for ongoing review. The timeframe for further review must be clearly documented on completion of the assessment. It should also identify the practitioner with ongoing responsibility to undertake this review. This will be the LAC Nurse in Dundee and LAC Nurse or Public Health Nurse in P&K and Angus. This review should be by face to face contact but there may be circumstances where this can be done by notes review, telephone contact and/or in discussion with the child s social worker. The reasons for this should be clearly recorded on MIDIS and should be led by the needs of the child. Referrals There may be a need for ongoing referral to health and other professionals after the health assessment is completed. Up to date information should be included in the referral and families should be made aware (where appropriate) of the need for ongoing referrals. Non attendance at Health Review If a child or young person fails to attend an appointment the child s social worker should be notified re failure to attend. This should be recorded on MIDIS/child s health record. A second appointment should be offered. If the young person fails to attend for this second appointment the child/young person s social worker should be notified and a plan of action should be agreed. All actions and discussions must be carefully recorded on MIDIS/child s health record. 6. CONSENT Consent For children who are aged under 12, or aged over 12 without the capacity to consent, it is important that appropriate consent has been obtained before undertaking a LAC health assessment. The type of consent obtained written or verbal must be recorded in MIDIS. For children aged 12 or over, consent should be ascertained at the face to face contact. This includes consent to share information with multi-agency colleagues. This should then be recorded on MIDIS. Non Consent For children/young people aged 12 or over who refuse consent for a face to face health assessment it is important that all the health information available is collated to identify any outstanding health needs. Discussion with the young person s social worker and/or others involved in their care should also take place to ascertain any concerns they may have. A second appointment should be offered as the child/young person may need a period of stability before they agree to a face to face contact. In working with all health and other multi-agency colleagues, LAC nurses will work within the parameters of both professional and organisational guidance and policies e.g. Nursing and Midwifery Council (NMC) Code of Conduct (2008), NHS Tayside Informed Consent Policy and Information Governance Policy. Intranet reference: http://staffnet.tayside.scot.nhs.uk/safeeffectiveworking/policies/finance. 7. NON DISCLOSURE OF ADDRESS There may be situations when it is not in the child s best interest for their new address to be disclosed. It is the responsibility of the local authority to make health aware re non disclosure of address. This may be at the time of accommodation or when a child has to move for a planned and unplanned reason. Service specification for Tayside LAC Nursing Service Page 6
LAC/Public Health Nurse should refer to Management of Non-Disclosure of Place of Residence or Whereabouts Guidelines (2012) in these circumstances. http://staffnet.tayside.scot.nhs.uk/ourwebsites/childprotection/index.htm 8. REGISTRATION WITH A GP It is important when a child/young person becomes accommodated the GP is notified of the change of address. It is the responsibility of the carers to do this. Carers should not change the child/young person s GP unless they have discussed this with the child s social worker. For children who are not registered with a GP, the LAC/Public Health Nurse should advise in the case of the looked after child at home, the parent/carer to register the child/young person with a GP. For children who are accommodated or in kinship care the LAC/Public Health Nurse should discuss with the child s social worker that the child is not registered with a GP and agreement should be made about where to register with the GP. 9. ATTENDANCE AT LAC REVIEWS/ LAC/Public Health Nurses are asked to attend LAC Reviews. If unable to attend a LAC review, a report should be sent. LAC Nurses will respond to report requests timeously and will follow agreed process for the typing, signing, posting and tracking of reports. 10. DISCHARGE FROM ACCOMMODATION. In P&K and Angus Each local authority will notify the child health department that a child/young person is no longer looked after. This will be recorded on MIDIS to alert the LAC Nurse and/or Public Health Nurse that the child/young person is no longer accommodated. The LAC Nurse and/or Public Health Nurse should review health records to ascertain if there are any outstanding health needs. They should then ensure that the caseload holder (If different) is aware of ongoing health needs. Dundee The local authority will notify LAC Health if a child/young person is no longer looked after. This information is forwarded, within Health, to the relevant Lac nurse/caseload holder and to NHS Tayside s Child Health Department for information. The LAC Nurse and/or Public Health Nurse should review health records to ascertain if there are any outstanding health needs. It is the responsibility of the LAC Nurse to ensure that the caseload holder is aware of any outstanding health needs and the ongoing health responsibility when transferring the child/young person. 11. LOOKED AFTER CHILD OUT OF THE AREA TRANSFERS. If a looked after and accommodated child/young person moves out of the area to another health board area, it is the responsibility of the LAC Nurse (and/or Public Health Nurse in Angus and P&K.) to ensure that mainstream services in the new area are aware of the child. If there are child protection issues, the LAC Nurse/Public Health Nurse should notify the Nurse Adviser for Child Protection in their area for advice. The Nurse Adviser for Child Protection in the new area should also be notified with as full health details as possible. (Any transfer of records should be as per child health department). Looked after children/young people who are accommodated and move out of the area remain the responsibility of the LAC nurse. If there is need for a review LAC health assessment, the LAC nurse should discuss with our local authority partners the best way to undertake this review. This may mean that the young person has to return to Tayside. Mainstream public health services in the area that the child/young person moves to should be notified that the child/young person is in their area and any outstanding health needs should be discussed. Service specification for Tayside LAC Nursing Service Page 7
