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4.8.1 Health and Emotional Wellbeing Assessments and Health Plans

NOTE

This procedure applies to all Looked After Children. Different provisions apply to children who acquire Looked After status as a result of a remand to local authority accommodation or Youth Detention Accommodation. In relation to those children, please see the Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Section 8. Care Planning for Young People on Remand.

Please see relevant section of Forms Library to access the required template.

RELEVANT GUIDANCE

Who Pays? Determining which NHS commissioner is responsible for making payment to a provider

AMENDMENT

In November 2022, a link to NHS guidance, Who Pays? was added.


Contents

Caption: contents list
   
1. Introduction - Responsibilities of Local Authorities and Integrated Care Boards
2. Principles
3. Responsibilities of Foster Carers
4. Health Needs of Children in Care
5. Health and Emotional Wellbeing Assessments
  5.1 Good Health Assessment and Planning
  5.2 Frequency of Health and Emotional Wellbeing Assessments
  5.3 Who Carries out Health and Emotional Wellbeing Assessments?
  5.4 Arranging Health and Emotional Wellbeing Assessments
  5.5 Consent to Health and Emotional Wellbeing Assessments
6. The Health Plan
7. Health Reviews
8. Confidentiality and Information Sharing
9. Out of Area Placements
10. Procedures for Health and Emotional Wellbeing Assessments and Health Reviews
  Further Information


1. Introduction - Responsibilities of Local Authorities and Integrated Care Boards

The local authority, through its Corporate Parenting responsibilities, has a duty to promote the welfare of Children in Care, including those who are Eligible and those children placed in adoptive placements. This includes promoting the child’s physical, emotional and mental health; every Child in Care needs to have a Health and Emotional Wellbeing Assessment so that a Health Plan can be developed to reflect the child’s health needs and be included as part of the child’s overall Care Plan.

The achievement of optimum health starts in infancy and involves the provision of good quality care, which provides the child with a positive sense of identity and self-esteem.

The relevant Integrated Care Board (ICB) and NHS England have a duty to cooperate with requests from the local authority to undertake Health and Emotional Wellbeing Assessments and provide any necessary support services to Children in Care without any undue delay and irrespective of whether the placement of the child is an emergency, short term or in another ICB. This also includes services to a child or young person experiencing mental illness.

The Local Authority should always advise the ICB when a child is initially accommodated. Where there is a change in placement that will require the involvement of another ICB, the child’s ’originating’ ICB, outgoing (if different for the ‘originating ICB) and new ICB should be informed.

Both Local Authority and relevant ICB(s) should develop effective communications and understandings between each other as part of being able to promote children’s well being.


2. Principles

  • Children in Care should be able to participate in decisions about their healthcare and all relevant agencies should seek to promote a culture that promotes children being listened to and which takes account of their age;
  • That others involved with the child, parents, other carers, schools, etc are enabled to understand the importance of taking into account the child’s wishes and feelings about how to be healthy;
  • Foster carers and residential staff must be prepared and supported to promote the progress of children in relation to their health, emotional, social and psychological wellbeing;
  • Children and young people should be supported to maintain good health and manage long term conditions;
  • Health issues (including their mental and sexual health needs, as appropriate) should be identified by the multi-disciplinary team around the child or young person. The child and young person should also have access to local Health services when needed such as CAMHS;
  • Carers should develop good working relationships with Health professionals and services to meet the needs of the child or young person;
  • There is recognition that there needs to be an effective balance between confidentiality and providing information about a child’s health. This is a sensitive area, but ‘fear about sharing information should not get in the way of promoting the health of looked After Children’. (See Annex C: Principles of confidentiality and consent, DfE and DoH Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015);
  • When a child becomes Looked After, or moves into another ICB area, any treatment or service should be continued uninterrupted;
  • A Child in Care requiring health services should be able to access these without delay and any wait should ‘be no longer than a child in a local area with an equivalent need’;
  • A Looked After Child should always be registered with a GP and Dentist near to where they live in placement;
  • A child’s clinical and health record will be principally located with the GP. When the child comes into local authority care, or moves placement, the GP should fast-track the transfer of the records to a new GP;
  • Where a child is placed within another ICB, e.g. where the child is placed in an Out of Authority Placement (see Out of Area Placements Procedure), the 'originating ICB' remains responsible for the health services that might be commissioned;
  • Arrangements for managing medication must be safe and effective and promote independence whenever possible. There must be safe management of controlled drugs (such as morphine, pethidine, methadone and Ritalin). See CQC Information on Controlled Drugs.


