Guidance on Health Assessments and Health Plans

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 secure KCC email 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 CoramBAAF 'Initial Health Assessment Form' (CoramBAAF IHA forms (0-9 years or 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 9: On-going 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 CoramBAAF Consent form is to be completed, by the birth parent of child/young person or agency/other adult with parental responsibilities for obtaining and sharing of health information. (Please note this is additional consent to the Health Assessment being undertaken). See CoramBAAF 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 into the health section on Liberi - see Liberi Guidance to Record Health and Dental Assessments.

The health professional conducting the assessment will complete a relevant CoramBAAF 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 2: Adoption Health Pathway 2019 - Information for Child's Social Worker and Adoption Service.

If a child has not had an Initial Health Assessment the child's social worker should follow the guidance in Section 2, Child's Initial Health Assessments 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.

If the child has had an IHA completed and the plan changes to adoption the CIC Social Worker (CICSW) requests a MAR Part 1 from KCHFT LAC admin hub (see checklist for requesting MAR Part 1) using a MAR Part 1 request form. Please allow a minimum of 3 weeks for this to be returned. KCHFT LAC admin hub request MAR Part 1 to be completed by Medical Adviser (MA) in same team as child is placed and KCHFT LAC admin hub sends all required reports and forms to identified MA (SW cover letter, child's IHA or paediatric assessment, any RHAs, Coram BAAF PH, M & B if available and any other relevant reports e.g. acute paediatrics, therapists). See Appendix 7: Decision to Proceed with Adoption - Flowchart.

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.

The MA completes MAR Part 1 and becomes child's Named MA (see MA guidance on completing MAR). If the child is placed out of Kent, then the Medical Adviser (MA) covering the area from which the child moved out shall complete the MAR Part 1 and become the child's Named MA. See Appendix 3: Medical Advisers Report (MAR) Part 1 Request Form.

The MAR Part 1 is to be used for the ADM Meeting (and at Panel if relinquished baby).

Timeframe between MAR Part 1 request and completed MAR Part 1 is 3 weeks.

Medical Adviser Report (MAR) Part 1:

This is a short summary that accompanies the child's previous health assessments and outlines the main health factors that need to be taken into consideration by the Agency Decision Maker (ADM) in making the decision that adoption is the best plan for the child and also by the family finding team to assist in finding appropriate prospective adopters for the child. It also includes a health action plan that identifies any actions that are required prior to an adoption match.

As soon as adoption becomes child's proposed plan, a Medical Adviser Report Part 1 (MAR Part 1) is requested from the KCHFT LAC admin hub. The MAR Part 1 replaces the need for a child to have an 'Initial Adoption Medical or report' or 'Medical Adviser report' and it will clearly articulate for the ADM the key issues to be taken into account from a health perspective in permanency plans. A secondary aim of the MAR Part 1 is to provide robust health information to inform family finding and for prospective adopters at the 'finding' stage of the adoption process.

Requesting a Medical Adviser Report (MAR) Part 1:

To request a MAR Part 1 the child's social worker will send the following to the KCHFT LAC Admin team with a completed MAR Part 1 request: See Appendix 3: Medical Advisers Report (MAR) Part 1 Request Form:

• Cover letter indicating outcome of LAC review and why child's plan is now adoption;
• A copy of the core assessment or child and family assessment;
• Completed Coram BAAF Paternal PH form if available and if not available this must be requested;
• Completed Coram BAAF Maternal PH form if available and if not available this must be requested;
• Completed Coram BAAF Form M, if available and if not available this must be requested;
• Completed Coram BAAF Form B, if available and if not available this must be requested;
• Any other health reports or expert reports.

To ensure that a child's needs are fully understood, it is vital to have information about the child's family history, pregnancy, birth and experiences to date. A lack of background information significantly affects the quality of medical advice that can be given. Missing information at this stage can lead to gaps in the medical advice given and may cause delay in the process.

The request and accompanying paperwork should be sent to kcht.vsklacinitial@nhs.net.

PLEASE ALLOW AT LEAST 3 WEEKS FOR THE RETURN OF THE COMPLETED MAR PART 1 REPORT.

Admin will pass this MAR Part 1 request onto the Medical Adviser who covers the area in which the child is resident who will then complete MAR Part 1. This will be sent by the KCHFT LAC Admin hub back to the child's social worker to be included in the papers for the ADM decision and, if the decision is made that adoption is the child's plan, then subsequently for discussion with prospective adopters as part of family finding. This Medical Adviser will then become the child's Named Medical Adviser.

