Dorset Health Authority s1

AGENDA ITEM 5

HEALTH OF CHILDREN IN CARE IN POOLE ANNUAL REPORT April 2012 –March 2013 CONTENTS

SECTION CONTENT PAGE 1. Introduction

2. Numbers of Children Placed in Care in Bournemouth & Poole

3. Destination of LAC Leaving Care

4. Adoption

5. Initial Health Assessments

6. Key performance indicators

 Review Health Assessments  LAC placed out of Borough  Service Level Agreement (SLA)  Dental Health  Immunisations

7. Supporting Children and Young People with Disabilities

8. Diet and Obesity

9. Reducing Sexually Transmitted Diseases and Teenage Pregnancy

10. Alcohol and Substance Misuse

11. Referrals

12. Mental Health/Emotional Well-being

13. Listening to Young People: Satisfaction Survey

14. Summary of Key Areas of Development 2012/13

15. Key Areas for Development During 2013/14

16. References

2 1. INTRODUCTION 1.1 This annual report for 2012-2013 aims to review the service for the Poole Children in Care Specialist Nurse and set priorities for the coming year. This report is set out in line with the agreed Service Specification for Children & Families Looked After Children & Young People. The aims of the Children in Care Specialist Nurse Service in Poole are:

2. To co-ordinate and develop health services for children who are ‘Looked After’ or ‘in care’ across Bournemouth and Poole. 3. To have a commitment to improving the health outcomes for all children and young people in care so that they are able to reach their full potential in achieving the 5 outcomes of Every Child Matters; be healthy, stay safe, enjoy and achieve, make a positive contribution, achieve economic wellbeing.  To ensure the health and wellbeing of children in care is identified as a local priority and that all structures are in place to manage and monitor the delivery of health care for children and young people in care.  To work in partnership with statutory and voluntary services in co- ordinating additional health services to address identified complex health needs for children in care, whilst supporting access to universal health services where appropriate.

1.2 The team has also continued to adhere to the ‘Promoting the Health of Looked after Children’ guidance (2009) in its approach and ethos in practice.

1.3 The following abbreviations are used throughout the report:

 CiC Children in Care

 CiCHT Children in Care Health Team

 IHA Initial Health Assessment

 RHA Review Health Assessment

 CYPSC Children and Young People’s Social Care

 SW Social Worker

 CAMHS Child & Adolescent Mental Health Service

4. NUMBER OF CHILDREN IN CARE IN POOLE

Table 1 Number of children in care in Poole

Year 2 2 2 2 2 2 20 0 0 0 12/ 0 1 1 13 9 0 1

3 / / / 1 1 1 0 1 2

Poole 1 1 1 1 1 1 14 1 3 6 6 9 3 4

5. Following a sharp rise in the number of children in care between 2006 and 2012 the number appears to have now stabilised. 6. This is due to a number of factors; consideration re thresholds for children to be brought into care 7. High level of support and intervention offered by family support teams 8. Increased number of children being placed with extended family 9. Rapidity of adoption processes being finalised

Graph 1 No. of Poole Children in Care from April 2012 –March 2103

Although there is some fluctuation in numbers of the overall population of children in care throughout the year the base line number remains relatively stable. This can however ‘hide’ the level of movement within the child in care population.

Graph 2; ‘Ins and Outs’ April 2012-31/3/13

4 9.1 There has been a total of 70 new admissions to care in the year ending 31/3/13. Graph 2 shows the clear fluctuation in the numbers of admisions and discharges of children in care throughout the year. Of these new admissions,13 left care before the IHA could be completed and a further 17 left care within the first 12 months of their admission. This means a total of 40 children remain in care from this year’s new admissions.

9.2 The majority of the children and young people coming into care over the year have suffered some form of abuse or neglect. There have been a number of older children (aged 12+) who have suffered acute family breakdown or dysfunction. These young people have often been known to social care for a number of years and also have a history of poor childhood experiences often including neglect and domestic violence. They present with complex emotional, social and physicalhealth needs.