3. Responsibilities of Foster Carers

Foster carers play a key role in ensuring that the health needs of Children in Care are met. They have the following responsibilities in particular:

  • To encourage and support children in achieving optimum health, by acting as health educator on behalf of the local authority;
  • To provide a home environment which actively encourages and supports a healthy lifestyle;
  • To ensure that the child attends health appointments and clinics and receives routine immunisations;
  • To ensure that the child attends for routine dental checks. Attendance at the dentist should commence from the age of 2 years. The Health Visitor will undertake dental checks and provide advice and guidance in respect of dental hygiene for children aged between 6 months to 2 years;
  • To contribute to the child's Health Plan;
  • To contribute to other aspects of the child's Care Plan which impact on the child's overall well-being such as promoting family contact, and enabling the child to fully benefit from educational, sporting and other recreational opportunities.


4. Health Needs of Children in Care

Children in Care often have increased health needs in comparison with young people from comparable socioeconomic backgrounds. They may have health needs arising from:

  • Living in families affected by substance misuse or domestic abuse;
  • Special educational needs or a disability;
  • Coming from highly mobile families.

They may have experienced poorer access to routine universal services such as dental services, immunisations, routine child health surveillance and health promotion. Sometimes they may have experienced language or cultural barriers in receiving health care. The local authority must be proactive in ensuring that looked after children have prompt access to the health services they need.

It is good practice to obtain comprehensive child and family health information at the earliest opportunity following the child or young person first becoming looked after. Full information is required if Health and Emotional Wellbeing Assessments and Health Plans are to accurately reflect and address all the health needs of the child or young person. The gathering of such detailed information may appear to be over burdensome and excessive when the child or young person is to be looked after on a temporary basis and will be returning home within a clear and relatively short timescale. However at the outset of a looked after episode it is often difficult to predict exactly how long a child or young person will remain looked after; it may also be much more difficult to obtain information from the child's parents at a later stage. Therefore an informed decision will need to be made at the outset of each looked after episode regarding the extent that medical information will need to be gathered. However once it becomes apparent that the child or young person will continue to be looked after for an indefinite period, or the child's plan involves being placed for adoption or other permanent placement option, full medical information must be obtained. This information is essential for planning the child's long-term care and informing the child's carers of any potential health problems.


5. Health and Emotional Wellbeing Assessments

5.1 Good Health and Emotional Wellbeing Assessment and Planning

Role of Social Worker in Promoting the Child’s Health

The social worker has an important role in promoting the health and welfare of Children in Care:

  • Working in partnership with parents and carers to contribute to the Health Plan;
  • Ensure that consents and permissions with regard to delegated authorities are obtained to avoid any delay. Note: however, should the child require emergency treatment or surgery, then while every effort will be made to contact those with Parental Responsibility, this must never delay any urgent medical procedure (see Section 5.5, Consent to Health and Emotional Wellbeing Assessments);
  • Ensure that any actions identified in the Health Plan are progressed in a timely way by liaising with health relevant professionals;
  • In recognising that a child’s physical, emotional and mental health can impact upon their learning, liaise with the Virtual School Head to ensure as far as possible this is minimised for the child. (Should there be any delay in the child’s Health Plan being actioned, the impact for the child with regard to their learning should be highlighted to the relevant health practitioners);
  • To support the child’s carers in meeting the child’s health needs in a holistic way; this includes sharing with them any health needs that have been identified and what additional support they should receive, as well as ensuring they have a copy of the Care Plan;
  • Where a Child in Care is undergoing health treatment, to monitor with the carers how this is being progressed and ensure that any treatment regime is being followed;
  • To communicate with the carer’s and child’s health practitioners, including dentists, those issues which have been properly delegated to the carers;
  • Social workers and health practitioners should ensure the carers have specific contact details and information on how to access relevant services, including CAMHS;
  • Ensuring the child has a copy of their Health Plan.
It is important that at the point of accommodating a child, as much information as possible is understood about the child’s health, especially where the child has health or behavioural needs that potentially pose a risk to themselves, their carers and others. Any such issues should be fully shared with the carers, together with an understanding as to what support they will receive as a result.

