Health Care Assessments and Plans

NHS Practitioners have an important role to play in the identification of the health care needs of children and young people in care. They often have prior knowledge of the child, birth parents and carer, helping them to take a holistic and child-centred approach to health care decisions.

Roles and responsibilities of the Integrated Care Board (ICB)

• Ensure that the health and well-being of children and young people in care, is an identified local priority.
• Ensure that structures are in place to plan, manage and monitor the delivery of health care for all Children in Care.
• Ensure that clinical governance and audit arrangements are in place to assure the quality of Health Assessments and Health Planning.
• Ensure that there is a named public health professional, who will input into children in need issues, including child protection, as necessary. Children in Care are part of this wider group of children in need.
• Identify a Designated Professional (doctor and nurse) to provide strategic leadership and advice in relation to the health needs of Children in Care.
• Where a child is placed “out of authority”, ensure systems are in place to provide continuity of the Health Assessment and planning process.
• Through the commissioning process ensure that Children in Care are registered with GP's and dentists near to where the child is living.
• When Children in Care need to register with a new GP (e.g., when they enter care or change placement), ensure systems are in place to “fast track” the GP held clinical and dental records.
• Ensure systems are in place through the commissioning process to make sure that Children in Care are not disadvantaged when they move from one ICB to another, i.e., NHS waiting lists.
• Ensure that arrangements are in place for the transition from child to adult health services.
• Ensure that an appropriate data set is collected and reviewed annually.

Roles and Responsibilities of the Designated Professionals

The broad role of the designated doctor and nurse is to assist relevant NHS bodies in fulfilling their responsibilities as commissioners of services to improve the health of Children in Care. They will advise relevant bodies on, and contribute to planning, strategy, and audit of quality standards for health services for Children in Care. As well as providing expert advice, the designated doctor and nurse will take a strategic overview of the service and monitor quality.

• Develop and ensure awareness of relevant policies, procedures, and roles in relation to Children and young people in care.
• Maintain regular contact with local health staff undertaking Health Assessments. They will also liaise with social services departments and other areas over Health Assessments and Health Plans for out of authority placements.
• When a child moves from Lancashire to another area, the responsibility for the child will transfer to the area in which the child now resides.
• Ensure that all relevant staff are appropriately trained in undertaking Health Assessments for Children in Care.
• Monitor the quality of the Health Assessments ensuring that sensitive health promotion is offered to all.
• Contribute to the production of health data on Children in Care, ensuring an effective system of audit is in place.
• Produce an annual report, evaluating the delivery of health services for Children and Young People in Care.

Roles and Responsibilities of the Enhanced Children in Care Team (including the Specialist Children in Care Nurses) and Care Leavers Nurses

The Enhanced Children in Care and Care Leavers Nurses are Specialist Nurse Practitioners, based within the locality Safeguarding Team and have responsibility for the co-ordination of health needs of Children in Care and Care Leavers up to the age of 25 years. The team has a wealth of experience ranging from paediatric nursing, midwifery, health visiting and school nursing. There are 4 separate Teams of the Lancashire South Cumbria Foundation Trust (LSCFT), based in 4 localities within Lancashire: Pennine (Lancashire East and Blackburn with Darwen); Central and West Lancashire; Fylde and Wyre (Blackpool, Fylde & Wyre Hospitals at Blackpool Victoria Hospital) and Lancaster (University Hospitals Morecambe Bay Trust). Key Responsibilities include:

• Co-ordination and facilitation of all Initial Health Assessment (IHA)/Review Health Assessments (RHA);
• Quality assurance of Health Assessments using a standardised national tool and in-depth auditing of Health Assessments;
• Advisory role for foster carers, social workers, personal advisors and other professionals regarding health needs of children in care and Care Leavers;
• Attendance at multi-agency safeguarding meetings, strategy discussions/meetings, statutory Children Looked After Reviews;
• Supporting the wider safeguarding agenda;
• Attending multi-disciplinary meetings for Children in Care and Care Leavers with complex needs;
• Supervision and duty advice for professionals;
• Quarterly/annual reporting to commissioners;
• Review and updating health processes in line with government guidelines/ legislation;
• Participation in child safeguarding practice reviews (CSPR) learning on a page review for Children in Care.