Table 2 Breakdownby Age and Gender of Poole Children in Care 31/3/13

9.3 There continues to be a significantly higher proportion of boys to girls in care. It is interesting to note that there are a significant number of children in the 6+

5 year’s age range, who if unable to return to their birth family are less likely to achieve permanence through adoption. They are therefore likely to spend the rest of their childhood in care. It is vital to engage with this age group to promote key health massages and to support the foster carers in the delivery of health care.

Table 3 Placement Location of Poole Children in Care 31/3/13

2.4 The vast majority of Poole Children in Care are placed within the county of Dorset. Only a small number of the total live outside Dorset which does allow for easier contact and visiting. It also lessens the need to comission nurses from other areas to complete RHAs.

10. DESTINATION OF CHILDREN AND YOUNG PEOPLE LEAVING CARE

Graph 3 Destination of Poole Children discharged from care

6 10.1 A total of 74 children and young people have left care over the year. Their ‘destination’ is shown in Graph 2. Whenever a child or young person leaves care the CiCHT liaises with the relevant health professionals to ensure continuity of health care and in some instances to ensure safegaurding concerns are monitored from a health perspective.

10.2 A child’s ‘permanence’ is decided through a clear pathway of decision making (Public Law Outline 2008) . A number of formal, multi-agency meetings take place and the CiCHT are regularly invited to attend and contribute to these decision making forums. This ensures that all health professionals involved in a child’s health care can be kept informed of permanency plans.

11. ADOPTION 11.1 About 15 children have been placed for adoption over the past year. The CiCHT have ensured that a health assessment is completed prior to the child leaving their foster placement. This ensures that current health information is available to the adoptive family and receiving health professionals.

11.2 Each child being placed for adoption is also issued with a replacement Red Book to ensure continuity of health information and to give the child an accurate health life story.

4.3 The Designated Doctor completed 20 adoption medicals during the year.

12. INITIAL HEALTH ASSESSMENT (IHA) FOR CIC (NEW INTO CARE) 12.1 A total of 57 IHAs have been completed during the year. These have been co-ordinated by the CiCHT and completed by the Designated Doctor. Each IHA presents its own challenges to arrange but generally the process is working well with the collaboration of the Social workers and foster carers.

12.2 Birth parents have been encouraged and enabled to attend the appointments whenever possible and this provides invaluable information for the assessment.

7 12.3 The time frame for the completion of the assessment and issuing of the health plan has steadily improved over the year.

 Birth history and immunisation history has been returned reliably from the Child Health Information Department.

 GP printouts have been returned generally within a few days of the request.

 5School health records and Health Visitor information have been returned reliably.

5.4 All of the above are contributing to a more robust and thorough IHA. 5.5 The Specialist Nurse has attended a number of initial CiC review to present the health plan and to assess whether any immediate health intervention is needed. 5.6 Benefits seen this year since changing thepathway for IHA completion; 13. Closer involvement of birth parents 14. Access to GP/school nurse and child health information 15. Health plan being available at time of child’s first in care review 16. Assessment undertaken by Designated Doctor for CiC 17. Designated Doctor will sometimes complete the adoption medical at a later date and will have already met the child for their IHA.

18. KEY PERFORMANCE INDICATORS Review Health Assessments (RHA) Pre-school Children 6.1 Responsibility for completing the RHA for pre-school children has been transferred to the Health Visitors (HVs). Training by the Poole Specialist Nurse has been given to all the HVs in Poole to enable them to understand both the process and also the aims of the assessment. 6.2 To date, 12 RHAs have been completed by 6 different HVs. There are a relatively low number of Poole pre-school children in care (30). A high percentage of this age group are in the ‘adoption arena’ which means that they will have had an adoption medical as part of the process of preparing for the court decision. 6.3 The adoption medical is counted as their RHA which also explains the relatively low number completed by the HVs. 6.4 The CiCHT has liaised closely with the HVs to ensure that they are invited to the CiC reviews and relevant meetings. The Specialist Nurse has attended HV locality meetings and a triangle meeting to liaise with HVs about their new role. 6.5 The HVs have also been active in liaising with the receiving HV when a child is placed for adoption.