12. LOOKED AFTER CHILDREN WHO RESIDE IN TAYSIDE BUT ARE THE RESPONSIBILITY OF ANOTHER LOCAL AUTHORITY. If the looked after Children s Nurses are notified regarding the above children/young people, they have the responsibility to ensure that mainstream services/public health nurses (school nurse and/or health visitors) are aware that the children/young people are in their area. It is then the responsibility of these practitioners to ensure that they are registered with a GP and follow up any health issues. 13. WORKING IN PARTNERSHIP AND ENGAGING WITH FAMILIES Members of the LAC health team will endeavour to work in partnership with families and carers where possible. There may be particular circumstances where it is not possible to involve the family e.g. the young person (with capacity to consent) who lives away from home refuses to share health information with the family. If the LAC nurse is unsure whether or not to share information they can seek advice from the Nurse Adviser Child Protection for the CHP area or the paediatrician who has responsibility for the child. Advice can also be given by the designated LAC Nurse for Tayside. All team members will aim to deliver a service which may be accessed as flexibly as possible. If a child or young person is looked after away from home, the carer s views on the health of the child/young person should be sought. The service aims to be responsive to diversity and to address individual communication needs e.g. through information leaflets being made available to service users in a format which is suitable to them and the availability of an NHS Tayside translation service. 14. WORKING IN PARTNERSHIP WITH OTHERS In addition to working with colleagues from a wide range of NHS settings, LAC Nurses will work in partnership with colleagues from other agencies. It is important that they adhere to the following in working with all health and other multi-agency colleagues. LAC Nurses will work within the parameters of both professional and organisational guidance and policies e.g. Nursing & Midwifery Council (NMC) Code of Conduct (2008), NHS Tayside Informed Consent Policy and Information Governance Policy. Intranet reference http://staffnet.tayside.scot.nhs.uk/safeeffectiveworking/policies] 15. RECORD KEEPING Every LAC nurse will comply with NMC guidelines. NHS Tayside policy and any additional local level guidance on records and record keeping. All records will be maintained in accordance with NHS Tayside s Records Management Policy. Important details on retention of health records are contained within the policy and should be referred to as required intranet reference: http://staffnet.tayside.scot.nhs.uk/safeeffectiveworking/policies] Requests for access to, and copies of, child/family health records will on occasion be made to LAC nurses. Line managers should be informed of all such requests and NHS Tayside Information Governance Policy should be followed. Intranet reference: http://staffnet.tayside.scot.nhs.uk/safeeffectiveworking/policies/finance] 16. MANAGEMENT SUPERVISION LAC Nurses will be directly managed within each of their CHP s and will receive supervision from their manager. Each individual member of staff will receive a review on a 1:1 basis. The purpose of the process is to support and enable the individual staff member to achieve agreed and defined objectives of their role and to ensure clarity regarding accountabilities and responsibilities of the role held. Service specification for Tayside LAC Nursing Service Page 8
17. CHILD PROTECTION CASE SUPERVISION Case supervision for LAAC nurses will be provided by the Nurse Adviser for Child Protection or other senior practitioner trained in case supervision. The process followed and responsibilities of each party are clearly described within NHS Tayside s Child Protection Case Supervision Policy http://staffnet.tayside.scot.nhs.uk/ourwebsites/childprotection/index.htm 18. CHILD PROTECTION All NHS Tayside staff have responsibilities in relation to protecting children. NHS Tayside s Child Protection Multi-agency Guidance provides comprehensive guidance on these responsibilities and associated actions. LAC Nurses/Public Health Nurses will require to work together with other agencies to be proactive in responding to the care and protection needs of children. This role involves planning, implementing and evaluating integrated care plans for children who are at risk of harm, attending and contributing to child protection case conferences/core groups, IRD/LAC review meetings and effectively communicating and liaising in an inter-agency manner. LAC Nurses will be familiar with and adhere to the following policies and procedures whilst undertaking their role. All of these documents can be accessed on the NHS Tayside Intranet. Working with the Scottish Children s Reporter Administration (SCRA) o The Role of the Reporter at Hearings o Process of tracking SCRA referrals & reports Working within a Multi-agency Context o Pre-Referral Screening Multi Agency Protocol Working within the Health context o NHS Tayside Policy for Unborn Babies/Child in Need o NHS Tayside Protocol for Children who FTA appointments o NHS Scotland Missing Family Alert Protocol (2006) The Nurse Adviser for Child Protection is responsible for providing mandatory case supervision as per NHS Tayside Policy and will promote best