Roles and Responsibilities of the Health Provider Organisations Named Doctor and Lead Nurse for Children in Care

• Each health provider must have a named doctor and lead nurse for Children in Care with the skills, knowledge, and competencies to support all activities necessary to ensure that the organisation meets its responsibilities;
• Lead nurses and doctors for Children in Care have an important role in promoting good professional practice within their organisation and providing advice and expertise for fellow professionals. The named health professional will work in (and usually be employed by) a health provider organisation. He or she will act as a principal health contact for Children’s Social Care and should have up-to-date specialist knowledge of the health needs of Children in Care or know how to access it;
• Working with the designated professionals for Children in Care, named health professionals should:
  • Coordinate the provision of local health services for individual Children in Care and the input into Health Assessments and their reviews for individual Children in Care;
  • Ensure the timeliness and quality of Health Assessments for Children in Care and ensure actions taken to implement the Health Plan are tracked;
  • Act as a key conduit and contact point for the child and their carer, where they have difficulties accessing health services.

Roles and Responsibilities of the Named Nurse for Children in Care 0-19 years and the Specialist Children in Care Nurses 0-19 years (commissioned via HCRG in 2023)

• The Children in Care Nursing Team support all Children in Care who reside in Lancashire or attend a Lancashire school for the duration of the child’s care order
• The Children in Care Nursing Team complete all RHAs for children aged 0-18 who reside in Lancashire regardless of their originating authority.
• The Children in Care Nursing Team comprises of Health Visitors, School Nurses and Staff Nurses
• Children in Care Health Visitors also complete the Healthy Child Programme for children in care aged 0-5 years, so these children only have one Health Visitor whilst in care
• The Children in Care Nursing Team can support children with arising health needs, signpost to specialist services and/or support new referrals to other services e.g., mental health, speech and language or paediatrician
• The Children in Care Nursing Team will complete quality assurance for all RHAs completed by the team using the standardised ICB wide quality assurance tool
• The Children in Care Nursing Team complete audits of Health Assessments and health needs on a quarterly basis and complete and provide an annual report to Commissioners

Roles and Responsibilities of the School Nursing Service

• Ensure every school age Child in Care, has a named School Nurse;
• Advise the carer that each Child in Care should be registered with a GP and Dentist;
• Conduct RHA and complete Health Plans in respect of Children in Care and ensure copies are sent to the relevant person’s (including a copy in the school nursing records);
• Provide health promotion, support, and advice, as required, to carers and Children in Care, focusing particularly on sexual health, mental health, and substance use;
• Attend statutory reviews in respect of Children in Care;
• Support Children in Care with specific health needs;
• Ensure immunisations are up to date.

Roles and Responsibilities of the Health Visiting Service (for children below the age of school entry)

• Ensure that the agreed Child Health Promotion Programme is carried out as per local protocols. The contact should be a face-to-face contact with both the Child in Care and their carer/s. Special consideration should be given to:
  • Speech and language;
  • Gross and fine motor function;
  • Vision and hearing;
  • Play and pre-literacy skills;
  • Social and self-help skills.
• Advise carers that all Children in Care should be registered with a GP and dentist;
• Attend statutory Child Looked After Reviews;
• Conduct RHAs in respect of Children in Care as deemed appropriate by the Designated Doctor. This will include a holistic assessment of the child’s health needs and will incorporate relevant health promotion topics, e.g.:
  • Attachment behaviour;
  • Physical health;
  • Growth;
  • Diet;
  • Immunisations;
  • Play and early learning;
  • Safety;
  • Oral and dental health.
• A Health Plan will be completed which will identify areas of need, plan of action and eventual outcome. A copy of the plan will be sent to relevant persons.  A copy will remain within the child’s health visiting record.

Roles and Responsibilities of Primary Care

• Provide a Named GP for every patient;
• Ensure timely access to a GP;
• Provide summaries of the health history of a child who is in care;
• Maintain a record of the Children in Care Health Assessment (IHA/RHA) and contribute to any necessary action within the Health Plan;
• Make sure the GP-held clinical record for a Child in Care is flagged, maintained, and updated.