5.2 Frequency of Health and Emotional Wellbeing Assessments

Each Child in Care must have a Health and Emotional Wellbeing Assessment at specified intervals as set out below.

  • The first Assessment must be conducted before the first placement or, if not reasonably practicable, in time for the Health Care Plan before the child's first Looked After Review (unless one has been done within the previous 3 months);
  • For children under5 years, further Health and Emotional Wellbeing Assessments should occur at least once every 6months;
  • For children aged over 5 years, further Health and Emotional Wellbeing Assessments should occur at least annually.

If a child is transferred from one Looked After Placement to another, it is not necessary to plan an assessment within the first month. In these circumstances, the social worker should furnish the carer/residential staff with a copy of the child's Health Care Plan.

If no plan exists, the social worker should arrange an assessment so that a plan can be drawn up and available for the child’s first Looked After Review which will take place within 20 working days.

5.3 Who carries out Health and Emotional Wellbeing Assessments?

The first Health and Emotional Wellbeing Assessments must be conducted by a registered medical practitioner. Subsequent assessments may be carried out by a registered nurse or registered midwife who should provide the social worker with a written report.

5.4 Arranging Health and Emotional Wellbeing Assessments

The social worker should liaise with the carer/residential staff to arrange the first assessment with the child's GP or Looked After Children Health Coordinators.

Before a Health and Emotional Wellbeing Assessment takes place, social workers must complete Part A of the CoramBAAF 'Initial Health Assessment Form' to ensure it is available at the time of the appointment.

In order for the Health and Emotional Wellbeing Assessment to be conducted, the social worker must ensure that the parent(s) have given consent - this will usually be recorded on the Placement Plan/Initial Health Assessment Form at the point of becoming Looked After.

The health professional conducting the assessment will complete a relevant CoramBAAF Form and a Health Plan, which should be passed to the child's social worker - who should give copies to carers/residential staff.

Many children will have been known to Children’s Social Care and other statutory agencies prior to becoming Looked After. Health issues may already have been considered, therefore, as part of Single Assessment. There may have been a recent medical examination during Child Protection enquiries, or the child may be well known to one or more health professionals as a result of ongoing health problems or disability. The Health and Emotional Wellbeing Assessment should take account of all available information concerning the child's health. It should not be seen, therefore, as an isolated event, but as part of continuous activity to ensure continuity of health care before, during and after the period the child is looked after.

The individual child or young person should be at the centre of the process of Health and Emotional Wellbeing Assessment, planning, intervention and review. The child or young person should be given the opportunity at all stages to express their wishes and concerns and these should be listened to. The child or young person's informed consent to all health care and treatment should be actively sought and recorded in a way appropriate to the child or young person's age and understanding.

In relation to all Health and Emotional Wellbeing Assessments carried out in relation to looked after children aged 13 or over, their substance misuse needs and the risks of substance misuse should be considered - through the use of a screening tool - in which case it will be recorded on Azeus that the screening tool has been completed - see Substance Misuse Treatment Services Procedure.

5.5 Consent to Health and Emotional Wellbeing Assessments

A valid consent will be necessary for a Health Emotional and Wellbeing Assessment. Who is able to give this consent will depend on the age and understanding of the child. In the case of a very young child, the local authority as corporate parent can give the consent. An older child with mental capacity may be able to give their own consent.

Young people aged 16 or 17

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

Children under 16 – ‘Gillick Competent’

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 disorder, 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.

Children under 16 - Not 'Gillick' Competent

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 (foster 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 (see Delegation of Authority to Foster Carers and Residential Workers Procedure).

For further information on consent, see Department of Health and Social Care Reference guide to consent for examination or treatment.


6. The Health Plan

The Health Plan should be developed from the Health and Emotional Wellbeing Assessment, and forms part of the overall plan for meeting the child's developmental needs. The Health Plan should set out both short and longer term objectives together with the actions needed to achieve them. It should address how to provide health advice and health promotion, including age appropriate information on lifestyle, diet, exercise, sexual behaviour, risky behaviour (e.g. substance misuse) in addition to guidance and support on the management of specific health problems.


7. Health Reviews

A regular assessment of the child or young person's state of health is undertaken:

  1. At least once in every period of 6months before the child's 5th birthday; and
  2. At least once in every period of t12 months after the child's 5th birthday.

