Adoption & Fostering
Abstracts

Winter 2002 - Vol 26 (4)

Special Issue: Promoting Children’s Health

Issues concerning the health of looked after children
Harriet Ward, Helen Jones, Margaret Lynch and Tricia Skuse

There is substantial evidence that looked after children have extensive health needs and disabilities, that they have often missed out on routine health surveillance and health promotion before entry to care or accommodation, but that at present they receive little compensatory care. Ward et al look at how frequent changes of placement and poor inter-agency communication exacerbate difficulties in gaining access to adequate health care, especially when children lack an advocate who takes proactive action on their behalf. The Department of Health has responded by issuing new Guidance that sets clear standards for service delivery, encourages children’s participation, and ensures that health assessments recognise inequalities and take a holistic view of healthcare needs. The implementation of the Integrated Children’s System should improve the quality and accuracy of health information concerning all children in need. New Regulations and Standards for foster care, a National Healthy Care Standard and, on a broader policy front, the National Service Framework for Children should all ensure better access to health care for this population. However, as the authors conclude, such measures will only be successful if inter-agency working can be improved through multi-disciplinary training and better co-ordinated structures for service delivery.

Harriet Ward is Director of the Centre for Child and Family Research, University of Loughborough; Helen Jones is Social Services Inspector at the Department of Health, London; Margaret Lynch is Professor of Community Paediatrics at Guy’s, King’s and St Thomas’s School of Medicine, University of London; Tricia Skuse is a Research Fellow at the Centre for Child and Family Research, University of Loughborough

Health information and teenagers in residential care: a qualitative study to identify young people’s views
Annabelle Bundle

This article presents the results of a qualitative study, undertaken in a mixed residential children’s home, which aimed to identify what looked after young people see as important in terms of health information. The young people wanted information particularly on mental health issues, keeping fit, substance use and sexual health. Many were reluctant to request appointments for personal matters and did not feel they were encouraged to ask about personal health concerns during medical examinations.

The interface between medicine and social work in working with looked after children
Daphne Batty

On the basis of her long career in social work with children and their families, Daphne Batty reviews the interface between doctors and social workers, its nature, how it has developed and attitudes to it displayed by both professions.

Daphne Batty was formerly a team leader of fostering and adoption teams and then Co-ordinator of the BAAF Medical Group

The emerging role of the specialist nurse: promoting the health of looked after children
Catherine Hill, with Vanessa Wright, Carolyn Sampeys, Kathy Dunnett, Sue Daniel, Lesley O’Dell and Janet Watkins

In the light of recent guidelines from the Department of Health, Hill et al discuss the growing contribution that specialist nurses are making in promoting the health of looked after children. To illustrate this trend two projects, in Southampton and Cardiff, are examined, followed by a review of the current professional status of looked after children’s nurses in England & Wales. All the evidence presented points to better outcomes and additional quality through nurse-led assessments.

Dr Catherine M Hill is Senior Lecturer Child Health, University of Southampton; Vanessa Wright is Nurse Consultant for Looked After Children, Brighton; Dr Carolyn Sampeys is Associate Specialist, Looked After Children, Cardiff and the Vale of Glamorgan; Kathy Dunnett is Designated Nurse for Looked After Children, Hertfordshire; Sue Daniel is Specialist Nurse for Looked After Children, Southampton; Lesley O’Dell is Training and Development Co-ordinator, School Nursing and Health Visiting , Southampton; Dr Janet Watkins is Consultant Community Paediatrician, Southampton

Caring for the health of children brought into the UK from abroad
Mary Mather and Marko Kerac

Growing up is never easy. For children separated not only from their birth families but from their countries of origin, it can be a long, hard struggle to achieve even the basic levels of good health that are so often taken for granted. This article focuses on the health needs of two particular groups of young people: intercountry adoptees and unaccompanied refugee and asylum-seeking children. They discuss the limitations of Department of Health guidance and identify in some detail the range of health problems which frequently go unrecognised in intercountry adopted children. Although the same problems apply to refugee and asylum-seeking children, these already traumatised young people carry the double burden of the problems they arrive with and the problems that arise once they are in the UK. Mather and Kerac provide practical suggestions towards easing this burden in the effort to make health care for this group in particular, at once ethical, humane and acceptable. They end with a plea for tolerance and sensitivity, and the need to recognise that health goes way beyond the remit of the National Health Service. The aspiration to and attainment of health is determined by education, politics, the micro-climate of attitudes and the very fabric of our society.

Dr Mary Mather is Consultant Community Paediatrician, Greenwich Primary Care Trust; Dr Marko Kerac is Senior House Officer, Paediatrics, for the same Trust

Vaccination and immunisation
Marion Miles

From a medical perspective vaccination, the process whereby someone is made immune to significant disease, has a long and distinguished track record and has proved highly beneficial. More recently public faith in some aspects of the process has diminished dramatically. This article presents the background to, and development of, the immunisation programme currently recommended by the Department of Health. It seeks to explore reasons for non-compliance with the programme and to discuss the consequent dilemmas thus presented to professionals. Particular problems presented by looked after children are also considered.

Marion Miles is a retired paediatrician

Constructing mental health services for looked after children
Eddy Street and Mike Davies

Recent years have seen a welcome series of government measures aimed at meeting the mental health needs of looked after children. However, as argued by the authors of this paper, there remains a clear lack of integration of models of ‘good practice’ among childcare and mental health professionals. Taking into consideration the‘tiered model’ recommended by the NHS Health Advisory Service report (1995), they advocate a developmental approach through the implementation of a multi-disciplinary service that combines the best of psychiatric, psychological, social work and childcare perspectives.

Eddy Street is Consultant Clinical Psychologist, Department of Child Health, Llandough Hospital, Penarth, Wales; Mike Davies works in a private practice in South Wales

"Whose baby is it anyway?" Developing a joined-up service involving child and adult teams working in a mental health trust
Clive Britten and Amynta Cardwell

This article describes how clinicians from a London-based child and adolescent mental health service (CAMHS), in partnership with the National Society for the Prevention of Cruelty to Children (NSPCC), developed a joined-up service with colleagues in the local adult mental health teams at St Charles Hospital. The aim was to raise awareness of the potential risk factors posed to children being cared for by an adult with a mental health problem and to provide a designated clinical service for this particular client group. In discussing how the service developed, the authors highlight key learning points and identify the sources they have drawn on. These including direct clinical work, the findings of other colleagues working in the mental health field and methodological approaches designed by practitioners specialising in the area of cross-boundary working.

Dr Clive Britten, Consultant Child and Adolescent Psychiatrist, was employed by CNWL Trust until August 2002. His special interest in parental mental health services is informed by his work with adults at C G Jung Clinic, which is affiliated to the Society of Analytical Psychology; Amynta Cardwell is a Senior Family Therapist, CNWL Mental Health Trust