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Children in Care

Introduction to Children in Care (CIC)

There are currently over 92,000 Children in Care in the UK. The term ‘Children In Care”(CIC) is generally used to mean those children who are looked after by the state. This includes those who are subject to a care order or temporarily classed as looked after on a planned basis for short breaks or respite care.  The term is also used to describe ‘accommodated’ children and young people who are looked after on a voluntary basis at the request of, or by agreement with, their parents.  These children are referred to as "children in care".

More than half of children are taken into care because of abuse or neglect 
(Source: NPSCC. Children in care. Statistics. Accessed 25 March 2015)

CiC have the same health risks as their peers but the extent is often exacerbated due to their previous experiences. Children’s early experiences have a significant impact on their development and future life chances. Children in Care show significantly higher rates of mental health issues, emotional disorders such as anxiety and depression, hyperactivity and autistic spectrum disorder conditions. It is therefore vital that our focus is on improving the outcomes for this group of vulnerable children and young people.

When children enter care, they are offered a statutory Initial Health Assessment (IHA) with a local paediatrician or GP.  Children already in care are offered a statutory Review Health Assessment (RHA) by the child’s Health Visitor or specialist Children in Care nurse (6 monthly for children under the age of 5 years and annually for those aged 5 to 18 years).

Unaccompanied Asylum-Seeking Children

An Unaccompanied Asylum Seeking Child (UASC) is defined by the Home Office as a young person under the age of 18 making an application for asylum in his or her own right and who "has no adult relative or guardian to turn to in this country". These young people may have arrived in the UK by themselves or with an adult who later abandoned them or who does not present as suitable carer or guardian.

UASC are supported within the framework of the Children Act 1989 and this should be guided by the principle that they are "children first and foremost". Following an initial age assessment, a young person judged to be under 18 years of age, is entitled to the same rights as other children and young people in care, including accommodation, some finance, education, statutory health assessments, support and reviews. 

Research shows that the adversities affecting many unaccompanied young people include traumatic experiences as part of their flight, as well as separation from or loss of family members, and that an increasing number fall victim to international trafficking for exploitative purposes. Unaccompanied children have significant physical and mental health needs relating to communicable (infectious) Diseases (e.g. Tuberculosis screening and vaccination), dental health, nutrition (e.g. anaemia), sexual and reproductive health and post traumatic stress disorder. It is therefore vital that their health needs are assessed and met in a timely manner.

Role of Designated Nurse LAC/CiC

The role of the Designated Nurse and Designated Doctor for Children In Care focuses on improving outcomes, quality and safety for the most vulnerable children across the healthcare services that the CCGs commission by:

  • Raising key issues with commissioners and providers of health services for children in care.
  • Providing expert advice to increase quality, productivity, and to improve health outcomes for Children in Care and Care Leavers. 
  • Developing, leading and  monitoring quality assurance processes and service improvement of health services for Children in Care.
  • Ensuring all health services commissioned meet the statutory requirement to promote the health and wellbeing of Children in Care.
  • Ensuring the voice of Children in Care and their Carers are taken into account locally including those children in care placed out of the local area.
  • Ensuring that there is enough provision within the local area to meet the needs of any Unaccompanied Asylum Seeking Children placed within the CCG area.

Resources for professionals working with CIC and UASC

  1. The Statutory Guidance, Promoting the Health and Wellbeing of Looked After Children, March 2015 aims to ensure looked-after children have access to any physical or mental health care they may need. This guidance is for: 
    • Local Authorities
    • Commissioners of health services for children
    • NHS England
    • Designated and Named Professionals for looked-after children/children in care
    • GPs, Optometrists, Dentists and Pharmacists
    • Managers and staff of services for care leavers, and personal advisers
    • Teachers
    • Health visitors, School nurses and any other professional who is involved in the delivery of services and care to looked-after children, UASC and Care Leavers.

  2. The NICE “Looked-after children and young people” Public health guideline [PH28], May 2015 aims to improve the quality of life (that is, the physical health, and social, educational and emotional wellbeing) of looked-after children and young people. It focuses on ensuring that organisations, professionals and carers work together to deliver high quality care, stable placements and nurturing relationships for looked-after children and young people. 

    Its recommendations set out how agencies and services in a complex, multi-agency environment can improve the quality of life for looked-after children and young people through more effective collaboration that places them at the heart of all decision making. The recommendations cover local strategy and commissioning, multi-agency working, care planning and placements, and timely access to appropriate health and mental health services.

  3. The CCG's Designated Nursing Team has developed local best practice guidance for health professionals working with Children in Care and Unaccompanied Asylum Seeking Children which you can download for use in your organisation or team.

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Safeguarding Children Designated Professionals Team

Suffolk CCG Safeguarding Children Team
Tel.: 01473 264357
Email: wsccg.suffolksafeguardingchildren@nhs.net

Looked after children (LAC) nurse team
The team offer a specialist health assessment, known as a review health assessment, to all children looked after by the council.
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