Once social workers receive a copy of the completed MAR Part 1 they will need to check through the section called 'Health Actions Identified Prior to a Match' and complete any tasks allocated to you. These tasks will typically be related to outstanding information required.

The Named Medical Adviser:

• The completion of a MAR Part 1 triggers Health to allocate a Named Medical Adviser to the child. The Named Medical Adviser is usually the MA who covers the region in which the child is currently resident (or if placed out of Kent where they were resident prior to moving out);
• The Named Medical Adviser should be indicated on all electronic databases and will be made clear on the MAR Part 1 and all subsequent paperwork. If the child moves the Named MA may need to change (to be discussed between the MAs) and any change will then need to be updated on systems and you would be informed;
• If there are queries about child's health, the Named MA is the point of contact and provides ownership/leadership to decisions such as need for BBI screening;
• The provider will ensure there is cover by a suitable trained colleague when the Named MA is on leave to ensure there is no delay in providing Medical Advice. There is an Escalation process if there are issues with availability of the MA. The first point of contact for social care would be to the Named Doctor for Looked After Children in the provider (contact details via the KCHFT LAC admin hub).

Parallel Planning:

Social care may indicate that they are 'parallel planning' at the time of the IHA request. With the previous pathway, this would have triggered a request for an 'Initial Adoption Medical' at the same time as the IHA. Now, this means that the SW will need to request a MAR Part 1, using the request form at the same time as the IHA. This means that the IHA should be undertaken by a Medical Adviser or experienced doctor and that they should complete a MAR Part 1 report in addition to the usual IHA report.

Child's Plan for Adoption is agreed by ADM/Placement Order Granted.

See Appendix 8: Adoption Plan Agreed with ADM.

CICSW request a MAR Part 2 to be completed by sending to KCHFT LAC admin hub a MAR Part 2 request form and all required reports and forms (Coram BAAF PH, M & B, IHA Paediatric assessment on any RHAs, CPR and any expert reports and any other relevant reports e.g. acute paediatrics, therapists). Please allow a minimum of 4 weeks for this to be returned.

Named MA confirms that a face to face AMA is required (based on timescales and/or clinical need. Named MA completes face to face AMA (see MA guidance on undertaking AMA) if required and then produces MAR Part 2 as a comprehensive up to date Adoption Medical report.

KCHFT Lac admin will send MAR Part 2 to SW who can share with prospective adopters.

If the baby is in a 'Foster to Adopt' placement then a request for an extended AMA appointment can be made so the findings can be discussed with prospective adopters. Alternatively an appointment for further Prospective Adopter meeting should be made as soon as possible through the normal route.

Requesting Medical Adviser Report (MAR) Part 2:

Once the ADM as agreed a plan for adoption, Health must be notified to ensure that the subsequent health requirements are in place in a timely manner to avoid any delay in matching. To do this a MAR Part 2 request form should be completed and sent to the KCHFT LAC admin hub.

The request and accompanying paperwork should be sent to kcht.vsklacinitial@nhs.net.

To ensure that an up to date account can be given of the child's health, development and behaviour, the child may need to be seen again for an Adoption Medical Assessment (AMA). The need for this will depend on the age of the child, the time period since the IHA and when a Matching Panel is likely to take place. This is to ensure that information provided on health for the matching stage is as up to date as possible and takes into account developmental progress. This is particularly relevant to very young babies who may have had their IHA performed at only a few weeks of age when developmental requirements are limited.

As soon as the ADM has decided that adoption is the agreed plan for the child, Health needs to be notified and requests made for a MAR Part 2. The Named MA will confirm the need for an AMA and will indicate this need on the MAR Part 2 request form. A child must have had a medical assessment within 3 months of the proposed date of Matching Panel if they are under the age of 12 months and otherwise within 6 months.

The MAR Part 2 Request Form:

The child's social worker should complete Part A should indicating whether a link has been identified and the proposed matching Panel date. The request form then needs to be sent to kcht.vsklacinitial@nhs.net with any additional background information that is now available. At this stage it is essential that the Named Medical Adviser has a copy of the child's permanence report (CPR) and this will need to be sent in with the MAR Part 2 request if not previously made available.

PLEASE ALLOW AT LEAST 4 WEEKS FOR THE RETURN OF THE COMPLETED MAR PART 2 REPORT.

