Guidance for Social Workers Regarding Review Health Assessments Requests for Children and Young People

1. Process for Requesting Review Health Assessments for Children and Young People Looked After by Kent County Council

Local authorities have a statutory responsibility to ensure that all children and young people in care have an Initial and Review Health Assessments and an effective health action plan in place. The frequency of health assessments is set out in Guidance on Health Assessments and Health Plans, Frequency of Health Assessments. This chapter should be read in conjunction with Statutory Guidance on Promoting the Health and Well-being of Looked After Children (DH).

2. Review Health Assessments for Kent Children and Young People in Care Placed in Kent

1. 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 for child whose Care Plan is adoption should be sent to kentchft.lacram@nhs.net from a KCC secure email account;
2. Children whose Care Plan is not 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.vsklacinitial@nhs.net;
3. See Guidance on Health Assessments and Health Plans, Appendix 1: Process for Requesting Health Assessment for Children in Care - Flowchart and Guidance on Health Assessments and Health Plans, Appendix 6: Medical Advisers Report (MAR) Part 2 Request Form and Guidance on Health Assessments and Health Plans, Appendix 7: Decision to Proceed with Adoption - Flowchart;
4. The request for a review health assessment should be submitted 12 weeks in advance of the review being due;
5. The request to complete the Strength and Difficulties Questionnaire will be made directly to the parent / carer at the time the letter of appointment is sent to them by the health admin team (guidance attached as Appendix A: Strengths and Difficulties Questionnaire) if the child is aged 4-16 at the time the health assessment is due. The SDQ will be sent to the allocated social worker for completion in respect of young people aged below 17 years who are living independently or who are placed with parents on interim or care orders;
6. The Children in Care nursing team in Health will e-mail the social worker and the lead administration officer in the district social care team a copy of the appointment letter. If a child or young person in care declines a health assessment their Social Worker will be notified and if appropriate, the young person will be contacted by the Children in Care nursing team in health, who will then decide if it is appropriate to arrange a home visit;
7. On completion of the review health assessment a copy will be emailed to the social worker's admin shared email account and a copy uploaded to the child's health section on Liberia;
8. The health Care Plan and summary will be inserted into Liberi by the health admin team. The social worker / lead admin of each district can access copies and can forward these to the Independent Reviewing Officer for consideration at the Child in Care Review;
9. On completion of the review health assessment all relevant referrals will be made by the Children and young person's in Care nurse undertaking the assessment, and in instances where a CYMHS / Accent referral is required the Children in Care nurse will liaise with the case holding social worker to ensure that a referral is made and may contact the Children and Young Peoples Services, Children in Care Services. Information about this service and how to make a referral can be accessed via Kent Children and Young People's Mental Health Service (CYPMHS);
10. The Child in Care nurse will follow up on onward referrals and will act as a health advocate for the child / young person to resolve any health issues;
11. The foster carer and social worker have a responsibility for all children they look after, especially for Children in Care under 5 years old to ensure that the Child in Care Nursing Team are advised of any change of placement for a child;
12. Any change to an appointment that has been offered should be negotiated in advance directly with the Children in Care nursing team to avoid cancellation at short notice or a DNA (Did Not Attend), allowing for the appointment to be offered to another child / young person and arrange another appointment to ensure the child has a review health assessment in line with statutory timescales.

3. For Kent Children and Young People in Care Placed Out of Kent including Medway

1. Requests for all review health assessment in respect of Kent Children and young people in Foster care (where the plan is not adoption) placed outside of Kent should be made to kxht.OLALAC@nhs.net. Requests for all Review Health Assessments for children that the plan is adoption should be sent to kcht.OLALAC@nhs.net from a KCC secure email account;
2. The Children in Care nursing team work with the social worker to ensure that the child's health assessment takes place;
3. On notification by the social worker to the Children in Care Nursing Team that a child or young person in care or a young person leaving care is moving out of the Health Trust area the Children in Care's nursing team will be responsible for a transfer of health information to the new health trust where the child will be resident.

Appendix A: Strengths and Difficulties Questionnaire

Since April 2008 all local authorities in England have been required to provide information on the psychological and emotional health of Children in Care, and specifically emotional and behavioural difficulties. This information needs to be collected using a Strengths and Difficulties questionnaire (SDQ). This is a widely used tool for assessing a child's emotional wellbeing, looking at the likelihood of problems being already present or of developing in the future. 

All children or young people aged between 4 and 16 years old inclusive must have a questionnaire completed by their main carer and should be aligned to the health assessment. The request to complete the SDQ will be made directly to the parent / carer at the time the letter of appointment is sent to them by the VSK nursing team. The allocated social worker will be asked to complete the form in respect of young people aged below 17 years who are living independently.

The questionnaire asks the carer to read various statements and then judge how well it describes the young person living with them. The answers are given by ticking one of 3-4 boxes for each question. On average this should only take the carer between 5-10 minutes to complete.

An administrative officer within the VSK will input the information from the SDQ onto a national computer data base which analyses the data and produces a total score. The score will then be input by this person on to Liberi. If the score is identified as being of concern (as per the SDQ guidance) triangulation will be requested which will result in the VSK contacting the school to request completion of the teacher's questionnaire. Notification will also be sent to the child's social worker with a request for the young person's questionnaire to be completed if they are aged 11 years or over.

A triangulated approach will provide a more rounded picture of the young person and enable a decision to be made about what if any further services they may need to address the difficulties identified.

The SDQ information will be considered within the health assessment by the Children in Care nurse. The health assessment, health plan with recommendations, the SDQ form and score will be sent to the social worker. The SDQ and the scoring sheet should be filed in the child / young person's case record.

The SDQ guidance and forms can be found on Kent Trust Web and the on the VSK website.

Appendix B: SDQ Flowchart

Click here to view Appendix B: SDQ Flowchart (Forms/Practice Guidance).