Unit objectives

• To become aware of the health needs of looked after children and care leavers.
• To understand the factors that can impinge upon the health of looked after children.
• To explore the impact of health difficulties on the learning of looked after children.
• To explore resources and strategies to improve and support the health of looked after children.

Resources required to deliver unit

• Helen Minnis: Looked after children’s mental health
• Hand-outs: Components of health; Health and Wellbeing of Looked after children; Extract from “Safe and Well”; Healthy Care Briefings; Hand outs “Guidance on Health Assessments for Looked After Children and Young People in Scotland”
• Health and wellbeing presentation
• Video: Bullying

Introduction to trainer

This short unit is designed to remind participants of the importance of health in determining outcomes for looked after children. A focus is given to the impact poor health has on children’s capacity to engage in educational and other developmental opportunities, but the relationship between child health and long-term outcomes is wider than this, which should be emphasised to participants.

The unit also encourages participants to identify ways of promoting and improving the health of looked after children. This unit complements the material in the units on attachment, trauma and resilience.

Outline of Unit

• Introductory activity exploring the impact of health on learning, social interaction and development.
• Presentation on the health needs of looked after children.
• Looked after children’s mental health (Video Clip).
• Group discussion exploring strategies to improve and support the health of looked after children.

Introductory exercise

Distribute the hand-out “Components of health”. Ask participants to discuss – in small groups – what health factors affect our capacity to learn and interact with others (be that socially or through physical activities). Encourage participants to draw on their personal lives rather than their professional experience, but emphasise again that there is no expectation to share uncomfortable material. The discussion should not focus on health issues faced by looked after children, but rather those experienced across the general population.  Do not ask for feedback immediately; this work will underpin the large group discussion later.

Presentation

Use the hand-out and resources provided to develop a presentation on children’s health.  Although the focus may be on how health relates to the educational experience and outcomes of children, it is important to highlight that the health needs of looked after children often create a vulnerability to poor outcomes across most areas of life.  Being aware of and addressing the health needs of looked after children is a critical task in its own right, as well as being essential to ensuring better learning and personal development experiences for this vulnerable group of children.

Ensure that participants are aware of the significant health needs which many children display on entry to the looked after system. Most research has been undertaken with children who are looked after away from home, but it is likely that the health and wellbeing of those children who are looked after at home is even more seriously compromised than those who are in foster or residential care. Many children ‘looked after at home’ will still be at risk of neglect and the absence of basic health care (such as dentistry, podiatry or optometry). They may also be in situations that place their emotional wellbeing in jeopardy, leading to mental health issues.

For those living at home, identify what factors in the system are likely to compound health problems (such as poor monitoring, continued exposure to risk factors, etc.) Repeat the process for those children living away from home, identifying the factors in the system that are likely to compound problems (such as impact of placement instability and poor information management).

Discuss the evidence that suggests that looked after children are particularly likely to become involved in unhealthy behaviours, including smoking, taking drugs and sexual behaviour, and that they are more likely to engage in such behaviour from an early age.

Emphasise the mental health needs of looked after children. An Office of National Statistics (ONS) study in Scotland found a lower level of mental health difficulties among looked after children than that recorded elsewhere in the UK, but even then it concluded that the majority of Scottish looked after children had diagnosable mental health problems (Meltzer et al., 2004).

Highlight the particular vulnerability of young people leaving care, facing the responsibilities of adulthood and the transition between child and adult services. Some looked after children become parents before or shortly after leaving the care system.

Participants should be aware that current guidance is contained in Guidance on Health Assessments for Looked After Children and Young People in Scotland (Scottish Government, 2014). How is this guidance reflected in local arrangements?

Video Clip

Helen Minnis talking about the mental health difficulties experienced by looked after children.

Large group discussion

Invite feedback from the earlier group exercise. Encourage participants to explore the impact of health difficulties on looked after children’s capacity to engage with education and social activities, to learn and develop. Ask participants for examples of positive strategies to support the wellbeing of looked after children (especially in educational settings) which address health needs sensitively.

Ensure you have examples of your own if participants are unable to identify any from their own experiences. It is best if these examples are local, but if not you could include the use of nurture groups, availability of counsellors within the school, carefully managed health education, targeted schemes to engage children in positive creative, play and sporting activities etc.

Key Messages

• Looked after children often have complex and unmet emotional, mental and physical health needs.
• Educational outcomes can be strongly influenced by a child's health and wellbeing.
• Instability of care and school placement adversely affects children’s health.
• Disrupted schooling and school exclusion can lead to a social exclusion which places children at risk of behaviours which may be detrimental to their health and wellbeing.
• Looked after children are more likely to smoke, drink and take drugs than their peers.
• Looked after children are more likely to engage in early and unprotected sex than their peers, and are significantly more likely to become parents as teenagers.
• The majority of looked after children will have mental health difficulties that need to be managed sensitively.
• Social, recreational and sport activities need to be considered as part of a holistic approach to supporting and improving the health of looked after children.
• School can boost looked after children’s health through raising self-confidence and self-esteem, improving participation in sports and providing access to health and sex education.

Emphasise the mental health needs of looked after children. An Office of National Statistics (ONS) study in Scotland found a lower level of mental health difficulties among looked after children than that recorded elsewhere in the UK, but even then it concluded that the majority of Scottish looked after children had diagnosable mental health problems (Meltzer et al., 2004).

Resources to support this unit

• Care Commission (2010) The physical health of children and young people in residential care
• Care Commission (2009) The mental health & wellbeing of children and young people in residential care
• Care Inspectorate (2012) Suicide Prevention for looked after children and young people
• Children in Wales (2012) Supporting and promoting the health needs of looked after children
• Felitti, V & Anda, R (2009) The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behaviour: Implications for Healthcare
• Growing Up in Scotland (2010) Health inequalities in the early years
• Healthy Care Briefing (2010) Corporate parenting can improve health and wellbeing
• Healthy Care Briefing (2005) Mental health
• Healthy Care Briefing (2008) Promoting the health of young people leaving care
• Healthy Care Briefing (2006) Secure attachment promotes health
• Healthy Care Briefing (2005) Sexual health
• Healthy Care Briefing (2005) Substance misuse
• Healthy Care Briefing (2006) Supporting young parents
• NHS Health Scotland (2008) Capability framework for LAAC Nurses
• NHS Health Scotland (2010) Developing systems to improve LAC health
• NHS Health Scotland (2009) Improving the Health of Looked After And Accommodated Children and Young People in Scotland: An A-Z Guide
• National Institute for Clinical Excellence (2010) Quick reference guide for promoting quality of life for looked after children
• Office for National Statistics (2004) The mental health of young people looked after by local authorities in Scotland
• Rees, P (2012) The mental health, emotional literacy, cognitive ability, literacy attainment and ‘resilience’ of looked after children: a multidimensional study
• Scottish Government (2010) Equally Well: Update
• Scottish Government (2011) Nutritional Guidance for Looked After Children in Residential Care
• Scottish Government (2007) Vulnerable young people and their transition to independent living
• Scottish Government (2014) Guidance on health assessments for looked after children and young people in Scotland
• Scottish Healthy Care Network  (2007) The Health & Well-being of Children and Young People in and Leaving Care in Scotland
• Scottish Institute for Residential Child Care (2008) SIRCCULAR: Health & Wellbeing
• Social Work Inspection Agency (2008) Extraordinary Lives
• Social Work Inspection Agency (2006) The health of looked after and accommodated children and young people in Scotland: messages from research
• Who Cares? Scotland (2005) They Shouldn’t Judge Us Right Away
• Supporting sex and relationships education for looked after children and young people