Roles and Responsibilities of the Social Worker

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

• Working in partnership with the child/young person, their parents and carers and health professionals to contribute to the Health Plan.
• Ensuring that consents and permissions regarding delegated authorities are obtained timely to avoid any delay. Note: Should the child require emergency treatment or surgery, then every effort should be made to contact those with Parental Responsibility to both communicate this and seek for them to provide medical consent where appropriate. Nevertheless, this must never delay any necessary medical procedure (see Section 3.6, Consent to Health Care Assessments).
• Ensuring 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, where this is necessary, liaising 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 about their learning should be highlighted to the relevant health practitioners).
• Supporting 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 Our Care is undergoing health treatment, monitoring with the carers how this is being progressed and ensure that any treatment regime is being followed.
• Communicating 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.
• Social workers should attend the Initial Health Assessment to support the early identification of health needs and ensuring that the appropriate support is in place as social workers hold significant information about the child's and family history. Also, social workers have a key role alongside carers to ensure that children and young people have a good understanding of what is likely to happen at the Health Assessment.
• Arrange for an interpreter to be available for the Health Assessment appointment, if required.
• Ensuring the child has a copy of their Health Plan, where this is appropriate. It is important that at the point of a child becoming looked after by the Local Authority, as much information as possible is understood about the child's health, especially where the child has health or behavioural needs which 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.

Roles and Responsibilities of the Foster Carer/Residential Worker/Worker in supported/semi-independent accommodation

• Ensure that the Child in Our Care is registered with a local GP and Dentist;
• Keep an accurate and dated record of all health issues and treatment relating to the Child in Our Care and ensure this record along with any health concerns the carer may have in respect of the child are presented at statutory reviews;
• Proactively ensure the child or young person is enabled to attend health appointments and clinics, to attend with the child or young person unless agreed unnecessary and provide the health professional with any relevant information in respect of physical and emotional well-being, including behaviour;
• Keep the Social Worker informed of any health and dental issues relating to the Child in Our Care and ongoing health appointments e.g., GP attendances and statutory Health Assessments;
• Involve children and young people in discussions and decisions regarding their health care in accordance with their age, understanding and in consultation with the child’s social worker, including issues around eating, hygiene, alcohol, drugs, and sexual health;
• Promote healthy living home environments and health awareness for all children and young people in our care and encourage the child in age-appropriate personal responsibility for own health and hygiene;
• Encourage children and young people to participate in leisure activities, hobbies, and sport. These should be tailored to the needs of the individual, including those with special needs, seeking the advice and support of their supervising social worker where necessary;
• Provide nutritionally balanced meals with young people being encouraged to eat a varied and healthy diet. They should be encouraged to participate in the planning, purchase, and preparation of food to gain an understanding and appreciation of healthy eating;
• Participate in the development of Health Plans for children and young people, monitoring and initiating any required action. Encouraging and supporting contact and communication with the child or young person’s family, appropriately, as agreed in Care Plans;
• Keep self-up to date on relevant issues important to the needs of Children in Our Care, e.g., through active participation in knowledge and skill development opportunities, supervision, training, etc.

