Looked After Children (LAC) is a term used to describe any children under the care of local authority. Currently, 83,000 children are Looked After in the UK and the number is steadily increasing. As part of a statutory health assessment, the British Association for Adoption &Fostering (BAAF) has published in 2008 a guidance to help with the identification, assessment, testing and referral of those children at risk of blood-borne infections (BBI).
In Community Paediatrics in our University teaching Hospital, specialist LAC clinics run 3 times per week. Our department trying to ensure that best care is delivered to this vulnerable population launched a quality improvement project, aiming to assess, how well and how effectively our service identifies and tests children at risk of BBI, interrogating simultaneously its cost-effectiveness. Taking into account the difficulties in organising and getting consent for investigations in the LAC population, the cost of those investigations to NHS, but, on the other hand, the implications of potentially missing a serious infectious disease, we wanted to ensure that only those children who met the criteria had a BBI screen.
We assessed our service provision through an audit, basing our standards on the 2008 BAAF guidance. This was a retrospective audit from June 2013 to June 2014. In total 212 children attended the specialist LAC clinic. A risk assessment was carried out, based on information about parental health and lifestyle and the results of antenatal screening for Hepatitis B, Syphilis and HIV. Hepatitis C results were only available in high risk population (IV drug users). 37 children (17%) were identified as needing a BBI screen. Out of these, only 22 children (60%) were screened. 8 out of the 22 children (36%) had a complete screen (including Hepatitis B/C and HIV); with the remaining having a partial screen. 12 children had Hepatitis C positive mothers. Worryingly, only 8 of those 12 children (66%) had a BBI screen. There were no Hepatitis B or HIV positive mothers. Reasons for not having a BBI screen were difficulties in obtaining consent, failure to identify the children at risk or to get the extended information about parental lifestyle and screening results. BBI screen revealed 2 children positive for Hepatitis C antibodies and appropriate follow-up was arranged. No children had a BBI screen when that was not indicated.
We subsequently developed a protocol in the form of two flowcharts. These will be included in the LAC health assessment paperwork and aim to promote clarity and good clinical practice. As failure to obtain consent played an important hindering factor in getting our vulnerable population screened, we suggested, when possible, consent is taken at the time of consultation. Improved communication and information sharing between Health and Social Care is essential. Finally, team education is greatly important and will be reinforced by the integration of BBI risk assessment to the induction programme of the new community trainees.
The feedback has so far been very positive. We strongly believe it promotes good clinical practice. We plan to implement this in March 2015 and we aim to maintain and reinforce those changes by continuous monitoring and evaluation of our service.
Looked After Children are, sadly, a growing population in our society. Their health promotion and safeguarding is a responsibility of both Social Care and Health Authority. It is crucial that we, as health professionals, constantly strive to offer a high quality service, by enhancing clinical enquiries and audits, supporting changes to practice and implementing those for improved patient outcomes and experiences.
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