Unless the MAR Part 2 stage has been completed, it will not be possible to proceed to arranging a meeting between prospective adopters and the Medical Adviser (except in the case of Foster to Adopt when an early meeting should be requested) or to proceed to an adoption match at Panel. 

The Named MA will complete Part B of the MAR Part 2 request form, making the decision as to whether a face to face adoption medical assessment (AMA) is required. The Named MA should also indicate when an AMA would become due in case there is any delay in the next stage of the process. For example: A MAR Part 2 is requested in January 2019 following an ADM decision in late December 2018. The child is a 9 month old baby who had their IHA in October 2018. Given the child's age they will need an AMA because the child will need to have been seen within 3 months of the Matching Panel. Assuming the child is seen on 29th Jan 2019 the child's MAR Part 2 will then be 'in date' for a Matching Panel to be held at any time up until 29th April. After this time the child would need to be seen again.

The Named Medical Adviser will confirm if an AMA is required and if required this will be booked. If the time period between IHA/PA and the likely date for a Matching Panel is very short (less than 3 months in a child a year of age or younger or within 6 months) then it may not be required but this would be an exception, decided upon by the Named MA.

The Adoption Medical Assessment (AMA):

This is a face to face assessment of the child and must be done no more than 3 months before Matching Panel if the child is a year or younger and no more than 6 months before Matching Panel if the child is older than a year. This is to ensure that up to date information on the child's health, development and behaviour is available for prospective adopters and for the Matching Panel. The Medical Adviser will use the information gathered from the AMA, any RHAs undertaken and other health information gathered to date to produce the MAR Part 2.

Medical Adviser Report (MAR) Part 2:

The MAR Part 2 is a comprehensive adoption health report that provides the most up to date information about the child's health, including the outcome of the AMA. This includes a summary of all relevant factors in the child's background and health history and includes the most recent developmental assessment (performed at IHA/PA or AMA) and also incorporates essential background information obtained from the CPR and any Coram BAAF forms (such as Form M and B) which may not have been available at the MAR Part 1 stage.

Aim of report:

• The MAR 2 is to provide robust health information about the child to the Matching Panel and to Court;
• The report will also to inform adopters of any health needs of the child that they are being matched with and facilitate healthcare provision and continuity of care for the child as they move to an adoptive placement;
• The report will need to be updated if it has been more than 3 months prior to Matching Panel for an under one year old and more than 6 months prior to Matching Panel for all other children.

Once the MAR Part 2 has been completed by the Named Medical Adviser, this will be sent to the child's social worker.

In summary the MAR Part 2 is required before any meeting between the prospective adopters and the Medical Adviser and before a Matching Panel. The Named Medical Adviser will confirm if the child requires a face to face Adoption Medical Assessment.

Link Identified

As soon as a potential link family has been identified for a child (or if child is in foster to adopt placement), the family finding social worker will complete the Health Matching Alert form (HMA), copying the child's social worker and send it to the KCHFT LAC admin hub who alert the Named MA that an adoption match is likely. This will be returned to the SW with a clear outcome, this will trigger a prospective adopter meeting (PAM). The PAM is arranged at this stage. PAM held and any other clinical expert meetings (see MA guidance on undertaking PAM) and report outlining discussions (PAMR) produced by MA.

MAR Part 2 and PAMR available for Matching Panel.

Health Matching Alert Form (HMA) & Prospective Adopter Meeting (PAM):

Once a family have been linked to a child and it seems likely that there will be an adoption match, then the family finding social worker will need to request a meeting for the prospective adopters with the Medical Adviser (PAM) and alert Health that an adoption match is imminent. This is done by completing a Health Matching Alert Form (HMA).

The family finding social worker sends a completed HMA to KCHFT LAC admin. This provides a final checking stage. A Medical Adviser cannot be expected to meet with prospective adopters without having sight of the child's CPR. This should have been sent prior to the MAR Part 2 being produced but if it was not, it MUST now be sent.

KCHFT LAC admin arrange the meeting directly with prospective adopters and will liaise with the child's social worker and the family finding social worker regarding the appointment. It is really important that the child's social worker or an adoption social worker is present at this meeting to provide support to the prospective adopters and to be aware of what has been shared with them.

PLEASE ALLOW AT LEAST 3 WEEKS TO ARRANGE A PROSPECTIVE ADOPTER MEETING.

