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One of your own

05 July 2019

Safeguarding nurse Caroline Waldron explores the role of the health practitioner as a corporate parent for looked-after children and care leavers, identifying practical steps.

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The Department for Education’s statistical return for the end of March 2018 reports that there are 75,420 looked-after children (LAC) currently in England (Department for Education, 2019). A study of care proceedings in England identifies that, year-on-year, these numbers are rising, which is only adding to the already significant pressures to both local authorities and health services in securing timely access to LAC statutory health assessments (Trowler, 2018).

There is a plethora of research that outlines the health inequalities faced by LAC and care leavers, and it is widely recognised that they are the most vulnerable children in our society. Statutory guidance and NICE guidelines are clear around the key role of health services in improving health outcomes for this cohort, and the required skills, knowledge and competences of the workforce are clearly specified in the Intercollegiate Role Framework for LAC (Royal College of Nursing and the Royal College of Paediatrics and Child Health, 2015; Department for Education and Department of Health, 2015).

Despite this, learning focused on recognising the specific health needs and challenges for this vulnerable cohort of children and young people is not a consistent feature of the educational programmes for pre-registration nurses or post-registration specialist community public health nurses (SCPHNs) such as health visitors and school nurses. It is also worth noting that there are limited opportunities for the continued professional development for health professionals in relation to supporting and developing their key roles as advocates involved in a corporate parenting situation.

Looked-after children

LAC often have greater health needs than other young people their age, which may have a lasting impact on their adult lives. This is often a result of their adverse childhood experiences (ACEs) prior to them becoming looked after. The term ‘ACE’ was first generated from the CDC-Kaiser Permanente Adverse Childhood Experiences Study in America in 1995-97 (Felitti et al, 1998). The study examined the relationship of childhood neglect/abuse on the impact of life health outcomes. Below is a list of the ACEs linked with risk factors for disease, early death and poor life chances as included in the original study:

  • Sexual abuse before age 18
  • Emotional abuse by a parent/loved one
  • Physical abuse by a parent/loved one
  • Emotional neglect by a parent/loved one
  • Physical neglect by a parent/loved one
  • Loss/abandonment of, or by, a parent
  • Witness to abuse in the household
  • Drug/alcohol in the household
  • Mental illness in the household
  • Loved one incarcerated.

The research concluded that the increased number of ACEs can have the most significance in poorer health and life outcomes, with those who have experienced four or more ACEs increasingly likely to experience long-term impacts. Although ACEs are common across the entire UK population, children who become looked after tend to have experienced at least four (Felitti et al, 1998).

The table LAC health difficulties on page 25 categorises some of the health difficulties experienced by the LAC and care leaver population as a potential result of their ACEs and pre-care experiences (Department for Education and Department of Health, 2015; National Audit Office, 2015; Biehal and Wade, 2009; Mooney et al, 2009; Meltzer et al, 2003).

The role of health professionals

As a registrant with the NMC, nurses, midwives and SCPHNs are expected to uphold the human rights of the people using health services, as outlined in the NMC code (NMC, 2015) and Human Rights Act 1998 (HM Government, 1998). This includes the rights of the child to be protected from harm (United Nations, 1989), with their needs responded to with due process. Given their specialist knowledge and skill focused on children and young people, SCPHNs play an important role in their ability to act as advocates for the LAC and care leaver population. They are best placed in being able to identify and subsequently navigate the required access to health provision across their local health economies. The lead health record for LAC is the GP record, but health information within community health visiting and school nurse records gives detailed information of their social and medical history. This can be used to inform a comprehensive assessment of the LAC’s health needs, and includes crucial elements of their life story.

The statutory health assessments of LAC in England are predominantly carried out by health visitors and school nurses within the ‘0 to 19 services’ commissioned by public health, with other models of service delivery involving specialist LAC nursing teams who, when present, take responsibility for these statutory assessments. To be effective in their role, it is imperative that all health professionals undertaking a health assessment have the necessary knowledge and understanding of what it means to be a corporate parent, and what the aim of health services should be in this.

To support practitioners, we would recommend they consider the following questions and statements in their local context, or for those children who are placed outside the area they are originally from.

Ask yourself, would I accept this for a child in my own family – for example, my own child, grandchild, niece/nephew?
Advocate for timely access to the right services and listen to the child/young person’s voice. Correspondence regarding LAC should highlight their status and their need for timely access.

Ensure your local area practice and systems offer the opportunity to build resilience for LAC.
Promote consistency so that children and young people are able to build relationships and do not have to continually repeat their life stories.

Be competent in your knowledge of the specific health needs of LAC and the barriers that can prevent children and young people from improving their health outcomes.
All practitioners supporting LAC should have the specific competencies required to maintain awareness about the child or young person’s increased vulnerability and continued need to be effectively protected from harm, as well as the ability and confidence to highlight any gaps or barriers in services through organisational governance structures.  

Raise awareness of the role and responsibilities of corporate parents.
In your role, continue to share with other health colleagues and partner agencies the principles of corporate parenting. Take every available opportunity to raise the profile of LAC and care leavers.