See also Section 10, Procedures for Health and Emotional Wellbeing Assessments and Health Reviews.


8. Confidentiality and Information Sharing

(See also Consent for Medical Treatment Procedure for a Looked After Child).

The same principles apply in relation to obtaining consent for information sharing as in consent to treatment. Young people aged 16 and 17 years are regarded as adults for the purposes of consent to treatment and are therefore entitled to the same duty of confidence as adults.

Children under 16 years who have the capacity and understanding to take decisions about their own treatment are entitled also to decide whether personal information may be passed on and generally to have their confidentiality respected. However, unless it is clearly not in the child's best interests, they should be encouraged to share information and decision making with parents.

The wishes of a competent child regarding disclosure of confidential information must therefore be respected unless disclosure can be justified on the grounds of public interest, or the child is suffering/is likely to suffer Significant Harm. The reasons for any disclosure against the wishes of the child should be recorded.

In other instances decisions to pass on personal information may be taken by a person with Parental Responsibility in consultation with the health professionals involved.

Where disclosure of a child's information might reveal information about other individuals (e.g. parents or other family members) consent should also be sought from the individual concerned.

The transfer of information about a child's health status and history becomes particularly important in circumstances when the child or young person does not retain links with the birth family. Obtaining consent to information sharing is therefore crucial to promoting the health of looked after children.


9. Out of Area Placements

Where an Out of Authority placement is sought, the responsible authority should make a judgment with regard to the child’s health needs and the ability of the services in the proposed placement area to fully meet those needs. The placing authority should seek guidance from within its own partner agencies and the potential placement area to seek such information out.

The originating ICB, the current ICB (if different) and the proposed area’s ICB should be fully advised of any placement changes and to ensure that any health needs or Health Plan are not disrupted through delay as a result of the move.

Where these are Placements at a Distance the responsible authority is required to consult with the area of placement and that Director of the responsible authority must approve the placement.

Where the child’s health situation is more complex, it is likely that both health and Children’s Social Care services will need to be commissioned; this will need to be undertaken jointly within the originating agencies’ respective fields of responsibility together with the health and social care services in the area where the child is placed.

Who Pays? provides information on which NHS Commissioner is responsible for making payment to a provider.


10. Procedures for Health and Emotional Wellbeing Assessments and Health Reviews

When a child or young person first becomes looked after, the social worker will complete the Placement Plan and a copy of this must be provided as soon as possible to the Looked After Children Health Coordinators, the Education Programme Worker, the child's carer and any other key professional. The carer needs this record at the point of placement in order to provide for immediate health needs, e.g. allergies, medication, health appointments. The Looked After Children Health Coordinators need the information to inform the initial Health and Emotional Wellbeing Assessment. The parent should also be provided with a copy.

10.1 Initial Health and Emotional Wellbeing Assessments

When a child or young person first becomes Looked After, the social worker should discuss with the child's parent(s), and where a appropriate, the child or young person, the requirements in respect of the initial Health and Emotional Wellbeing Assessment, and the need to gather relevant medical information in order to inform this assessment. The social worker should obtain separate consent to undertaking the Health and Emotional Wellbeing Assessment and to obtaining and sharing information:

  1. It is the responsibility of the allocated social worker to ensure that a Health and Emotional Wellbeing Assessment is completed and that a Health Plan is in place;
  2. The social worker must arrange for the CoramBAAF consent form for obtaining and sharing information to be completed. The social worker is responsible for arranging the initial Health and Emotional Wellbeing Assessment of the child/young person using CoramBAAF form IHA - C for children aged 0-9 years and IHA - YP for young people aged 10-18 years. The social worker should complete Part A of the form and also arrange for Part B of the Consent Form to be signed by a parent for all children who are accommodated. This gives separate consents in relation to sharing both parental health information and child health information and giving consent to the Health and Emotional Wellbeing Assessment. The social worker signs as a witness to these signatures. If the child or young person has capacity to consent for him/herself, the examining doctor should seek their consent before commencing the medical examination. See also Section 5.5, Consent to Health and Emotional Wellbeing Assessments.

