Health Promoting the Health and Wellbeing of Children and Young People

In promoting positive outcomes for Children and Young People the Fostering Services National Minimum Standards (2011) states that:

• Children live in a healthy environment where their physical, emotional, and psychological health is promoted and where they are able to access the services to meet their health needs.

Foster Carers play a significant role in promoting the health and well-being of Children and Young People and meeting their needs with the input from other professionals and identified services.

The Fostering Agency is committed to fully supporting Foster Carers in this role.

Key guidance contributing to this policy is Promoting the health and well-being of looked-after children. Statutory guidance for local authorities, Integrated Care Boards and NHS England (DfE, 2015).

The Fostering Agency promotes the principles of this guidance in relation to promoting the health of Children and Young People. The guidance states:

Looked-after children should be able to participate in decisions about their health care. Arrangements should be in place to promote a culture:

• Where looked-after children are listened to;
• That takes account of their views according to their age and understanding, in identifying and meeting their physical, emotional and mental health needs. That helps others, including carers and schools, to understand the importance of listening to and taking account of the child’s wishes and feelings about how to be healthy.

As an integral part of care planning, Social Workers must make arrangements to ensure that every looked-after Child or Young Person has:

• Their physical, emotional and mental health needs assessed;
• A Health Plan describing how those identified needs will be addressed to improve health outcomes;
• Their Health Plan reviewed in line with care planning requirements or at other times if the Child or Young Person’s health needs change.

The initial health assessment should result in a Health Plan, which is available in time for the first statutory review by the Independent Reviewing Officer (IRO) of the Child or Young’s Care Plan. This case review must happen within 20 working days from when the Child or Young Person started to be looked after.

The health assessment should address the following:

• The Child or Young Person’s state of health, including physical, emotional and mental health;
• The Child or Young Person’s health history including, as far as practicable, their family’s health history;
• The effect of the Child or Young Person’s health history on their development;
• Existing arrangements for the Child or Young Person’s health and dental care appropriate to their needs, which must include:
• Routine checks of the Child or Young Person’s general state of health, including dental health;
• Treatment and monitoring for identified health (including physical, emotional and mental health) or dental care needs;
• Preventive measures such as vaccination and immunisation;
• Screening for defects of vision or hearing;
• Advice and guidance on promoting health and effective personal care;
• Any planned changes to the arrangements;
• The role of the appropriate person, such as a Foster Carer, School Nurse or Teacher, and of any other relevant persons.

The review of the Child or Young Person’s health plan must happen at least once every six months before a Child’s fifth birthday and at least once every 12 months after the Child’s fifth birthday. The Child or Young Person’s Social Worker and IRO have a role to play in monitoring the implementation of the Health Plan, as part of the Child or Young Person’s wider Care Plan.  

All reasonable steps must be taken to ensure that the Child or Young receives the health care services they require as set out in their Health Plan. Those services include mental health services, medical and dental care treatment and immunisations, as well as advice and guidance on personal health care and health promotion issues.

Health assessments should:

• Not be an isolated event but, rather, be part of the dynamic and continuous cycle of care planning (assessment, planning, intervention and review) and build on information already known from health professionals, parents and previous Foster Carers, and the Child or Young person themselves;
• Focus on emotional and mental well-being as well as physical health;
• Inform other aspects of care planning, such as the impact of a Child or Young Person’s physical, emotional and mental health on their education;
• Be undertaken with the Child or Young Person’s informed consent, if they are ‘competent’ to give it;
• Be child-centred and age-appropriate and carried out with sensitivity to the Child or Young Person’s wishes and feelings and fears, so that the Child or Young Person feels comfortable. Health assessments, including reviews, should also be carried out as far as possible at a time and venue convenient to the Child or Young Person, their Foster Carers and where appropriate, parents. They should take account of any particular needs, including attention to issues of disability, race, culture and gender and if they are unaccompanied asylum seekers;
• Give the Child or Young Person clear expectations about any further consultations, support or treatment needed. Explanations should include the reasons for this and the choices available, and the appropriateness of plans kept under review as necessary;
• Pay particular attention to health conditions that may be more prevalent in looked-after Children and Young People and which may otherwise have been misdiagnosed.

The health assessment should also:

• Be integrated with any other assessments and plans such as the Child or Young Person’s Core Assessment or an Education and Health Care (EHC) Plan where the Child or Young Person has special educational needs;
• Involve birth families as far as possible, so that an accurate picture of the Child or Young Person’s physical, emotional and mental health can be built up;
• Involve a named health professional to coordinate the health assessment and the actions set out in the Health Plan developed from that assessment.

The health practitioner carrying out the assessment has a duty of clinical care to the Child or Young Person. That includes making the necessary referrals for investigation and treatment of conditions identified at the assessment. Even if the placement is brief, the practitioner should follow up concerns and if the Child or Young Person returns home, every effort should be made to continue to implement the Health Plan.

