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5.5.1 Guidance on Health Assessments and Health Plans

SCOPE OF THIS CHAPTER

This procedure applies to all Children in Care. Note, however, that as from 3 December 2012, all children remanded other than on bail will be Looked After Children. Different provisions will apply in relation to those children/young people.

This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for Children in Care.

This chapter should be read in conjunction with Statutory Guidance on Promoting the Health and Well-being of Looked After Children (DH).

RELATED CHAPTER

Guidance for Social Workers Regarding Review Health Assessment Requests for Children and Young People Looked After by Kent County Council

RELATED GUIDANCE

General Medical Council Protecting Children and Young People - The Responsibilities of All Doctors

AMENDMENT

This chapter was updated in March 2016 to include a link to the statutory guidance Promoting the Health and Welfare of Looked After Children (March 2015).


Contents

  1. Health Assessments
  2. Child’s Initial Health Assessments
  3. Child’s Care Plan is Adoption
  4. Health Action Plans
  5. Review Health Assessments – (children not in the adoption process)

    Appendix 1: Process for Requesting Health Assessment for Children in Care - Flowchart

    Appendix 2: (A) Copy of BAAF IHA forms (0-9 years)

    Appendix 2: (B) Copy of BAAF IHA forms (10 years and older)

    Appendix 3: Additional BAAF consent form (PH Form)


    Appendix 4: Copy of covering letter requesting M/B, M/B form

    Appendix 5: List of Names and Addresses of Obstetric Departments from where M/B Forms are requested

    Appendix 6: (A) Copy of BAAF Adoption IHA Form (0-9 years)

    Appendix 6: (B) Copy of BAAF Adoption IHA Form (10 years and older)

    Appendix 7: (A) Copy of BAAF RHA Forms (0-9 years)

    Appendix 7: (B) Copy of BAAF RHA Forms (10 years and older)

    Appendix 8: On-going Delegated Consent to Routine Health and Dental Assessments

    Appendix 9: Notification of Plan for Adoption Letter


1. Health Assessments

The purpose of Health Assessments is to promote children’s physical and mental health and to inform the child’s Health Action Plan.

1.1 Frequency of Health Assessments

Every Child in Care must have a Health Assessment at specified intervals as set out below:

  • The first Assessment (Initial Health Assessment IHA) must be conducted within 20 working days of a child coming into care - in time for the Health Action Plan to be available before or at the child's first Child in Care Review (unless one has been completed within the previous 3 months);
  • For children under five years, further Health  Assessments should occur at least once every six months;
  • For children aged over five years, further Health Assessments should occur at least annually.

If a child is transferred from one Child in Care Placement to another, it is not necessary to plan an assessment within the first month. In these circumstances, the Social Worker should provide the carer/residential staff with a copy of the child's Health Action Plan.

If no plan exists, the Social Worker should arrange an assessment within a month of the placement so that a plan can be drawn up.

1.2 Who Carries out Health Assessments?

The first Health Assessments (Initial Health Assessment IHA) must be conducted by a registered medical practitioner. Subsequent assessments in Kent will be carried out by a registered nurse, unless the plan is adoption for the child where medical advice should be sought from the medical advisor as to who would be the best person to undertake the Health Assessment. The relevant medical professional will provide the Social Worker with a written report. (See Section 1.3, Arranging Health Assessments below).

1.3 Arranging Health Assessments

(See Appendix 1: Process for Requesting Health Assessment for Children in Care - Flowchart for process and paperwork required).


2. Child’s Initial Health Assessments

The Social Worker/Lead Administration officer within SCS should liaise with and make a request for an Initial Health Assessment electronically kcht.vsklacinitial@nhs.net from a GCSX account – see Appendix 1: Process for Requesting Health Assessment for Children in Care - Flowchart) within five working days of a child coming into care. The date the request is submitted must be recorded onto the health section of Liberi on the same day - see Liberi Guidance to Record Health and Dental Assessments.

Before a Health Assessment takes place, social workers must fully complete Part A of the age appropriate BAAF 'Initial Health Assessment Form'. See Appendix 2: (A) Copy of BAAF IHA forms (0-9 years and Appendix 2: (B) Copy of BAAF IHA forms (10 years and older). This information must be accurate in order to avoid the form being returned for correction or further information, and the health assessment thus delayed.

In order for the Health Assessment to be conducted, the social worker must ensure that those with parental responsibility have given consent by signing the ‘On-going Delegated Consent form - see Appendix 8: Ongoing Delegated Consent to routine Health and Dental Assessments. The Consent form is enduring unless withdrawn and should go with the child if he/she changes placement. It should be held in the case file on Liberi in the document area.