8 6.6 Where it has been advised against the child’s HV meeting the birth family e.g. when a child is placed in a concurrent foster/adoption placement, the Specialist Nurse has attended some contact sessions. This has ensured that birth parents have been kept fully informed about health issues and have been given the opportunity to ask questions about their child’s health / development. Benefits seen this year since HVs completing the RHA (0-5yrs)

19. Continuity of care for children if original HV is involved – this continues through to the child’s permanence i.e. either through liaison with new HV if adopted or through supporting the birth family if the child returns home 20. Higher level of satisfaction for the HV to see child through their journey into and out of care 21. Raised level of awareness of the specific health needs of CiC 22. Increased awareness of the ‘unique journey’ for children who have been adopted and placed in Poole from other areas

School age children and young people (5-18 years)

6.7 The Specialist Nurse has continued to complete the RHA for this age group. This direct involvement with the children is held in high regard by our colleagues in Social care. It also underpins the role of the CiCHT in supporting children and young people to reach their potential in fulfilling the 5 outcomes in the ‘Every Child Matters’ agenda. Review of RHAs

6.8 Only 2 young people have refused to have direct contact with the Specialist Nurse. However, the CiCHT has been actively involved in supporting the health care of these 2 young people through both their carers and their Social Workers. 6.9 For children and young people in long term foster care the RHAs are now being timed to take place just before their birthday. It is anticipated that this will inform and benefit specific transitions i.e. transfer to Pathways Team (age 16 yrs) or when young people leave care (age 18 yrs). 6.10 The Specialist Nurse has attended the Poole Kids in Care Group (PKiC) to discuss potential changes to the process for the RHA. The group gave positive overall feedback regarding the proposed changes and were able to give specific suggestions as to how the changes could be implemented. These changes are being implemented from April 2013 and will be discussed later in the report. 6.11 Data regarding dental check, immunisation status, BMI, substance use, Strengths and Difficulties questionnaire (SDQ) and sexual health are recorded using a traffic light system which enables the CiCHT to see which children and young people have high level health needs.

9  A total of 167 RHAs have been completed during the year. This is equivalent to 95% of expected RHAs.

 Only one out of area RHA has been completed through a Service Level Agreement (SLA). This is because the other young people placed out of area have not been due for reviews during the year.

 The Specialist Nurse did travel to see 2 children placed in the same out of area placement – sharing the journey with the children’s Social Worker who was also visiting. This was a cost effective way of completing the assessments.

 When children who are placed out of area come home for holidays or to visit their family, the Specialist Nurse has seen them during their visit. A dialogue with their carers has also taken place to complete the assessment.

Poole CiC Placed Out of Dorset

6.12 It has been an ongoing challenge to ensure that CiC who have been placed outside Dorset have received the same level of health support as those placed within the county. 6.13 The CiCHT have had an ongoing dialogue with the carers to monitor the children’s health needs. This has been supplemented by a regular sharing of information with the child’s Social Worker and the reviewing officer. In Poole, the Social Workers visit out of county placements every 4 weeks which has helped to monitor their health needs but it has been evident that the level of opportunistic health support is understandably less than for local children. 6.14 There have been no real difficulties in accessing health care for children placed out of county. The Specialist Nurse has been involved in accessing emotional health support through CAMHS for one young person.

Service Level Agreements (SLA)

6.15 The Poole CiCHT has completed 20 RHAs for CiC placed in Poole from other areas. These have been completed following the SLA being returned by the requesting health team. 6.16 It has been noticeable that some of these children have quite complex health needs. They often do not enjoy the same high level of visiting from their SWs which Poole Children receive. 6.17 The health plans for these children are often complex and it has been frustrating not always knowing the outcome of referrals made through the RHA.

