The Health and Well-being Standard
Regulation 10
In November 2023, information was added into Section 3, Health Care Plans in relation to allergies. Section 1, Health Issues for Children Looked After in a Residential Setting was updated in line with local procedure.
In a residential setting, staff will not only need to take on the responsibility of a good parent, but will also need to take into account the following:
In view of these points, residential staff will need to have a planned pro-active approach for helping children and young people with health issues and work in partnership with health professionals.
Humber Teaching NHS Foundation Trust (HTFT) has close links with East Riding Local Authority Children’s Services in order to provide a Looked After Children’s Child and Adolescent Mental Health Service for children and young people, and care leavers aged 0-25 years, under the care of East Riding Local Authority. The East Riding Child and Adolescent Mental Health Service (CAMHS) Looked After Children (LAC) team, also known as the Emotional Health and Wellbeing Service offers support to East Riding Children Looked After (CLA) aged 0-16 years, and care leavers under the care of the Pathway Leaving Care Team aged 16-25 years. Similarly, support is also provided to the networks around them (Social Care, Education, Foster Carers, Residential Care Teams, Connected Carers, East Riding Local Authority Residential Homes and support is also limited support is offered to East Riding Post Adoption Support Team). The team is trauma-Informed and follows the Attachment, Resilience, Competency (ARC) Framework in all aspects of thinking around the child’s need and support offered. Interventions are highly influenced by Dyadic Developmental Psychotherapy (DDP) and PACE (Playful, Accepting, Curious & Empathic approach to care). The team consists of Clinical Psychologists, Advanced Practitioners, and a Team Lead. The service offers consultations for Social Workers and Personal Assistants (working in the Pathway Leaving Care Service), residential care staff, and young person’s professional network, to discuss concerns/queries relating to cared for children and care leavers. Requests for consultations can be made by completing a consultation request form (see attached). Consultations provide a ‘space’ for workers to think about, for example, psychological formulation, complex systemic/relational dynamics, appropriate service/s and therapeutic interventions. If appropriate follow up consultations may be offered to referrer in order to provide continued support. Following consultation, therapeutic intervention/s may be provided to the young person, their carers or professional network, informed by a thorough assessment and individualised therapeutic care plan.
At present, all East Riding Local Authority children’s residential homes receive support from a clinician within the East Riding Looked After Children CAMHS service. Amount of support varies depending on the individual needs of the staff team and young people in residence but is usually provided on a weekly or fortnightly basis. Clinicians offer regular reflective discussions to the team of staff, provide a link to East Riding Core CAMHS- facilitating any referrals needed into the service, build rapport with the young people in order to offer regular emotional well-being check-ins, and attend meetings as required in respect of the children and young people residing in residence.
Clinicians within the team offer consultation and reflective practice sessions, on a weekly to monthly basis, to all areas of Corporate Parenting within East Riding Local Authority, which includes Children Looked After Team, Pathway Leaving Care Team, and Fostering Teams (2 Mainstream Teams and a Connected Persons Team). Limited support is provided to the Post Adoption Support Team via discussion of requests for externally commissioned therapeutic intervention at the Emotional Mental Health Decision Making Forum.
Two clinicians from the East Riding CAMHS Looked After Children Team (Clinical Psychologists) take part in fortnightly Emotional Mental Health (EMH) Decision Making Forum meetings whereby any requests for externally commissioned therapeutic input are discussed. Representatives from East Riding Local Authority senior management, commissioners, and allied health professionals such as Looked After Children Health Nurse and East Riding Core CAMHS Team Leader also sit on this multidisciplinary forum and ensure that any externally commissioned therapies adhere to clinical governance standards and are monitored with regards to efficacy and value for money.
Every Child in Care should have a Health and Emotional Well-being Assessment soon after being placed and then at specified intervals; as set out below.
The purpose of a Health and Emotional Well-being Assessment is to carry out an initial assessment of the child’s physical, emotional and mental health. The Health and Emotional Well-being Assessment will inform the child’s Health Care Plan, and ensure that the placement meets the child's holistic health needs. As a minimum the child’s main carer will be required to completed the carer’s two-page version of the Strengths and Difficulties Questionnaire (SDQ) for the child in time to inform their Health and Emotional Well-being Assessment.
(See Annex B of the ‘DfE Promoting the Health and Well-being of Looked-after Children’, Strengths and Difficulties Questionnaire).
Health and Emotional Well-being Assessments must be conducted by a suitably qualified medical practitioner; who should provide the social worker with a written report.
Health and Emotional Well-being Assessments should not be seen as an isolated event but rather be seen as part of the continuous cycle of care planning (assessment, planning, intervention and review) and build on information already known from health professionals, parents and previous carers, and the child themselves.
The social worker is normally responsible for ensuring that Health and Emotional Well-being Assessments are undertaken, but this responsibility may be undertaken by the home.
In order for the assessment to be conducted, the social worker should ensure that all the necessary consents and delegated authority permissions have been obtained so that decisions are not delayed. Young people (dependant on their age and understanding) can provide informed consent for the assessment.
Young people aged 16 or 17 with mental capacity are presumed to be capable of giving (or withholding) consent to their own medical assessment/treatment, provided the consent is given voluntarily and they are appropriately informed regarding the particular intervention. If the young person is capable of giving valid consent, then it is not legally necessary to obtain consent from a person with Parental Responsibility.
A child of under 16 may be Gillick Competent to give (or withhold) consent to medical assessment and treatment, i.e. they have sufficient understanding to enable them to understand fully what is involved in a proposed medical intervention.
In some cases, for example because of a mental health issue, a child’s mental state may fluctuate significantly, so that on some occasions the child appears Gillick Competent in respect of a particular decision and on other occasions does not.
If the child is Gillick Competent and is able to give voluntary consent after receiving appropriate information, that consent will be valid, and additional consent by a person with parental responsibility will not be required.Where a child under the age of 16 lacks capacity to consent (i.e. is not Gillick Competent), consent can be given on their behalf by any one person with Parental Responsibility. Consent given by one person with Parental Responsibility is valid, even if another person with Parental Responsibility withholds consent. (However, legal advice may be necessary in such cases). Where the local authority, as corporate parent, is giving consent, the ability to give that consent may be delegated to a carer (or registered manager of the children’s home where the child resides) as a part of ‘day-to-day parenting’, which will be documented in the child’s Placement Plan.
For further information on consent, see: Department of Health and Social Care Reference Guide to Consent for Examination or Treatment.Each child's Placement Plan should identify the child’s health care needs (if any) and set out how these will be met by the home.
The initial Health Care Plan should be produced before the first Looked After Review. The Health Care Plan should then be updated after each Health and Emotional Well-being Assessment or as circumstances change.
The Health Care Plan should describe how the child’s physical, emotional and mental health needs will be addressed to improve health outcomes.
The Health Care Plan (and the Placement Plan as necessary) should cover the following:
Information should also be given about any allergies. See also First Aid, Home Remedies and Medication Procedure and Provision and Preparation of Meals Procedure.
One of the key responsibilities of the child's Linkworker is promoting their health and educational achievement, liaising with key professionals, including the Designated Nurse for Looked After Children, the child’s GP, optician and dental practitioner.
The Linkworker will also ensure that up to date records are kept on the child in relation to their health needs, development, illnesses, operations, immunisations, allergies, medications, administered, dates of appointments with GP's and specialists.
The Linkworker must also ensure the child is registered with a GP and other health care professionals as set out in Health and Wellbeing, Health Notifications and Access to Services Procedure.
Also see: Linkworker Guidance.