The Role of the Child or Young Person’s Social Workers in Promoting Health

Social workers have an important role in promoting the health and welfare of looked-after Children and Young People. In particular they should:

• Work in partnership with Foster Carers, looked-after Children and Young People, their birth parents where appropriate and health professionals to contribute to the formulation of the Health Plan;
• Ensure that all the necessary consents and delegated authority permissions have been obtained so that decisions are not delayed;
• Take action to liaise with relevant health professionals if actions identified in the Health Plan are not being followed up. Given the impact that poor physical, emotional and mental health can have on learning, they should also ensure the Child or Young Person’s Virtual School Head (VSH) is involved in resolving any health care needs that impact on the Child’s or Young Person’s education;
• Ensure the Child or Young Person has a copy of the Care Plan and the Health Plan;
• Support Foster Carers to promote the Child or Young Person’s physical and emotional health on a day-to-day basis. That should include providing them with information on the Child or Young Person’s state of health, including a copy of the Child or Young Person’s latest Health Plan;
• Ensure that there is clarity for Foster Carers, GPs and dentists, and for the Child or Young Person, about what health care decisions have been delegated to Foster Carers;
• Ensure that Children and Young People including teenage parents, have access to available positive activities such as arts, sport and culture, in order to promote their sense of well-being.

Social Workers and health professionals should give Foster Carers information on how to contact designated and named health professionals for looked-after Children and Young People and any other identified services.

Named Nurses and Doctors for looked-after Children and Young people have an important role in promoting good professional practice within their organisation and providing advice and expertise for fellow professionals. The named health professional will act as a principal health contact for Children and Young People’s social care and should have up-to-date specialist knowledge of the health needs of looked-after Children and Young People or know how to access it.

Working with the designated professionals for looked-after Children and Young People, named health professionals should:

• Coordinate the provision of local health services for individual looked-after Children and Young People and the input into health assessments and their reviews for individual looked-after Children and Young People;
• Ensure the timeliness and quality of health assessments for looked-after Children and Young People and ensure actions taken to implement the Health Plan are tracked;
• Act as a key conduit and contact point for the Child or Young Person and their Foster Carer, where they have difficulties accessing health services.

Before a placement commences, or where this is not possible, during the Placement Planning Meeting, Foster Carers must be provided with as full information as possible about the health needs of a Child or Young Person. These details will be confirmed in the Placement Plan and Care Plan. Any details not available at this stage must be provided to the Foster Carer by the Child or Young Person’s Social Worker as soon as possible.

They also need to know the content of the Personal Education Plan (PEP) and where applicable Education, Health and Care (EHC) Plan and understand their role in supporting these. Information about additional educational support provided should also be included.

Foster Carers Will Work Together with Other Relevant Professionals to:

• Promote the physical, emotional, psychological and social development needs of Children and Young People;
• Help Children and Young People understand their health needs, how to maintain a healthy lifestyle and to make informed choices about their own health;
• Give advice and know where to seek advice and information around risks to health including alcohol and substances, smoking, intimacy and relationships, sexually transmitted diseases and keeping themselves safe;
• Ensure Children and Young People have prompt access to doctors and other health professionals including specialist services;
• Ensure they have any aids or equipment required for particular health needs or disability;
• Promote Children and Young People’s health in accordance with their Health Plan and Placement Plan and fulfil their duties and responsibilities as identified in these plans. Foster Carers will be aware of what decisions are delegated to them and where consent for medical treatment needs to be obtained through decision making around delegated authority at the Placement Planning Meeting;
• Ensure Children and Young People’s wishes and feelings are sought and taken into account in their health care, according to their stage of development and understanding;
• Advocating on behalf of Children and Young People where required;
• Ensure any Child or Young Person placed is registered with a GP and Dentist;
• Ensure all health appointments are maintained;
• Ensure Children or Young People are provided with a healthy balanced diet;
• Ensure personal hygiene tasks and general health is promoted;
• Encourage Children and Young People to participate in a range of positive activities that contribute to their physical, emotional and psychological health.

Carers need to ensure that the update the Child’s Social Worker and their Supervising Social Worker of any changes to the child/young person's health as soon as possible. This includes any new or changes to medical prescriptions, any planned or emergency treatment.

Carers must also be recorded all health and medical treatments in the daily logs.

Tips on what to Record

• Visits to doctor, dentist, optician, and/or clinic;
• Advice/medication given;
• Therapy or other appointments;
• Milestones achieved/concerns/regressions;
• Accidents and injuries and action taken. Including bruising;
• Changes in behaviours.

DLA (for Children and Young People under 16 Years of Age)

DLA is a benefit to help support children under 16 with care and mobility needs. Foster Carers who apply for DLA on behalf of the Child or Young Person must inform the Child or Young Person's Social Worker and the Supervising Social Worker of the application and receipt of benefit if such application is successful. Two rates of DLA can be claimed for the "lower rate" and "higher rate" and each has a care and mobility component.

Where a Child or Young Person is in receipt of DLA, this allowance should be spent on promoting the welfare of the Child and Young Person. How DLA will be spent should be discussed with the Child or Young Person's Social Worker and recorded as part of care planning for the Child or Young Person.

A record should be kept by Foster Carers of how the allowance is spent and this record should be available on the request of the Child or Young Person’s Social Worker or the Supervising Social Worker. 

The Supervising Social Worker will also discuss this with the Foster Carer within supervision visits.

When the Child or Young Person moves on from placement, any items purchased from DLA monies is their own property which they should take with them. 

PIP (for Young People 16 Years and Over)

PIP is not a means-tested benefit and is not affected by earnings, other income or savings. It has two parts – daily living component for people who need help to take part in everyday life and mobility component for people who find it hard to get around.

This will need to be applied for prior to the Young Person turning 16.

The same principles apply as for DLA in respect of how the monies will be spent however it is recognised that Young People will have increasing input at this stage and might take responsibility for the spending of this. This will be discussed and agreed with the Young Person’s Social Worker.

• Health Plan;
• Education and Health Care (EHC) Plan;
• Placement Plan;
• Care Plan;
• Delegated Authority Proforma.