Be ACE aware.
LAC will have experienced several ACEs. Early identification of their individual support needs around emotional health and wellbeing is crucial, along with a clear understanding about where to access support.

Enable an effective transition to adult services.
A key challenge for LAC is the transition between children’s and adult health services, particularly in relation to mental health. Practitioners should ensure a seamless transfer of care and equip young people with the tools to navigate the health economy.  

Key messages.
The named and designated nurses’ roles and responsibilities for LAC are clearly defined in statutory guidance and explain the operational and strategic leadership for their local health economies (Department for Education and Department of Health, 2015). Health visitors and school nurses, as public health practitioners for all children from age 0 to 19 years, hold a pivotal role in working in partnership with local authorities, and in discharging their corporate parenting responsibilities to LAC within their localities.        

Caroline Waldron is deputy designated nurse – safeguarding children and looked-after children, at East Lancashire & Blackburn with Darwen Clinical Commissioning Groups.


Corporate parenting

The concept of corporate parenting for local authorities is not new. The Children’s Act 2004 (HM Government, 2004) introduced the concept for local authorities to take on the role of the ‘corporate parent’, with health services being key cooperating partners working to improve the outcomes of the LAC population.

A ‘corporate parent’ can be defined as holding the same high aspirations and life goals for LAC as if they were your own child, and acting as their strongest advocate to enable to achieve those goals (Department for Education, 2018).

Corporate parenting was further strengthened by the Children and Social Work Act in 2017 (HM Government, 2017), defining a set of principles for corporate parents to:

  • Act in the best interests, and promote the physical and mental health and wellbeing, of those children and young people
  • Encourage those children and young people to express their views, wishes and feelings
  • Take into account the views, wishes and feelings of those children and young people
  • Help those children and young people gain access to, and make the best use of, services provided by the local authority and its relevant partners
  • Promote high aspirations and seek to secure the best outcomes for those children and young people
  • Enable those children and young people to be safe, and to have stability in their home lives, relationships and education or work
  • Prepare those children and young people for adulthood and independent living (HM Government, 2017).

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References:

Biehal N, Wade, J. (2009) Outcomes for children looked after for reasons of abuse or neglect: interim findings. Paper presented at Safeguarding Research Initiative Annual Seminar, Commonwealth Club, London.

Department for Education. (2019) Statistics: looked-after children. See: www.gov.uk/government/collections/statistics-looked-after-children (accessed 25 June 2019).

Department for Education. (2018) Statutory guidance – Applying corporate parenting principles to looked-after children and care leavers. See: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/683698/Applying_corporate_parenting_principles_to_looked-after_children_and_care_leavers.pdf (accessed 25 June 2019).

Department for Education, Department of Health. (2015) Promoting the health and well-being of looked-after children. See: www.gov.uk/government/publications/promoting-the-health-and-wellbeing-of-looked-after-children--2 (accessed 25 June 2019).

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. See: ajpmonline.org/article/S0749-3797(98)00017-8/pdf (accessed 25 June 2019).

HM Government. (2017) Children and Social Work Act 2017. See: legislation.gov.uk/ukpga/2017/16/contents/enacted (accessed 25 June 2019).

HM Government. (2004) Children Act 2004. See: legislation.gov.uk/ukpga/2004/31/contents (accessed 25 June 2019).

HM Government. (1998) Human Rights Act 1998. See: legislation.gov.uk/ukpga/1998/42 (accessed 25 June 2019).

Meltzer H, Corbin T, Gatward R, Goodman R, Ford T. (2003) The mental health of young people looked after by local authorities in England. The Stationery Office: London. See: https://webarchive.nationalarchives.gov.uk/20121006174036/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4060671.pdf (accessed 25 June 2019).

Mooney A, Statham J, Monck E, Chambers H. (2009) Promoting the health of looked after children: a study to inform revision of the 2002 guidance. See: https://dera.ioe.ac.uk/11156/1/DCSF-RR125.pdf (accessed 25 June 2019).

National Audit Office. (2015) Care leavers’ transition to adulthood. See: https://www.nao.org.uk/wp-content/uploads/2015/07/Care-leavers-transition-to-adulthood.pdf (accessed 25 June 2019). 

NMC. (2015) The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. See: https://www.nmc.org.uk/standards/code/ (accessed 25 June 2019).

Royal College of Nursing, Royal College of Paediatrics and Child Health. (2015) Looked after children: knowledge, skills and competences of health care staff. See: rcpch.ac.uk/sites/default/files/Looked_after_children_Knowledge__skills_and_competence_of_healthcare_staff.pdf (accessed 25 June 2019).

Trowler I. (2018) Care proceedings in England: the case for clear blue water. See: https://www.sheffield.ac.uk/polopoly_fs/1.812158!/file/Sheffield_Solutions_Clear_Blue_Water_Full_Report.pdf (accessed 25 June 2019).

United Nations. (1989) Convention on the rights of the child. See: unhcr.org/uk/4aa76b319.pdf (accessed 25 June 2019).

 


Image credit | iStock

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