If the child is on an Interim Care Order/Care Order a copy of the Interim Care Order/Care Order must be attached.

Essentially it is good practice to seek and secure parental consent whether or not there is a legal order in place, but consent should not delay a referral being made for a child who is subject to a legal order.

If the young person is aged 16 years then he/she should be asked to give consent. This can be verbal or signed consent as the examining clinician will always confirm this with the young person before undertaking the health assessment. If he/she refuses agreement the referral should still be made in order to allow the health clinicians to contact him/her to discuss the merits of having a health assessment and the reasons for reluctance. If he/she continues to refuse this should be recorded on Liberi - see Liberi Guidance to Record Health and Dental Assessments.

An additional BAAF Consent form is to be completed, by the birth parent of child/young person or agency/other adult with parental responsibility/ies for obtaining and sharing of health information. (Please note this is additional consent to the Health Assessment being undertaken). See Appendix 3: Additional BAAF consent form (PH Form). Other relevant information to be provided - e.g. core assessment / case conference report / other medical reports to enable to provide the medical practitioner with as much background information as possible.

Other relevant information should be provided such as a single assessment / case conference report or / other medical reports to provide the medical practitioner with as much background information as possible.

The responsible Social Worker and where appropriate the birth parent/previous carer should attend the IHA appointment with the child and the current foster carer, again to provide as much information as possible about the child’s medical history and current needs. The Social Worker should inform their Lead Administration Officer that the health assessment took place and the date of the assessment input in to the health section on Liberi - see Liberi Guidance to Record Health and Dental Assessments.

The health professional conducting the assessment will complete a relevant BAAF Form and a Health Action Plan. Part C of this will be emailed to the child's social worker via their admin leads GCSX account who should give appropriate copies to carers/residential staff. The completed IHA should be uploaded into the ‘document’ section on Liberi and the date the IHA took place must be added in the ‘health’ section of Liberi - see Liberi Guidance to Record Health and Dental Assessments.

Full copies of the IHA will be emailed to kcht.vsklacinitial@nhs.net – see Appendix 1: Process for Requesting Health Assessments for Children in Care - Flowchart.


3. Child’s Care Plan is Adoption

It is critical that there is a comprehensive medical report available progressing Adoption Plans for a child. The Initial Health Assessment will be used and enhanced to ensure all relevant medical information available is incorporated in to a written summary for the purpose of informing and advising prospective adopters and the adoption panel about the health and development of the child taking into account the likely prognosis of any risk factors in the child's health history. This will be regarded as the child’s adoption medical report and the date of this should be entered on Liberi as the Initial Adoption Medical (IAM) - see Liberi Guidance to Record Health and Dental Assessments.

It is therefore essential that the Adoption Medical Advisors are able to secure access to comprehensive information on a child to provide appropriate and timely advice to the Agency Decision Maker when considering whether a child should be placed for adoption, to ensure an appropriate match, and to assist prospective adopters to have a clear picture in mind while making a decision. See Appendix 1: Process for Requesting Health Assessment for Children in Care - Flowchart.