Dental Health  92% (KPI 80%) of Poole CiC have had a dental check during the year.

10 6.18 It is noticeable that there has been a continued reluctance for the 16- 18 year olds once they leave their foster carers and move to supported lodgings providers to maintain their 6 monthly dental checks.

6.19 There is no shortage of NHS dentists locally so it would appear to be a lack of motivation rather than lack of available dental service which is affecting the uptake.

6.20 A number of children have required clinic or hospital treatment for tooth decay this year. These children have come into care with poor dental health.

6.20 A pathway for delegating responsibility to consent to the CiC’s foster carer has been agreed locally. This was facilitated by the CiCHT, Poole Hospital and the legal department at Social care. This has removed the need for representation from Social Services to sign the consent for the operation at the hospital. This has been a real success for everyone involved, especially the child and their carers.

Immunisations  93% (KPI 85%) of CiC are reported as being up to date with their immunisations.

6.21 The partnership working with the school health departments across Bournemouth and Poole has been crucial in ensuring that timely consent has been obtained for both the HPV and the year 10 booster (diphtheria/tetanus and polio).

6.22 There has continued to be some difficulty in obtaining historical immunisation data for children who have been registered with GPs outside of Dorset. This has meant that there are a number of children who appear to have missed some immunisations despite their birth family insisting that they have been given.

6.23 This has become particularly significant since the recent measles outbreak has heightened concern about children and young people who have not received their MMR immunisation.

6.24 The liaison and support from the Child Health Information Department has been invaluable in recording immunisation data.

23. SUPPORTING CHILDREN AND YOUNG PEOPLE WITH DISABILITIES

7.1 The Poole Child Health and Disability (CHAD) team have 12 children and young people in care (8% of total CiC). The level of involvement from the CiCHT has varied depending on where they are placed and the reason why they are in care.

7.2 There are currently only three young people in a residential school placement. The others are cared for by foster carers within a family home and attend a specialist education setting locally. Currently only two of the children are ‘in care’ as a result of their need for a specialist residential educational provision. The other 10 have been placed in care because of parenting and safeguarding concerns.

11 7.3 All the children and young people have a health plan in place. This has been completed either by the nursing staff at their residential placement or by the CiCHT in collaboration with other professionals and family / carers. The CiCHT has liaised closely with other health professionals involved with these children to ensure that their specialist knowledge and understanding of the child is incorporated into the health plan. The Specialist Nurse has been involved in the transition to adult services for 2 young people this year.

7.4 There are a number of CiC with an acknowledged learning ‘difficulty/disability’ who remain under the care of the generic CiC team at Social care. There continues to be an understanding that these difficulties may be a result of environmental factors rather than a developmental disorder per se.

7.5 The Specialist Nurse has been instrumental in accessing the relevant assessments needed to fully understand a child’s difficulties via speech therapy (8 children) and educational psychology services (5 children). This has been particularly important when considering the future provision of support for young people as they approach the Pathways Team. It has also proved vital in supporting carers and schools to really understand a child’s needs.

7.6 The Specialist Nurse has been instrumental in supporting the ‘reassessment’ of 3 children this year who had been previously been diagnosed with developmental disorders and prescribed stimulant medication and also medication to help them settle to sleep. As a result one child has become medication ‘free’ with the support of his Social worker and residential support workers.

7.7 The Specialist Nurse has also supported carers in applying for disability benefits to ensure that the child can benefit from extra resources to help them reach their potential across the 5 outcomes (DCSF 2003).

24. DIET AND OBESITY 24.1 There are currently 9 CiC with a BMI which places them in the ‘obese’ range. 2 of these are recent admissions to care.

