Guidance for Looked after Children (LAC) stipulates the requirement for detailed health assessments by specialised professionals on entry to care and regularly thereafter. However it was identified in 2012 that locally a high proportion of LAC consistently refused health assessments.
Aim To conduct a needs analysis and identify if new strategies could increase engagement and participation.
Method The specialist nurse for LAC contacted a randomised sample of ‘health decliners’, carers social workers collating reasons for refusal and feedback on suggested alternative approaches to address the issues. Reasons were categorised but general consensus was the current approach to health assessments was too clinical and rigid especially with venues and times. Many felt stigmatised resulting in non-compliance. The nurse drafted a ‘decliner pathway’ outlining a coordinated holistic response which included all key professionals and carers. Concurrently the nurse dip sampled nationally practice with assessments concluding a system wide re-think on practice (as below, Table 1) could benefit the whole LAC cohort:- different assessment documentation for children aged above nine increased holistic /less rigid focus alternative venues/times.
Subsequent informal and formal consultation with stakeholders, carers and cohort achieved agreement to pilot the decliner pathway and adapted practice*.
Results Based on a local LAC population of 366. Decliner cohort and therefore sample size was 75.
Conclusion This study evidences adapted practice and strategies with operational and strategic input (NICE standards) led to increased engagement with this highly vulnerable group.
Increased access to specialised support may help empower, reduce health inequality potentially optimising positive future health outcomes.
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