Roles and Responsibilities of the Independent Reviewing Officer

• The Independent Reviewing Officer’s role is to review the care plan for all Children in Our Care, which will include the health component of the child/young person's care plan. As part of the review process the Independent Reviewing Officer will ensure the views of the child/young person is sought and considered within the review process.  These views can be shared directly by the child/young person or by other means including direct work tools, Mind of my Own or an advocate;
• Ensure that there is an up-to-date Health Plan, SDQ and dental check and that this informs the looked after review process;
• If a young person in our care does not wish to have their statutory Health Assessment, then guidance should be offered, and an understanding explored as to the young person's views. They should be signposted to alternative advice and support in relation to their general health and welfare via their Lead Health professional (Children in Care Nurse or School Nurse.  Within the review process the Independent Reviewing Officer will check that this position still stands regarding the young person in relation to having their Health Assessments and that their health needs are being addressed;
• Monitor the effectiveness of Health Plans for children and young people who are in care through the review process and Independent Reviewing Officers case monitoring;
• If the health needs of a child or young person in our care is not being appropriately met, the Independent Reviewing Officer will address this through the children looked after review process and case monitoring and ensure that any issues are escalated appropriately;
• Promote the health and welfare of children and young people in our care by ensuring that they are provided with enough information to guide them and support them in making informed choices and taking responsibility for their own health needs in the future;
• Ensure that at the final review, before a young person reaches 18 years old, that the young person understands their entitlement to a Leaving Care Health Summary, have a completed health summary or plans are in place to have this completed and to confirm whether the young person consents to their Personal Advisor to hold a copy of the health summary to be shared with relevant professionals for continued support and future reference.

Each child in our care must have a Health Assessment at specified intervals as set out below.

• The Initial Health Assessment (IHA) must be conducted within 20 working days of a child coming into our care and the Health Plan be available for the child's first Looked After Review. A request for an IHA with all consent and paperwork has to be sent out within 2 working days from the child coming into our care, to meet that timescale;
• For children under five years, further Review Health Assessments (RHA) should occur at least once every six months;
• For children aged over five years, Review Health Assessments (RHA) should occur at least annually.

If a child moves to live in a new home the social worker should ensure that carers/residential staff/key workers are provided with the most recent copy of the child's Health Plan. Any changes should also be shared via the Enhanced Children in Care Team to ensure that any appointments are sent to the correct address and any ongoing health needs can continue to be supported.

The Initial Health Assessment must be conducted by a registered medical practitioner. Review Health Assessments may be carried out by a registered nurse or registered midwife and who is the most appropriate health professional. Following each Health Assessment, a Health Plan will be completed, and copies shared with the social worker (parent whereby indicated is appropriate to do so by the social worker) GP and carer. Copies of the Health Plan should also be shared with child/young person unless this would not be appropriate.

Initial Health Assessments

Before an Initial Health Assessment takes place:

• The social worker must ensure that consent is in place. For a child in our care under section 20 of the Children Act consent from the parent(s) has to be given. For a child in our care under section 38 (ICO) or section 31 (CO) this can be from the appropriate professional in Children's Services according to the scheme of delegation. Consent will usually be recorded on the Placement Plan/Initial Health Assessment Form at the point of the child coming into our care;
• Local Authority business support complete Part A of the CoramBAAF Initial Health Assessment Form;
• For the Initial Health Assessment to be conducted within statutory timescales of 20 working days, consent documentation and the CoramBAAF Initial Health Assessment Form must be sent via Local Authority business support within 2 working days from the child coming into our care to the relevant Enhanced Children in Care Team. This is to enable sufficient time for a health appointment to be provided (to avoid delay also see section below 'Consent to Health Assessments');
• Once the consent and CoramBAAF Health Assessment Form has been received via the Enhanced Children in Care Team it will be reviewed to ensure all sections of Part A are completed in full. Incomplete forms will be returned for amendment if required which could result in a delay in a Health Assessment being completed within the required timescales;
• An appointment letter will be sent to the child/young person’s current carer and social worker.
  
  If there is a change to the child’s address, it is imperative that the social worker informs Local Authority business support in a timely manner so that they can share this with the Enhanced Children in Care Team to ensure the invite is sent via the correct contact details. Failure to do so could result in a delay in securing timely access to the statutory Health Assessment and the early identification of a child’s health needs;
• Where an interpreter is required, this should be arranged by the social worker and should be available face to face wherever possible.

Every effort should be made for the child’s social worker to attend the initial Health Assessment at the appointment date provided to ensure key current and historical information that may impact on the holistic assessment of the child’s health is available. If the social worker is unable to attend, prior contact should be made with responsible clinicians to provide any key information of which an account should be documented on the child's record on LCS.

The Initial Health Assessments are carried out by Paediatricians in a clinic/community hospital setting. 