3.1 If a child has not had an Initial Health Assessment the child’s social worker should follow the guidance in Section 2 and state clearly on the form that there is a plan for adoption and apply for completion of MB forms. If the child was born at home, the Form should be sent to the mother's GP. See Appendix 4: Copy of covering letter requesting M/B, M/B form and Appendix 5: List of Names and Addresses of Obstetric Departments from where M/B Forms are requested.
3.2 If the child has had an IHA completed and the plan changes to adoption the SW’s Admin must submit the Notification of Plan for Adoption letter to kcht.vsklacinitial@nhs.net together with the completed M & B, previously completed IHA and any other relevant documentation. See Appendix 9: Notification of Plan for Adoption Letter. The IHA and Adoption Administrator will seek  advice from the Medical Advisor for the social worker on whether  another medical assessment is required (this may occur if there has been a substantial time lapse since completion of the IHA and/or if there are any significant health concerns) and who should conduct the medical and whether any test or opinions are required. (In some cases, the Medical advisor may consider that there is already sufficient up to date health information on the child and a further medical examination is not required). The IHA and Adoption Administrator will track and monitor all requests.
3.3 MB forms are important records for the medical adviser who is responsible for producing a written summary of health matters pertaining to the child requested by the Agency Decision Maker. However, an absence of this information will cause a delay in writing of the report required for the ADM to consider whether the adoption plan is appropriate but they are required by the medical adviser when informing the adoption panel and the ADM of a suitable ‘Match’ of the child with prospective adopters.
3.4 The Medical Advisor will provide a "Summary to Agency Advisor" and a copy of an updated health assessment if one has been completed. This will be shared with the Adoption Panel and Agency Decision Maker.
3.5 The child's social worker must seek the cooperation of both birth parents to provide written consent to the disclosure of medical information if this has not already been provided, including obtaining their consent to the Medical Advisor approaching their GP if necessary, as well as obtaining their written consent to the obstetric report on the mother and neo-natal report on the child.
3.6 The importance of the disclosure of medical information must be explained to the parents but where the parents refuse to sign consent forms, the social worker must complete as much as possible on the relevant forms, record the attempts made to engage the parents and the reasons for refusal in the child's file and Adoption Case Record, and inform the Medical Advisor of the position.
3.7 The foster carer and social worker should attend the medical with the child - and if possible the birth parent or other family member should also attend in order to provide relevant medical history.
3.8 The information on the child's medical report must be kept up to date if a placement is not immediately forthcoming. This must be done twice yearly for a child aged below five and annually for a child of five and above. The Medical advisor may, however, make specific recommendations in relation to particular children. The Child in Care Administration Manager must be informed of any changes of placement.
3.9 Matching with adopters: As soon as a potential match has been identified for a child, the child’s social worker should inform the Child in Care Administration Manager who will inform the medical advisor (the same medical advisor who provided advice for the Best Interest Decision by the Agency Decision Maker). A further medical assessment may be required at this stage, depending on the time period between the best interest decision and the match. Consideration should be given to arranging a meeting between the medical advisor (or senior paediatrician who has assessed the child) and the prospective adopters prior to adoption panel.
3.10

For pre-school children who are not subject to interim care orders, the local authority's legal representative should identify at day 10 of the Public Law Outline (Case Management Hearing), whether the child needs a paediatric health assessment. If so the legal representative will raise this with the legal representatives of the other parties, to ascertain whether the parents will consent to the assessment taking place in a situation where the local authority does not share parental responsibility for the child. If the parents will not consent, then an order (e.g. interim Care Order or a specific issues order will need to be sought) to ensure that there is no unnecessary delay in advancing a final care plan of adoption. (See Forms/Signs of Safety Practice Guidance)

Consideration will be given to a paediatric health assessment of an older sibling of a pre school child if a joint adoption plan is to be proposed. The paediatric health assessment will be sufficiently detailed to inform the agency decision maker, but is not for court purposes. If a placement order is subsequently made then the social worker should submit a request for an adoption assessment following the process in Section 3.2 above.


4. Health Action Plans

For every Child in Care their Care Plan must incorporate a Health Action Plan which must be available in time for the first Child in Care Review, with arrangements as necessary incorporated into the child’s Placement Plan/Placement Information Record.

This Plan must be reviewed after each subsequent Health Assessment and at the child's Child in Care Review or as circumstances change.


5. Review Health Assessments

Children whose care plan is adoption: The health plan should be reviewed in line with the statutory review timescales. Health assessments must be undertaken twice a year for children under five years, and annually for children and young people five years and over. Requests for all review health assessment should be sent to kcht.vsklacreview@nhs.net from a GCSX account.

See Appendix 1: Process for Requesting Health Assessment for Children in Care - Flowchart and Appendix 6: (A) Copy of BAAF Adoption IHA Form (0-9 years) and Appendix 6: (B) Copy of BAAF Adoption IHA Form (10 years and older).


Appendices

Appendix 1: Process for Requesting Health Assessment for Children in Care - Flowchart

Appendix 2: (A) Copy of BAAF IHA forms (0-9 years)

Appendix 2: (B) Copy of BAAF IHA forms (10 years and older)

Appendix 3: Additional BAAF consent form (PH Form)

Appendix 4: Copy of covering letter requesting M/B, M/B form

Appendix 5: List of Names and Addresses of Obstetric Departments from where M/B Forms are requested

Appendix 6: (A) Copy of BAAF Adoption IHA Form (0-9 years)

Appendix 6: (B) Copy of BAAF Adoption IHA Form (10 years and older)

Appendix 7: (A) Copy of BAAF RHA Forms (0-9 years)

Appendix 7: (B) Copy of BAAF RHA Forms (10 years and older)

Appendix 8: On-going Delegated Consent to Routine Health and Dental Assessments

Appendix 9: Notification of Plan for Adoption Letter

End