practice in relation to record keeping and report writing, supporting and advising staff development within these areas. The Nurse Adviser for Child Protection is available for staff where they are required to attend court or speak to solicitors/precognition officers involved in children in need of protection. http://staffnet.tayside.scot.nhs.uk/ourwebsites/childprotection/policiesprotocols/index.htm 19. REQUESTS FOR REPORTS LAC nurses may receive requests for reports from a range of colleagues and agencies. LAC nurses will respond to report requests timeously and will follow agreed process for the typing, signing, posting and tracking of reports Every effort should be made by the LAC nurse to share the content of any report with the family prior to the meeting, case conference or panel at which the report is to be tabled or discussed. If the LAC Nurse is unable to discuss with the family beforehand the reasons should be carefully recorded in the child/young person s health record/midis. 20. INFORMATION SHARING NHS Tayside s General Protocol for Sharing Information (2007) has been produced to guide staff on the exchange of patient/client information between colleagues across NHS Tayside, Dundee City Council, Perth & Kinross Council and Angus Council. Service specification for Tayside LAC Nursing Service Page 9
In keeping with Joint Futures and GIRFEC principles, LAC nurses will, at times, be required to share information they hold in relation to a child. The decision to share information must be made in accordance with the Data Protection Act 1998, the NMC Code 2008 and in the best interests of the child. Service specification for Tayside LAC Nursing Service Page 10
Dear Sir/Madam PLEASE USE THIS LETTER WHEN A CHILD OR YOUNG PERSON A. BECOMES LOOKED AFTER B. HAS A CHANGE IN THEIR LOOKED AFTER STATUS C. HAS A CHANGE IN DETAILS Appendix 1 CHILDREN WHO ARE LOOKED AFTER Recommendation from The Scottish Government CEL 16 (2009) document: The Director will be responsible for ensuring that Health Boards fulfil their statutory duties under the Looked After Children Regulations 1996. This will enable the Board, on the basis of information from local authority partners, to identify all Looked After children and young people and care leavers in their areas, including those who are Looked After at home and those placed from outwith their Health Board areas. Surname: DoB: Address: Forename(s) Social Work URN: Please confirm that this address may be disclosed School: GP: The child/young person named above is now: appropriate box Looked after at home In Kinship Care Looked After and Accommodated No Longer Looked After Please note the following: Medical Centre: effective from: effective from: effective from: effective from: Carer s Name: Placement Name/Agency: New Address: Please confirm that this address may be disclosed New GP: New School: Social Worker Name & Address: Other Changes (if any): Yours faithfully Name of Signatory Designation Copy to: Community Child Health, Ashludie Hospital, Monifieth, Dundee DD5 4HP Looked After Health Team: Angus Whitehills Health & Community Care Centre, Station Road, Forfar Dundee Armitstead Child Development Centre, Kings Cross, Clepington Road, Dundee. Perth Room 100, Drumhar Health Centre, North Methven Street, Perth Service specification for Tayside LAC Nursing Service Page 11
FORM LAC2 - LAC HEALTH ASSESSMENT OUTCOME & ACTION PLAN (under 12 years) Section A Health Assessment Childs Name Date of Birth/CHI Review Completion Date Action Required from Assessment Appendix 2 If yes, please ensure Section C completion Section B ALL CHSP Screening up to date Yes/N o Childhood Immunisations up to date Child Registered with a GP Child Registered with a Dentist Child requires referral to LAC Medical Team Section C Health Issue Identified / Requiring Action Action Required By When Agency/Person Responsible Child / Young Person s Wishes / Views (as appropriate) Completed By: Designation: Tel. Number: Please complete and forward to: Tay-UHB.lacdundee@nhs.net within 4 weeks of date of LAC notification.
FORM LAC 3 - LAC HEALTH ASSESSMENT OUTCOME & ACTION PLAN (aged 12 years and over) Section A Health Assessment Childs Name Date of Birth/CHI Review Completion Date Section B ALL CHSP Screening up to date Section C Mental Health Assessment Complete Yes/N o Yes/N o Childhood Immunisations up to date Advice Given on Sexual health Child Registered with a GP Advice Given on Mental Health Services Child Registered with a Dentist Action Required from Assessment Appendix 3 Child requires referral to LAC Medical Team If yes, please ensure Section D completion Advice Given on Substance misuse TBC Section D Health Issue Identified / Requiring Action Action Required By When Agency/Person Responsible Child / Young Person s Wishes / Views Completed By: Designation: Tel Number: Please complete and forward to: Tay-UHB.lacdundee@nhs.net within 4 weeks of date of LAC notification
References NHS Tayside Child Protection Policy (2009) Scottish Government (2007) Better Health, Better Care: Action Plan Scottish Government (2008) Early Years Framework Scottish Executive (2006) Getting it right for every child NMC (2008) The Code; Standards of conduct, performance and ethics for nurses and midwives NHS Tayside Informed Consent Policy (2008) NHS Tayside Information Governance Strategy and Policy (2009) NMC (2005) Guidelines for records and record keeping NHS Tayside Records Management Policy (2009) Butterworth T & Faugier J (1992) Clinical Supervision and Mentorship in Nursing Chapman & Hall, London NHS Tayside s General Protocol for Sharing Information (2007) Data Protection Act (1998) Social Work Inspection Agency (SWIA) (2006) Extraordinary lives creating a positive future for Looked After Children and Young People in Scotland Blackwell, Edinburgh. Angus Council (2009) Getting it Right for Looked after Children in Angus. A Corporate Parenting Strategy Scottish Government 2007 Looked after Children and Young People We can and must do better. www.ltscotland.org.uk/lookedafterchildren