Health of children looked after by the local authorities
Introduction
Children may be looked after by the local authorities for various reasons, such as neglect, abuse, breakdown of family relationships and homelessness. This may range from a short-term placement to long-term care. Children may be placed for adoption, with foster carers, family or relatives, or in community residential homes.
In the UK, local authorities are required to promote the welfare of looked-after children.1 However, the health of looked-after children has been a concern for several years. In 1998, a House of Commons Health Select Committee into the health of looked-after children concluded that the failure of local authorities to secure good health outcomes for the children and young people they look after is a failure of corporate parenting.2 Several authors from the UK have reported that this disadvantaged group of children has a higher prevalence of physical and mental health needs that are often unmet, poorly managed or uncoordinated.3., 4., 5., 6., 7., 8., 9.
The ‘Quality Protects’ programme was launched nationally in 1998 to improve the quality and management of children's services.10 This requires social services departments to produce annual management action plans endorsed by the whole local authority and produced in consultation with local health authorities.
Local initiatives include research carried out on children leaving care that highlighted the importance of providing stable placements so as to reduce emotional stress and insecurity.11 In 1999, the health of looked-after children was addressed in the Annual Report of the Director of Public Health, East Surrey Health Authority, and an assessment of the health needs of this vulnerable group was recommended.12 This work therefore aimed to assess the health needs of children looked after by the local authorities in East Surrey.
Section snippets
Methods
Healthcare needs assessment is defined as the population's ability to benefit from health care.13 The framework used for the health needs assessment in this project is that described by Stevens and Raftery.13
A list of children who were being looked after by Surrey Social Services on 1 June 2001 was obtained from their central database. After excluding children in respite care (short duration in care), there were a total of 269 children from East Surrey being looked after by Surrey Social
Results
In England, 58,100 children were looked after by the local authorities in the year ending 31 March 2000.14 Of these, 55% were boys and 43% were under the age of 10 years. In Surrey (East and West), 671 children were looked after by the local authority in the year ending 31 March 2001. Of these, 53% were boys and 43% children were under the age of 10 years.14
The number of children who started to be looked after during 2000/2001 in East Surrey was 78 (8.3 per 10,000 children under 18 years of
Health needs of looked-after children in East Surrey
Only 64% (87/136) of children had a medical examination during the previous year, although this is a statutory requirement. This is similar to the national figure of 65%. Of the 49 who did not have a medical assessment, five were recorded to have refused an examination; it was not possible to identify if any of the remaining 44 had medical examinations that were not recorded in the case notes. However, this is highly unlikely as the statutory medical examinations require the appropriate form to
Unmet need and gaps in service identified
Although health and health-related outcomes for looked-after children in Surrey are better than national figures, these children have a higher degree of health need than their counterparts who are not in the care system (Table 3).
Annual medical and dental examinations are a statutory requirement for looked-after children, but 36 and 45% of children did not have medical and dental examinations, respectively. Only 68% of looked-after children were registered with GPs; the corresponding figure for
Discussion
One of the limitations of this study was that data were obtained from case note review. Validity of the data depends on accuracy and completeness of the records. Children who did not have any morbidity recorded at the medical examination were assumed to be free of morbidity. However, this implies that the health needs detected could be an underestimate of the true need in this group. Secondly, foster carers' views on the health needs of looked-after children were not obtained. This was
Acknowledgements
I am grateful to Dr Lois Lodge, Consultant in Public Health Medicine, East Surrey Health Authority, for her support in carrying out this work, the staff of Surrey Social Services for their cooperation, the Information Officer, Surrey Social Services for data provided, and Dr Christine Arnold, Associate Specialist, Community Child Health, Surrey and Sussex Healthcare NHS Trust for her valuable suggestions.
References (22)
The Children Act 1989: guidance and regulations
(1991)Parliament: House of Commons HC. Second report: children looked after by local authorities vol I: report and proceedings of the committee
(1998)- et al.
The statutory medical and health needs of looked after children: time for a radical review?
Adopt Foster
(1997) - et al.
Better health for children in resident care
Arch Dis Child
(1996) - et al.
The health of children looked after by local authorities
Br J Nurs
(1997) - et al.
Improving the health care process and determining health outcomes for children looked after by the local authority
Ambulat Child Health
(1998) Adoption: a forgotten paediatric speciality
Arch Dis Child
(1999)- et al.
Prevalence of psychiatric disorders in young people in the care system
BMJ
(1996) - et al.
Psychiatric disorder among children at time of entering local authority care: questionnaire survey
BMJ
(1999) - Department of Health. The quality protects programme: transforming children's services. London: LAC 1998; 98:...