Once the Medical Adviser has met with the prospective adopters a PAM Report outling the discussions held (PAMR) will be produced and shared with the child's SW and the family finding SW (to also be given to the prospective adopters).

Matching Meeting

Chair of the meeting to confirm that the HMA form has been submitted and a MAR Part 2 is in process and the PAM has been arranged.

Matching Panel

Before a child's case can be heard at Panel, it is essential to have the following from Health:

• MAR Part 2;
• PAM Report.

If there has been sufficient time allowed in requesting the MAR Part 2 (4 weeks) and PAM (3 weeks) then there should be no difficulties completing the reports and submitting typed reports before Panel. Matching Panel should not proceed without a typed Adoption Medical Report (MAR Part 2). In the unusual case of a very short time frame between the PAM and Matching Panel then the PAMR may be submitted on day of Panel or as a scanned handwritten report (to be typed at a later date) submitted. The MAR Part 2 and PAMR together comprise a comprehensive summary of the health and development of the child and clearly articulate the information that has been given to the prospective adopters before Panel.

Ideally the Named MA will be present at Panel, recognising this is not always possible, a substitute MA will be present. If the MA attending Panel has any health concerns that come to light about the case (through reading Panel papers), they must have a pre-Panel discussion with the Named MA to avoid sensitive professional discussions in front of prospective adopters. If any new health actions arise as a result of Panel discussion, then the child's Named Medical Adviser must be informed and an agreement made as to who is best placed to action the next steps (normally this should be the Named MA).

CAPTION: terminology table

MA = Medical Adviser	MAR = Medical Adviser Report
AMA = Adoption Medical Assessment	PAM = Prospective Adopter Meeting
PAMR = Prospective Adopter Meeting Report

Escalation Process

• If issues arise regarding the receipt of the MAR Part 2 or PAMR in time for the Panel Admin to distribute prior to Matching Panel, then the Named MA will be contacted by Adoption Panel Admin via the KCHFT LAC admin hub;
• If there is an issue with availability of the Named MA at Panel then the Named Doctor for Looked After Children for the Provider should be immediately contacted to assist with resolution. The Named Doctor for Looked After Children has a role in supervision of the Medical Advisers;
• If the Named Doctor for Looked After Children cannot resolve the issue then they should escalate immediately to their Clinical Lead / Director and can also contact the Designated Doctor for Looked After Children for advice.

Post Panel Admin:

Once a child is placed with their prospective adopters the child's SW MUST write to KCHFT LAC admin with details of the placement and new GP details so that Health can send relevant health information (including MAR Part 2 and PAMR) onto the new GP.

Review health assessments (RHA)

All Looked after Children, irrespective of whether their plan is for adoption will have a statutory review health assessment with one of the KCHFT Specialist Looked after Children nurses (every 6 months if of the child is 5 years and under and otherwise every 12 months), until an adoption order is granted. The child enters Review Health Assessment Nurse led process for Looked after Children following an Initial Health Assessment. Once the child is on the Adoption pathway, the social worker requests RHA using the following email address: kentchft.lacram@nhs.net. Request should be made for an RHA (Adoption – non-placed) or an RHA (Adoption – placed) as appropriate - in order to indicate to Health whether the child is placed with prospective adopters.

Key Step for Social Workers:

1. Request IHAs and any subsequent RHAs as for any LAC;
2. Once adoption is plan, request MAR Part 1 (Allow 3 weeks);
3. Request MAR Part 2 by completing Part A of MAR Part 2 Request form (Allow 4 weeks);
4. Once family identified, complete HMA to arrange PAM (Allow 3 weeks);
5. Attend PAM;
6. Post placement, send new address & GP information to KCHFT LAC admin team;
7. Request post placement RHA, if required, as for any LAC.

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.

Information should also be given about any allergies. See also Health and Safety Procedure.

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 secure KCC email account.

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

Appendices

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

Appendix 2: Adoption Health Pathway 2019 - Information for Child's Social Worker and Adoption Service

Appendix 3: Medical Advisers Report (MAR) Part 1 Request 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: Medical Advisers Report (MAR) Part 2 Request Form

Appendix 7: Decision to Proceed with Adoption - Flowchart

Appendix 8: Adoption Plan Agreed with ADM

Appendix 9: On-going Delegated Consent to Routine Health and Dental Assessments

Appendix 10: Notification of Plan for Adoption Letter