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Promoting the Health of Looked After Children
- Sonya Leff (14 March 2000)
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looked after children
- Michael Greenberg (31 March 2000)
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CARE OF CHILDREN IN "CARE".
- S Acharyya (11 April 2000)
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Re: CARE OF CHILDREN IN "CARE".
- Penny Mellor (13 April 2000)
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Sonya Leff
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The editorial by Polnay and Ward raises highly significant concerns about this most vulnerable group of children. Of course these children need tailor-made care plans and not an annual physical inspection. In our Trust, our school doctors and nurses were asked to log all contacts with looked after and adopted children over one term, summer 1999. All 11 doctors and 17 nurses reported contacts, with a total of 122 children seen. The nurses saw 74 children, 45% for a pro-active health care assessment, 35% for support for their emotional difficulties and 11 % because of learning an developmental problems. The doctors saw 48 children, only 9 % for pro- active care, the rest for referred problems. Of these 65% had emotional difficulties and 19% learning difficulties. The remainder of the children had co-ordination problems, speech delay, encopresis or eneuresis, poor attendance, poor growth or poor hygiene. Both staff groups rated the rapport achieved as " excellent " for a third of the children , with the doctors ranking a further 58% as "good rapport" and the nurses 33%. With the nurses were doing more pro-active rather than referral work, they were more likely to experience reluctance ( 8%) in the young person. A wide range of services were contacted for just over half the children. The doctors discussed their contact with Social services for 52% of children seen, the nurses for 42%. The doctors discussed 21% with Child Psychiatric colleagues, the nurses 9%. Children were also discussed or referred to speech, eye, physiotherapy and hearing clinics, and discussed with educational psychologists, welfare officers or special units. The doctors planned to follow up 94% of those seen. The nurses selected 85% for planned review. Over 60 % in both groups had a planned review for the following school term. We propose to review these contacts in summer 2000 to ascertain how may are still under the care of their school doctors and nurses and how many have been lost to follow up. These children are undoubtedly a needy group and it is disgraceful that one still has to argue that it is advisable to replace the annual review with tailor made care plans utilising school health staff. Sonya Leff |
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Michael Greenberg
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Editor-We agree with Polnay and Ward's editorial1 on promoting the health of looked after children which draws attention to the need for a well resourced integrated health service, especially in mental health. Ensuring access to services by looked after children is difficult as many of them will find it hard to identify or acknowledge their health needs, in particular their unmet emotional needs. These may lead to unhealthy lifestyles that place them at risk of their own behaviour and lead to a poor outcome in life. Parenting hurt children and young people is a challenge, in particular when this is carried out by a 'service' rather than a family. We need to face this challenge through the development of new joint interagency initiatives. The Looked After Children 'We Are Not Alone Project' in Harrow brings together the expertise of professionals in health, education and social services. This initiative aims to help children and young people become more aware of their emotional needs as a first step to acknowledging emotional problems. The project is based on a visual message ( poster ) focusing on children and young people's wish to be like others in the peer group. The message is non-challenging helps to identify and share feelings. A random sample of twenty children attending mainstream middle and high school were shown the poster as part of a pilot study and asked to give a written interpretation. All recognised the feelings of sadness and loneliness of the 'different' individual in the poster and noted feelings of happiness once this individual was included in the group. A nurturing and compassionate environment where the emotional well-being of children and young people is seen as a priority may facilitate the parenting role of services. Ximena Poblete Michael Greenberg 1. Polnay L, Ward H. Promoting the Health of looked after children. BMJ 2000;320:661-2 |
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S Acharyya
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Editor - Children "looked after" are amongst the most vulnerable in our society with a higher level of health, mental health and health promotion needs than others of the same age(1). Local authorities should ensure proper monitoring of their morbidity and developmental progress, which ideally should be documented in the annual medical reports. Over a two week period last month, I surveyed the records of 60 looked after children in our borough, to find out whether their health needs have been adequately addressed. All of them were under five years when they were placed in care and the records were selected randomly from a total of around 150 children of that age group who are currently under care. 21 out of the 60 (35%) were placed with one of their biological parents while the rest were either with their relatives (11) or other carers(28). All of them stayed in care for at least a year and 24 (40%) had at least one change of placement within the first year of their placement. Of the 21 children who were placed initially with their parents 12 (57%) had a change of carer subsequently. 39 (65%) had their initial medical assessment within 3 months of placement but only 22 of them had a further check within the following 6-12 months. Of the 22 children who had a follow-up 15 (72%) had a satisfactory increase in growth parameters . 9 of these children developed speech and behavioural abnormalities which were dealt with appropriate referrals within 6 months of diagnoses. 28 out of the 39 (70%) medical reports were completed satisfactorily with clear documentation of the current health and behavioural concerns. However in 24 (60%) of these children the past medical and family history could not be elicited from the present carers. The recent survey reinforces some interesting observations about the morbidity of looked after children. It is worth highlighting the high incidence of change of placements and the poor access to the past medical and family history. The Children Act encourages local authorities to place children with their biological parents but, unfortunately the change of placements were particularly high amongst these children. We should also study the longterm psychological effects of these various placements on their future cognitive developments. There is definite scope of improvements in the overall physical and mental follow-ups of these children, particularly in documentation of these records. All local authorities and health care professionals should safeguard and improve the quality of care in these vital areas, otherwise these Will remain notoriously neglected. Reference 1.Polany L, Ward H, Editorial BMJ Volume 320, 11th March 2000. S Acharyya |
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Penny Mellor, Child Advocate Home
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What was glaringly obvious from the Waterhouse report "Lost in Care" was the total abandonment by health professionals. I notice that the BMJ despite it's numerous authors who specialise in child abuse, has taken a look at the role of practioners in the continual abuse of children in care. I question that no child was ever admitted to hospital with injuries and no child ever relayed to a doctor that they were being hurt. Yet I have yet to see one mandatory report of suspected abuse by the medical profession frome North Wales, South Wales, Northumbria, Liverpool, Cheshire etc... Waterhouse had a specific remit, conveniently the health professionals were ommitted from the investigations, yet they more than anyone could have highlighted the horror of what was going on, or am I to assume that all these children were never seen? Either way the lack of care was nothing short of negligent. Even more disturbing however is the silence from the medical profession that has ensued since the publication of the Lost in Care report, especially when that report mirrors child abuse at those levels up and down the entire length and breath of the UK. Where were you all then? Why did you do nothing? And where are you now for children in care? To this day the adult survivors of these atrocities still recieve no support and if that is the bench mark we have to go by, then nothing will ever change, these children are our societies most vulnerable and in neglecting them at all levels, we create the monsters of tomorrow. |
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