8.2 The CiCHT has also used the ‘Traffic Light System’ to record trends in weight over the year. This has enabled an ‘at a glance’ view of CiC growth patterns. 8.3 These young people have been encouraged and supported to be more physically active. Carers and the CiC are all entitled to have an Access to Leisure card to enable them to enjoy local sporting activities and clubs at a more affordable rate. This also applies to all care leavers. 8.4 Carers have also been encouraged to offer a healthy range of meals and snacks. 8.5 One young person has been actively engaged with the community dietician. 8.6 2 CiC have a very low BMI which places them within the severely underweight category. These young people have specific emotional health difficulties and are being supported appropriately through dietician and mental health support.

12 8.7 The CiC Team have continued to offer ‘Junior Chefs’ to young people to give them a fun cooking time, learning new skills and to boost their social skills at the same time. 8.8 There continues to be a need to ensure that children and young people are given opportunities to cook at home. Currently this is very sporadic. It has been a recommendation on RHA health plan on many occasions this year.

8.9 The relevance of children and young people’s emotional well being cannot be overstated when considering their eating habits and attitude to food. Once again, emotional support and understanding has proved vital if significant and enduring change is to be accomplished. 8.10 The 2 young people with the most enduring problem with their BMI have both ‘enjoyed’ long term foster placements and consistent schooling. However, neither has formed a really positive emotional attachment to their carers and neither has been able to retain or regain a positive relationship with their birth parents. Both would admit that food provides them with a comfort. Interestingly neither have ever accessed or really benefitted from traditional therapeutic support to address their life experiences.

25. REDUCING SEXUALLY TRANSMITTED DISEASES AND TEENAGE PREGNANCY 9.1 The approach to promoting positive sexual health and the enjoyment of healthy relationships has continued to be a priority for the Poole CiCHT. The team adopts a multi-faceted approach and involves all members of the Team around the Child. 9.2 Sexual health and relationships training has been given to 12 foster carers and supported lodgings providers. This training has included a focus on emotional health and adolescent brain development. The aim of this was to normalise some behaviours and to give carers ‘permission’ to allow an element of risk taking behaviour to support development and emotional growth.

9.3 Conversations about sexual health and relationships have been a routine part of the RHA. Foster carers are an intrinsic part of the support given to young people around their sexual health. The CiCHT have supported foster carers in taking young people (4) to local sexual health services. Emergency appointments have been made for young people to access contraception. Social care staff have been supported to help them address young people’s sexual health needs.

9.4 Individual young people (6) have been supported to access sexual health services for contraceptive advice as well as testing for sexually transmitted infections. 9.5 There has been a multitude of opportunities for carers to access emotional health training. This has been aimed at supporting them to enable the children and young people in their care to enjoy improved self esteem and friendship skills. It is hoped, that by enhancing a child’s regard for themselves and others they will enjoy positive relationships and take fewer risks with their sexual health.

13 9.6 There continues to be a number of young people in care this year aged 15+ who display chaotic sexual health and risk taking behaviours. These have been some of the most difficult young people to engage in making healthier and safer choices. The aim has been not only to initiate an effective form of contraception but also to give the young person a sense of respect and regard for themselves to reduce their risk taking behaviour.

9.7 During the past year no CiC have become parents.

26. ALCOHOL/SUBSTANCE MISUSE INCLUDING SMOKING 10.1 A more robust and accessible way of collecting data re substance use has been developed this year by the information management team at CYPSC. It has enabled the CiCHT to see a monthly report which records the young people with substance use problems. 10.2 It has become evident over the years that only a very small number of young people who are in ‘long term’ foster care start smoking before the age of 16. However, a high % of the young people aged 15+ who have come into care this year are already regular smokers (12 / 14). 10.3 Young people have been offered support/interventions to support them to stop smoking. 3 young people have stopped smoking with the support of their foster carers and family. None have chosen to access the local stop smoking service. 10.4 During the past year 16 individual young people in care have been known to have substance use problems at some point in the year. There has needed to be a team approach to try to access relevant support for these young people who have often been reluctant to accept support. 10.5 It is evident that the majority of these young people have ‘unmet’ emotional health needs and a ‘twin track’ approach has been needed to try to support them. A referral to the local young people’s substance use service (YADAS) has always been offered but the young people have generally been reluctant to accept this referral. Carers and workers have had access to a wide range of specialist training to enable them to offer an understanding and to have a basic knowledge of the issues involved. 10.6 A number of the young people have stopped using substances as a result of being detained or placed in residential settings where they cannot access substances. The challenge has been to ensure that this abstinence is maintained on their release from these settings.

