Looked After Children

The Initial Health Assessment (IHA)

• Conducted by a doctor, or, in some cases, a Paediatric Advanced Nurse Practitioner. 
• Held in a clinic at Northampton General Hospital or St Mary’s Hospital in Kettering.
• Depending on the circumstances, the birth parents and/or carers will be invited.  The Social Worker is always aware of the appointment and invited to attend.
• The child/young person’s medical history will be recorded, their height and weight will be measured and, if willing, they will be examined. 
• The IHA gives the opportunity for as much information regarding past and present health to be obtained and will result in the formulation of an action plan to ensure that all health needs are fully met.  This may include referral to other services or recommendation of actions which will need to be followed-up by the carers, other health professionals or the Social Worker.

The Review Health Assessment (RHA)

• Most RHAs will be undertaken by a LAC Nurse or the child’s Health Visitor (if they have not yet started school)
• The RHA may be held in a clinic setting, at school/college or in the home
• The team will try to ensure a degree of continuity and, if possible, the same nurse will see the LAC for subsequent assessments. 
• Growth will be checked if the child/young person is willing but they will not be asked to undress (other than heavy outer garments e.g. coats, hoodies), they will not have a physical examination, investigations or treatments e.g. blood tests or vaccinations.  
• If a child/young person is living outside Northamptonshire, their case will be looked at individually and, in some cases a Northamptonshire LAC Nurse will travel to visit them or, if more appropriate, a local LAC nurse may be asked to conduct the RHA on the team’s behalf. 
• The assessment is holistic and includes physical health, emotional wellbeing and health promotion. 
• If appropriate, the carer and child/young person will have the opportunity to be seen on their own for at least part of the assessment to discuss any sensitive issues
• If a young person chooses to attend their RHA independently or to be seen in school or college, the carer will still need to contribute to the RHA (possibly by telephone) to discussing their impressions of the young person, any concerns, to give an update on their physical, behavioural and emotional health and to provide dates of any medical, dental or optician’s appointments attended. 
• A Lead Health Professional is allocated for each LAC to be a named contact in the NHS for the social worker, carers and for young people themselves for advice andinformation on health concerns and services, and in particular where there are any difficulties in accessing health services.
• Health Visitors are the Lead Health Professionals for Children of pre-school age.  LAC Nurses are the primary Lead Health Professionals for all other Looked after Children although there may be occasions when the role may sit with a member of the LAC Mental Health Team or a Special School Nurse (in the case of a child having an Education, Health and Care Plan).  In these cases and when this health professional has an on-going positive relationship with the child/young person or sees them on a regular basis, they may be involved in conducting some or all of the RHA, to avoid the need for the LAC to attend an additional appointment .
• Carers should maintain and have easy access to a health record for the LAC in their care.  This should include any significant health event e.g. periods of illness, and details of any health appointments attended including the date seen, where the child was seen and by whom.
• The child/young people should be given every encouragement to attend and reassured that it is “their time” and an opportunity to have a chat about their health, ask any questions, seek advice and see how much they have grown!
• It is important to let us know if the LAC has recently had a medical e.g. a permanence medical, or seen a paediatrician or other specialist.  It may be possible for us to access a report from that appointment and, if the LAC and carer would prefer, we can then simply conduct a telephone update to ensure that there have been no health changes or new concerns.  This can avoid the need for repeated medical appointments.

Six weeks after the RHA the LAC Delivery Support Administrator will contact carers to ensure that they have received a copy of the Action Plan and to discuss its progress. If there are any difficulties with the action points, the Lead Health Professional is contacted to assist or give support.

In some circumstances, a Northamptonshire LAC Nurse will be asked to conduct the RHA for children who are placed within the county by other local authorities.  If this is the case, the full report will then be returned to the originating health authority who remain responsible for the child’s overall care and will pass the summary and health recommendations to the Social Worker to ensure that it they are progressed.

When a child/young person changes placement, as much medical information as possible should be passed on to the new carers to ensure that all health needs continue to be met.  This should include copies of all Health Action Plans held, details of any on-going medical care or appointments required and dates when the LAC was last seen by the dentist and optician.

Here’s how you can help us:

• Keep accurate records of any health issues or appointments your child/young person has had
• Be flexible around appointment times but ensure we are aware of any preferences or reservations
• Let us know if an interpreter is required or whether you would predict any other issues regarding the appointment
• Explain to your child/young person that their Health Assessments are “their time” to be able to discuss any concerns or ask questions
• Support attendance at appointments but accept that many young people prefer to be seen alone although your input will still be required to provide appointment details etc. and your impression of how the young person is getting on
• Ensure that any actions identified at health assessments are followed up and contact our team if you are having any difficulties in doing so.

We offer support for parents/ carers of children who are looked after, adopted or under a special guardianship order.

To access support from the team a referral would need to be made to the team this can be made via a professional such as GP or social worker.

Following the acceptance of a referral a consultation or initial assessment appointment would be made to discuss the current situation and what support you think you/ young person may need. All consultations and initial assessments are discussed at a team meeting to agree on what should happen next. Usually the most appropriate outcome is for you to attend our managing behaviour with attachment in mind group. (See leaflet)

Following the group a review appointment is offered to see if there is further support required, this can come in a variety of formats:

• Initial assessment with young person
• Cognitive Assessments

• 1:1 with the child working with attachment as the focus, such as
  • Anxiety
  • Self Esteem
  • Trauma
  • Emotional Regulation
• Family Work
  • Intensive work within the home
  • MBAM 1:1
  • Groups – self soothing, stories
  • Theraplay
  • DDP (Dyadic Developmental Psychotherapy)

The team also has ‘LAC duty line’ this line is staffed by a senior clinician who will be available to take calls to respond to queries, request advice or if you have any concerns. Please see our contact details tab.

Here’s how you can help us:

• Be flexible around appointment times but ensure we are aware of any preferences or reservations.
• Let us know if an interpreter is required or whether you would predict any other issues regarding the appointment.
• Explain to your child/young person why they are attending the appointment
• Support attendance at appointments but understand that we often ask to see young people on their own to ensure that their voice is being heard.
• If you are unable to attend to an appointment please let us know.