    A child or young person with capacity to consent should complete Part C of the form. A person with Parental Responsibility (who is not a birth parent) should sign Part D. For children subject to a Care Order, the consent of the parent should be sought whenever possible, but the Team Manager may sign the form in section D when parental consent cannot be obtained;
  3. The social worker should ask the child’s parents / mother to complete CoramBAAF form PH (Report on Health of Birth Parent), and CoramBAAF form M / B. (obstetric report on mother / neonatal report on child). This step should be completed as a matter of urgency when a Care Plan of adoption has been agreed (see Planning for Adoption and Preparation of Adoption Plan and Child's Permanence Report Procedure) and as soon as possible in all cases when the child becomes looked after to facilitate the Health and Emotional Wellbeing Assessment and any subsequent consideration of permanent placement options for the child;
  4. The completed CoramBAAF consent form, and CoramBAAF forms PH; M/B when available, should be sent (retaining a copy for the child's file) to the Health Coordinator at the Looked After Children Team;
  5. The initial Health and Emotional Wellbeing Assessment must be undertaken by a registered medical practitioner and this will usually be the child’s registered medical practitioner or the Designated Doctor for Looked After Children for children under the age of 5 years;
  6. CoramBAAF form IHA must be sent by secure email to the Looked After Children Health Coordinators generic email address. The Looked After Children Health Coordinators will arrange for the assessment to be undertaken. Following the medical examination, the registered medical practitioner/designated doctor will send the completed IHA directly to the Looked After Children Health Coordinators, who will then send out the assessment to the relevant health professionals and to the social worker. The social worker then distributes it to the Children's Independent and Safeguarding Reviewing Officer (CISRO), carer and others as appropriate;
  7. The social worker should attend the Health and Emotional Wellbeing Assessment with the child /young person if they have complex or additional needs. However, the responsibility to attend the medical with the child or young person may be delegated to a foster carer or residential care worker;
  8. On receiving CoramBAAF Form IHA, the Looked After Children Health Coordinators will assign a key health professional (usually the health visitor or school nurse) to each Looked After Child, and will notify the social worker of their name. The key health worker will be responsible for completing the initial Health and Emotional Wellbeing Assessment and Health Plan and for undertaking all subsequent Health and Wellbeing Assessments, and for providing information to the child's statutory review;
  9. The Looked After Children Health Coordinators will notify the information monitoring section when the Health and Emotional Wellbeing Assessment and Plan has been completed and will arrange for the completed CoramBAAF form IHA to be sent to the social worker;
  10. The social worker should decide in conjunction with the Young Person and their parent (and their team manager where the child is subject to a Care Order) who should have a copy of the Health and Emotional Wellbeing Assessment / Plan. It will be necessary for relevant information to be shared with child/young person's carer in order that they are able to provide appropriate care, even if a full copy of the Health and Emotional Wellbeing Assessment / Plan is not given to them. If a child of pre-school age is identified as having additional needs, the social worker will contact the education welfare service to consider a pre-school Personal Education Plan;
  11. Overseeing the implementation of the Health Plan and the provision of services will mainly fall to the designated key health professional, but the social worker should ensure there is good liaison between all involved in meeting the child's health needs. The social worker should monitor progress in meeting the objectives set out in the Health Plan, addressing issues arising from the SDQ, if in place, and ensure that these are reviewed alongside the child's Care Plan;
  12. The social worker should ensure that the child or young person is registered with a dentist. When difficulties arise in registering a child or young person with an NHS dentist, a request must be made to Dental Services for an appointment. A letter offering an appointment with an appropriate community dentist will then be sent to the child or young person's carer, with a copy to the social worker;
  13. The carer should facilitate the child or young person's attendance for regular dental checks. This should be monitored by the social worker during the statutory visits to the child. The social worker must ensure that the dates of dental checks are recorded on the Children's Social Care database and in the child's file. The date should be noted in section 18 of the Review of Arrangements form.

10.2 Review Health and Emotional Wellbeing Assessments

  1. It is the responsibility of the social worker to issue form CoramBAAF RHA - C or RHA - YP Part A to the Looked After Children Health Administrator 2 months prior to the review assessment being due in order to meet statutory timescales. This is to ensure that information about the circumstances of the child/young person is updated and accurate;
  2. If the legal status has changed, the consent for the review assessment will need to reflect this and a new consent form may be needed. (Part D of the Consent Form may need to be completed if the Local Authority has Parental Responsibility);
  3. The social worker needs to determine who will accompany the child to the assessment and ensure that the health practitioner undertaking the assessment is updated about any relevant developments in the child's life. The accompanying adult should have sufficient knowledge of the child's needs and be able to provide information to support an effective assessment;
  4. Social workers are required to ensure that a strengths and difficulties questionnaire is completed for all children who have been in care for over 12 months and are aged 4 to 16 inclusive. It is good practice to ensure that the questionnaire is completed for all children in long term care to promote a good understanding and appropriate response to their emotional needs. The questionnaire may also indicate what additional support the carer may need. A copy of the result of the strengths and difficulties questionnaire needs to be sent to the Looked After Children Health Coordinators for consideration at the review Health and Emotional Wellbeing Assessment (see paragraph below).