27. REFERRALS Number Referrals Service 2012/13 SALT 8 Dietician 1 CAMHS 5 Enuresis 2 Smokestop 1 Leisure 3

14 Number Referrals Service 2012/13 SN/HV 46 Dentist 18 C.Card 2 Chlamydia 2 Sexual health services 2 YADAS 1 Psychologist 12 GP 27 Community Paediatrician 3 Orthoptist 2 Learning disabilities services 3 Adult services Social Care 1 Occupational Therapist 2 Ed Psych 5

11.1 The number of actual referrals does not reflect the vast number of case discussions which have taken place over the past year with other colleagues in health and at CYPSC. These discussions often lead to a direct intervention but sometimes actually negate the need for referral.

28. MENTAL HEALTH/EMOTIONAL WELL BEING 12.1 It continues to be evident that the children and young people’s emotional well being underpins their physical and social health. It can also be seen that interventions from the CiCHT to support and address physical health needs has also had a positive effect on both the child’s emotional health and the coping of their carers. All aspects of health, emotional, physical and social are interchangeable and relate closely to each other.

12.2 The Poole CiCHT has been proactive in advocating for the best health support for both the CiC and their carers. This has helped to improve holistic health outcomes and in some cases improved the stability of placements.

12.3 Key relationships for the CiCHT

 Fully integrated member of the CiC team at CYPSC  Regular proactive and opportunistic contact with the Pathways /leaving care team  Close working relationship with fostering and adoption teams  Close working relationship with psychologists / CAMHS SW / CAMHS/ educational psychology service  Positive contact and working relationship with HVs and School Nurses

12.4 A CiC’s emotional health is considered from the earliest opportunity and actions are embedded into the child’s care plan from admission to care.

15 12.5 Opportunities and forums which the CiCHT have attended or been actively involved in to consider a child’s emotional well being include;

 Planning for care – weekly multiagency meeting to discuss all new admissions to care and those ‘on the edge’ of coming into care.  Child in care reviews  Permanency planning meeting  Team around the Child Meetings – these can be called by any person working with a child/young person – they give an opportunity for a multi agency perspective on a child who may be in crisis or a placement which is at risk of breakdown.  CiC team meetings – the CiCHT has an allocated space on the agenda  Foster carers news letter  Safe and Healthy Group (sub group of the overall strategic meetings for CiC)  Specific training eg; foster carers and supported lodgings providers, adoption planning, HVs, HV and paediatric students, student SWs,

12.6 The Specialist Nurse has been supported in her learning through continued monthly supervision with Rebecca Haworth (Clinical psychologist with a specific role in supporting fostering and adoption services across Bournemouth and Poole).

Strengths and Difficulties Questionnaire (SDQ)

12.7 The CiCHT has continued to lead on the collation of the SDQ. On admission to care an SDQ continues to be requested from the child’s school. It is felt that this provides a reliable base line for comparison at a later date. It also helps to give a sense of the immediate needs of the child.

12.8 Prior to the RHA a repeat SDQ is sent to the young person (aged 11-16), carer (children aged 4-16 yrs) and the school teacher. The results are stored on the main CYPSC computer record for each child and recommendations (sometimes in discussion with psychologist) are incorporated into the child’s health plan.