Review Health Assessments

Before a Review Health Assessment takes place:

• The social worker must ensure that consent is in place. For a child in our care under section 20 of the CA, consent from the parent(s) has to be given. For a child in our care under section 38 (ICO) or section 31 (CO) this can be from the appropriate professional in Children's Services according to the scheme of delegation. This will usually be recorded on the Placement Information Record/Placement Plan at the point of the child coming into our care;
• Local Authority business support complete Part A of the relevant CoramBAAF Review Health Assessment Form, e.g., for a child aged 10 years or over 10 years;
• A copy of the most recent SDQ and SDQ score is provided;
• For the Review Health Assessment to be conducted within statutory timescales, consent documentation, a copy of the most recent SDQ (incl. score) and the CoramBAAF Review Health Assessment Form must be sent via Local Authority business support with a minimum of 10 weeks' notice before the completion due date is required to the Enhanced Children in Care Team in the area where the child originates from;
• Once the consent and CoramBAAF Health Assessment Form has been received via the Enhanced Children in Care Team it will be reviewed to ensure all sections of Part A are completed in full. Incomplete forms will be returned for amendment if required which could result in a delay in a Health Assessment being completed within the required timescales;
• The Enhanced Children in Care Team will co-ordinate completion by the most appropriate health professional in their area of current residence;
• The appointment for completion of the Review Health Assessment will be arranged directly with the child's carer. The appointment time, date and venue will be agreed in recognition of the child/young person’s preference. An appointment letter will be sent to the child/young person's current carer and social worker. If there is a change to the child’s address, it is imperative that the social worker informs Local Authority business support in a timely manner so that they can share this with the Enhanced Children in Care Team to ensure the invite is sent via the correct contact details. Failure to do so could result in a delay in securing timely access to the statutory Health Assessment and the early identification of a child’s health needs;
• Where an interpreter is required, this should be arranged by the social worker.

Final Review Health Assessment

It is a statutory requirement for all Children in Care about to leave our care to be provided with a Leaving Care Health Summary. This Health Summary provides details of the child’s health conditions, immunisations, GP and Dentist details and NHS number. The Health Summary also provides contact details for the Enhanced Children in Care and Care Leavers Nurses to ensure all Care Leavers are able to contact a health professional regarding any health concerns they may have.

The Leaving Care Health Summary should be discussed with all children during their final review health assessment (RHA) before leaving care. The Health Action Plan from the last RHA must include an action which states whether the young person consents to this Health Summary to be completed by the responsible health practitioner and shared with their Personal Advisor. Additionally, if the young person provides their consent, the Health Action Plan must include an action that a Care Leaver Health Summary will be completed and shared with the young person and Personal Advisor.

Who should attend the Health Assessment

For the Initial Health Assessment to support completion of a high quality and holistic review of the child’s health needs when they first enter care, the social worker should attend the Initial Health Assessment at the appointment date to ensure key current and historical information that may impact on the holistic assessment of the child’s health is provided. If the social worker is unable to attend, prior contact should be made with responsible clinicians to provide any key information and they must ensure that the foster carer/residential worker/worker in supported/semi-independent accommodation is equipped with the child and family's relevant social and medical history.

Initial Health Assessments are carried out in a community or hospital setting. Where appropriate it is good practice for the parents with parental responsibility to attend the Initial Health Assessment. This should be co-ordinated by the child’s social worker.

For subsequent Review Health Assessments attendance should be supported by the child’s foster carer/residential worker/worker in supported/semi-independent accommodation at the child’s preferred venue and time. Opportunities will always be provided for the child/young person to be seen alone by the assessing clinician to enable them to discuss any health issues/concerns that they may not feel comfortable discussing in front of their social worker/carer.

Child or Young Person Was Not Brought to the Statutory Health Assessments

• If a child or young person was not brought to their statutory Health Assessment the allocated social worker will be notified to facilitate further discussions with their carer to identify any barriers and reasons for the child not being brought.
• Further appointments will be offered in discussions with the child, social worker and carer to support future attendance.
• If a child/young person does not wish to attend their Health Assessment appointment this needs to be communicated by the social worker/carer to the relevant health professional to consider how any unmet/unidentified health needs will be met and the opportunity to look at supporting future attendance

Following the Health Assessments

The health professional conducting the assessment will complete a relevant CoramBAAF Form and a Health Plan which will be shared as referred to in Section 4 Health Plans.

