Clinical update

Looked after children: a framework for better outcomes

Revised guidance details roles and competencies required of healthcare staff who work with looked after children

Revised guidance details roles and competencies required of healthcare staff who work with looked after children

Essential information

The term looked after children refers to any child who is in the care of the local authority or housed by them for more than 24 hours.

They may be subject to a court order or accommodated voluntarily, including in the short term.

For a majority of children this is the result of abuse or neglect, but there are rising numbers of unaccompanied asylum seekers and children who have been trafficked from abroad.

Although there are variations in trends across the four nations, the number of looked after children has increased steadily across the UK.

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    Revised guidance details roles and competencies required of healthcare staff who work with looked after children

    Looked after children refers to any child in the care of the local authority of housed by the for over 24 hours
    Picture: iStock

    Essential information

    The term looked after children refers to any child who is in the care of the local authority or housed by them for more than 24 hours.

    They may be subject to a court order or accommodated voluntarily, including in the short term.

    For a majority of children this is the result of abuse or neglect, but there are rising numbers of unaccompanied asylum seekers and children who have been trafficked from abroad.

    Although there are variations in trends across the four nations, the number of looked after children has increased steadily across the UK.

    The number is now higher than at any point since 1985, state the RCN and the Royal College of Paediatrics and Child Health (RCPCH) in a revised framework on roles and competencies of healthcare staff who work with looked after children.

    The document states there were 78,150 looked after children in England at the end of March 2019, a rise of 4% from a year earlier, 6,846 in Wales, up 7%, and 3,281 in Northern Ireland, up 6% – the highest figure since 1995.

    Comparable figures are not given for Scotland, but numbers peaked there in 2012 at 16,248 and fell to 14,897 in 2017.

    What’s new?

    The new framework published by the RCN and the RCPCH in December, Looked After Children – Roles and Competencies of Healthcare Staff, replaces an edition developed in 2012.

    Looked after children have greater mental health problems as well as developmental and physical health issues, according to the guidance. This includes speech and language difficulties, bed-wetting, coordination difficulties and sight problems.

    They are also more likely to be involved in risk-taking behaviour, come to the attention of the youth justice system and have poorer educational attainment.

    The framework is based on five levels of competence, ranging from all staff working in healthcare settings through to specialists in looked after children and designated professionals.

    It also includes education and training requirements. Healthcare staff working with this group of children must have the right knowledge, skills, attitudes and values, says the guidance.

    Access to highly skilled and knowledgeable healthcare practitioners results in improved outcomes, enabling young people to achieve their full potential, the colleges say.

    How you can help your patient

    Everyone working in healthcare services should be aware of the processes and terminology relating to looked after children, and be mindful of their increased needs.

    For healthcare professionals this includes having an awareness of the impact of adverse childhood experiences, abuse and family disruption, which may mean longer appointments are needed.

    As a professional, you should practice trauma-informed care, which emphasises physical, psychological and emotional safety.

    You should also be aware of safeguarding issues, including your local policies and procedures.

    A child’s health needs should be assessed fully, with access to services that meet their needs and a regularly reviewed health plan in place.

    Expert comment

    Lin Graham-Ray, designated nurse safeguarding children and senior designated nurse looked after children, Wandsworth, South West London CCGLin Graham-Ray is designated nurse safeguarding children and senior designated nurse looked after children, Wandsworth, South West London CCG

    ‘This is a helpful framework. It’s encouraging to see that looked after children have been placed on everyone’s agenda, right from administrative staff through to whoever leads in an organisation. It reminds us all that this is everyone’s responsibility – not just specialists.

    ‘You can be a nurse anywhere and you will come across a looked after child, in the same way that you may encounter safeguarding concerns. As a healthcare professional you need to understand their life experiences and how you might work with them in practice.

    ‘The document provides a clear framework to work towards, so each of us can understand our own learning needs. It is very specific about what is needed at each of the five levels identified.

    ‘It is also obvious that the higher up you get, the fewer training opportunities there are, as this area is so niche. How do we stay competent at a senior advanced level? That’s a future challenge.’



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