Currently 1,860 Unaccompanied Asylum Seeking Children and Young People (UASCYPs) are being “Looked-After” in England; NICE guidance on how best to meet their needs has called for cultural competency and highlighted a deficit in an applicable evidence-base. This study contributes to the evidence-base for the healthcare needs of UACYPs and factors which influence them within the context of the Initial Healthcare Assessment (IHA).

Methods Five in–depth interviews were conducted with expert healthcare professionals, identified via a purposive sampling technique. The interview transcripts underwent thematic analysis, and the findings were combined with that of the literature review to develop a Current Practice Survey. This was distributed to the 32 Looked-after Children’s teams in the area. All the findings were synthesised to enable exploration of this complex area.

Results The combined findings of the in–depth interviews and current practice survey (response rate 47%) supported the existing evidence around the importance of infectious diseases, screening, health promotion, and psychological wellbeing. It also provided insights into parental consent as a barrier to immunisation, into risk–taking behaviour and the impact of the immigration process on all aspects of UASCYP’s health and wellbeing. An understanding of the refugee experience was crucial; experience in country of origin, in flight, upon arrival in the UK and the possibility of return all impacted on physical, psychological, and social needs. Guidance, training, and resources were thought to be useful, but there was limited specialised training.

Conclusion and recommendations A socioecological framework for carrying out the IHA is proposed, which incorporates all these aspects, placing the child at the centre, and taking into account how their environment and life story impacts on health. Healthcare professionals have an important role in advocating for national and international policies that protect and promote the rights of UASCYPs.