Quality Assurance of Health Assessments

On completion of the IHA/RHA the completed Health Assessment is returned via the Enhanced CIC Health teams for quality assurance. Each Health Assessment is quality assured against the ICB wide Health Assessment tool to ensure it meets the required standard prior to returning via Local Authority business support. Health Assessments that don’t meet the required quality are returned to the responsible clinician for amendment.

The following information should be read with recognition of the Children Act (1989) and subsequent legislation and guidance, which places duties on all staff to recognise the potential for harm to the child or young person caused by significant ‘drift and delay’ in decision making. If in doubt seek legal advice.

Consent to Health Assessments has to be provided in writing at the point of requesting a Health Assessment. Informed consent must be sought for any Health Assessment, examination or treatment after careful explanation has been given to the young person, parent, or adult with Parental Responsibility (explanations given to children and young people should be age appropriate.) Young people aged 16 and 17 years are presumed to have the competence to give consent for themselves. Younger children who understand fully what is involved in the proposed procedure can also give consent (although ideally parents or those with Parental Responsibility will be involved).

For children who are accommodated on a voluntary basis under Section 20 of the Childrens Act 1989, Parental Responsibility remains with the birth mother or both parents if married. An unmarried birth father only has Parental Responsibility if named on the birth certificate or this has been obtained legally. For the purposes of Health Assessments, a parent with Parental Responsibility has to give consent or evidence of delegated authority to the Local Authority needs to be provided with the Health Assessment request. This is usually recorded on the Placement Plan at the point of the child coming into our care. An older child with mental capacity may be able to give their own consent.

For children who are the subject of Care Orders or Interim Care Orders, Parental Responsibility is shared with the Local Authority. For the purposes of Health Assessments parental consent should always be sought as far as this is reasonably possible. This is usually recorded on the Placement Plan at the point of the child coming into our care. When a Head of Service agrees that a child/young person is to come into care, the Head of Service will sign off all appropriate Health Assessments consents. In the absence of a Head of Service, a Senior Manager can sign off all appropriate Health Assessments consents. 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. If the young person can give 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 an existing learning need or a diagnosed mental health 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 can 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.

Refusal of Consent by the Child in Care

In the event of a Child Looked After refusing a non-urgent Health Assessment or examination, significant attempts should be made by the Social Worker, health professional or carer to counsel them about the importance of healthy lifestyle choices. If the child is agreeable, the health professional may still carry out some parts of the assessment such as health promotion and education. There should always be flexibility in approach which would allow the child or young person looked after, to see another health professional if this would enable their health needs to be addressed.

Understanding a Child Looked After's emotional, mental health and behavioural needs is as important as their physical health. All local authorities are required to use the Strength and Difficulty Questionnaires (SDQs) to assess the emotional needs of each child. This is required to be completed for children in our care who have been in care 12 months or more aged 4-16 years.

The SDQ Questionnaire, along with any other tool which may be used to assist, can be used to identify the needs and be part of the child's Health Plan. The social worker should ensure that the SDQ is completed with the child’s carer and child, if over 10 years, and in time for requesting the health assessment, where possible. A copy of the most recent SDQ and score should be forwarded by Local Authority business support to the Enhanced Children in Care Team for sharing with the health professional completing the RHA.

• Strengths and Difficulties Questionnaire Guidance Note;
• 'DfE promoting the health and well-being of looked-after children', Strengths and Difficulties Questionnaire.

Where an Out of Authority placement is sought, the responsible authority should make a judgment about 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 because of the move. In Lancashire and South Cumbria this should be communicated via Local Authorities to the Enhanced Children in Care Teams.

Where these are Placements at a Distance the Care Planning, Placement and Case Review (England) Regulations 2010 (as amended) make it a requirement that the responsible authority consults with the area of placement and that the 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 Children’s Social Care services in the area where the child is placed.