12.9 A total of 76 children have had at least one SDQ questionnaire response. 13 children have had all 3 returned over the past year.

12.10 Although the limitations of the SDQ have been recognised it is still viewed as being a facet of understanding a child’s emotional needs. A high level of difficulty identified through the SDQ does not always generate a referral to CAMHS – the ‘Team around the Child’ will try to think about innovative responses to support the child.

12.11 Referrals to CAMHS have only been made after discussion with the clinical psychologists or the CAMHS SW. Referrals have been made in partnership with the child’s SW. The CiCHT have collaboratively referred 5 children and young people to CAMHS this year.

12.12 It has often been inappropriate to refer the children themselves to CAMHS. The ‘therapeutic’ support has been facilitated through the carers themselves or through the pastoral support at school. The CiCHT has offered direct

16 advice and support to carers and has also referred carers (12) to the dedicated psychology service for support

12.13 On a number of occasions a suggested referral to CAMHS has been delayed by following the Pathway for referral and by accessing the clinical psychologists to support the foster carers. It has been hoped that having delayed the referral the child may be more agreeable to the referral or may make more use of the therapy in the future.

12.14 The CiCHT place an emphasis on developing resilience, self esteem and positive friendship and social skills for this age group. The CiCHT recognise the link between emotional health and healthy outcomes. It is hoped that by promoting emotional wellbeing, children in care will choose to take less risks with their health and enjoy making healthy choices long term. 12.15 An exciting innovation this year has been the availability of the ‘KORU’ project. This is a specialist emotional well being project which aims to get alongside young people who would not benefit from the CAMHS service. A number of Poole CiC (at least 5) are benefiting from the ‘KORU’ project either through their school or in the community after school.

12.16 It is fair to say that the CiCHT continues to strive to approach all physical health needs with consideration for a child/young person’s emotional well being. Each child is unique and the approach to each child’s health needs must reflect their individual circumstances and emotional strengths and vulnerabilities. In the same way all training delivered this year by the CiCHT has had an emotional component to it e.g. enuresis, sexual health.

29. LISTENING TO YOUNG PEOPLE 13.1 The Specialist Nurse attended the PKiC group (12 young people) in November 2012 to consult about proposed new ways of working;

 Introductory leaflet for children/young people on admission to care

 Pre RHA questionnaire for young people and carer

 Evaluation forms for young people and carers after RHA

13.2 The young people were generally positive about the proposed changes and offered suggestions and ideas about the proposed format and paperwork. These proposals have been introduced from April 2013. It is anticipated that they will inform future practice and initiatives.

30. SUMMARY OF KEY AREAS OF DEVELOPMENT DURING 2011/12  The IHA process using the specialist paediatricians is now embedded in practice and is providing a more robust and timely assessment.

 The RHAs for pre-school children are now the responsibility of the responsible HV.

 The CiCHT is fully integrated into the CiC team at CYPSC and is routinely invited to decision making meetings for CiC.

17  The initiation of giving young people a health chronology/passport as they approach leaving care. This has yet to be formally evaluated but the informal feedback has been positive.

 In consultation with young people there will be a new RHA process and paperwork in place from April 2013

31. KEY AREAS FOR DEVELOPMENT DURING 2013-14  To ensure all children and young people are fully immunised

 To ensure all children/young people have at least an annual dental check

 To reduce the uptake of smoking in the older ‘in care’ age group

 To consider the SLA in line with national recommendations

 To continue to develop the individualised support for children and young people with their emotional health needs

 To ensure that young people and carers have an opportunity to give feedback on their healthcare.

REFERENCES

1. Promoting the Health of Looked After Children: Department of Health, 2009 2. DfES Care Matters Time for Change: June 2007. 3. Health Survey for England, 2010: The NHS Information Centre, 2011 Available at: www.ic.nhs.uk/pubs/hse10report

4. National Institute For Health and Clinical Excellence NHS Looked After Children and Young People: October 2010