10.3 The Strengths and Difficulties Questionnaire

See also Strengths and Difficulties Questionnaires.

In relation to children aged 4 to 16, the social worker will arrange for the main carer to complete an annual Strengths and Difficulties Questionnaire (SDQ), which will contribute to the annual Health and Emotional Wellbeing Assessment. When completed, the social worker should ensure that a copy is placed on the child's record, a copy is sent to the SDQ coordinator and a copy to the Looked After Children Health Coordinators. When the social worker receives the individual result -the Total Difficulties Score- for the child from the SDQ coordinator, they should include this on the child's record and send a copy to the Looked After Children Health Coordinators with an update about any action they have taken as the result needs to be considered within the Health and Emotional Wellbeing Assessment.

If the social worker wishes to triangulate this with the views of the child or young person and his or her teacher, they may want to ask them to complete the SDQ designed for teachers and young people in addition to the one the carer completes. This is advisable if the carer SDQ indicates a possible or probable concern. The teacher or young person may also wish to complete their own version of the SDQ of their own volition.

A consultation with the dedicated Looked After Children CAMHS Team should take place about children and young people who have scores raising concern who are not already involved with CAMHS as a request for the service may be indicated. The social worker should also discuss the result and action to be taken with the carer and respond to any support needs the carer has. A score raising concern may reflect the carer's perception and ability to manage the behaviour as well as the significance of the behaviour itself. This may have been discussed when the SDQ was completed.

See Annex B of the ‘DfE promoting the health and well-being of looked-after children’, Strengths and Difficulties Questionnaire.

10.4 CAMHS and Emotional Wellbeing

Health and Emotional Wellbeing Assessments in relation to Looked After children should consider any significant emotional wellbeing needs and how these are being addressed. The child's carer may first notice issues of concern if they have not already been identified. Such needs may also emerge through the social care assessment or through the strengths and difficulties questionnaire. The social worker will consider a consultation with the dedicated Looked After Children CAMHS Team regarding emotional wellbeing concerns and this should take place as soon as these are identified. The CAMHS team may offer consultation with carers, teachers and/or the social worker and /or direct work with the child.

10.5 The Health Reviews

All arrangements for Health and Emotional Wellbeing Assessments and plans to be reviewed will be made through the Looked After Children Health Coordinators, using CoramBAAF form RHA -C or RHA -YP. Four weeks prior to the date the Health and Emotional Wellbeing Assessment and plan are due to be reviewed the social worker should complete part A of CoramBAAF form RHA - C (for children aged 0-9 years) or RHA -YP (for young people aged 10 years+) and forward the form to the Looked After Children Health Coordinators at the address given in step 4. Wherever possible the birth parent should be alerted to the need for the health review and asked to give consent. The same considerations for Initial Health and Emotional Wellbeing Assessments apply for reviews, except that a parent who has previously signed consent for the IHA may be deemed to consent to subsequent reviews unless they have subsequently withdrawn their consent.

All Health and Emotional Wellbeing Assessments carried out in relation to looked after children aged 13 or over should also consider the child's substance misuse needs and the risks of substance misuse - through the use of a screening tool - and it should be recorded on Azeus that the screening tool has been completed - see Substance Misuse Treatment Services Procedure.

On receipt of form RHA, the Looked After Children health Coordinator will arrange for the Key Health Professional to undertake the review and complete form RHA. Following the Health and Emotional Wellbeing Assessment review, the completed form RHA will be forward to the social worker by the NHS Looked After Children Health Coordinators team.

The Social worker should distribute copies of form RHA to relevant individuals.


Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children

Good Practice Guidance

Children's Attachment: Attachment in Children and Young People who are Adopted from Care, in Care or at High Risk of Going into Care, NICE Guidelines (NG26)

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