Healthy Care: Improving the Health and Emotional Wellbeing of Looked After children

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Healthy Care Improving the Health and Emotional
Wellbeing of Looked After children

• Helen Jones
• ACWA Conference
• Sydney

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Context and Rationale for Healthy Care

• Children and young people who are looked after
  are amongst the most socially excluded groups in
  England and Wales. They have profoundly
  increased health needs in comparison with
  children and young people from comparable
  socio-economic backgrounds who have not needed to
  be taken into care. These greater needs,
  however, often remain unmet. As a result, many
  children and young people who are looked after
  experience significant health inequalities and on
  leaving care experience very poor health,
  educational and social outcomes.
• (Department of Health 2002)

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What affects our health?
General socio-economic, cultural and
environmental conditions
Living and working conditions
Work environment
Unemployment
Social and community networks
Individual lifestyle factors

Water sanitation
Education
Health care services
Agriculture food production
Age, sex and constitutional factors
Housing
Source Dahlgren C and Whitehead M (1991)
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• National and International research indicates
  that looked after children and young people have
  a range of physical and mental health problems
• Eye and sight (16)
• Speech and language (14)
• Bed wetting (13)
• Coordination (10)
• Asthma (10)
• Psychiatric disorder (45)
• Needing outpatient treatment (52)

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Correlation of poor attachment

• Poor impulse control
• Oppositional behaviour with carers and authority
  figures
• Problematic peer relationships
• Less competent social behaviour
• Less empathy
• Lower self-esteem

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Looked after children may not have played because
of

• Abuse and neglect
• Damaged parental relationships
• Illness and disability
• Little opportunity to play and interact
• Disrupted education and schooling
• Bullying and exclusion

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The Impact

• Early trauma interferes with sub corticol
  limbic development extreme anxiety, depression,
  attachment difficulties, reduction in hippocampi,
  
• bio-regulation and stress response is impaired

• Chronic stress overdevelops areas related to
  anxiety and fear
• Stress hormone cortisol is produced at abnormal
  levels, evidence of altered activity in
  maltreated population

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Evidence-based approaches to promoting positive
mental health
I N D I V I D U A L L E V E L
Adapted from Key Topics in Public Health ed
Ewles (2004)
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What young people say promotes and maintains
mental health?

• Feeling safe physically and emotionally
• Being able to talk to an adult of their choice in
  confidence
• Access to sports centres and youth activities
• Personal achievement
• Being praised
• Generally feeling positive about oneself
• (Ahmad and others 2003, Kay 1999)

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Healthy Care Programme

• Is a holistic programme which promotes health and
  well-being and improves the life chances
• Provides a child-centred national standard
• Provides a portfolio of Healthy Care Resources
• Provides an information service
• Provides support and advice

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Healthy Care Programme history of development

• In development for 5 years
• Developed in partnership with national, regional
  and local partners including carers, parents,
  children and young people
• Piloted with 13 local pilot including 3 secure
  units, with evaluation
• Approx 80 Healthy Care partnerships
• Well-being, Creativity, Play Project
• Regional activity and development

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• Children and young people in a
• healthy care environment will
• Experience a genuinely caring, consistent, stable
  and secure relationship with at least one
  committed, trained, experienced and supported
  carer
• Live in an environment that promotes health and
  well-being within the wider community
• Have opportunities to develop the personal and
  social skills to care for their health and
  well-being now and in the future and
• Receive effective healthcare, assessment,
  treatment and support

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A child of young person living in a health care
environment is entitled to

• Feel safe, protected and valued in a strong,
  sustained and committed relationship with at
  least one carer
• Live in a caring, healthy and learning
  environment
• Feel respected and supported in his/ her cultural
  beliefs and personal identity
• Have access to effective healthcare, assessment,
  treatment and support
• Have opportunities to develop personal and social
  skills, talents and abilities and to spend time
  in freely chosen play, cultural and leisure
  activities and
• Be prepared for leaving care by being supported
  to care and provide for him/ herself in the
  future

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National Healthy Care Standard

• Health is a base from which to develop, enabling
  people to do or choose to do as many things as
  possible to achieve their potential
• (Seedhouse 1986)
• Children and young people need to have
  opportunities to develop personal, social and
  life skills, talents and abilities to spend time
  in freely chosen play, cultural and leisure
  activities and are encouraged to develop their
  life skills

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Healthy Care Audit and Action Planning Tool

1. Audit services what is working well, what needs
   to be better through consultation and
   inspection reports
2. Identify key priorities and key areas for action
   (e.g. fostering services, leaving care, LASCHS)
3. Plan action through partnerships, policy,
   participation and practice
4. Partners secure support and resources inform own
   agencies
5. Implement Action Plan
6. Monitor and Evaluate
7. Record, improve and celebrate success

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Policy

• Across all agencies meets health and well being
  needs
• Secures stable placemats
• Ensures participation, in care, health, policy
  and education, play, arts and leisure
• Adheres to national minimum standards
• Ensures training of staff
• Ensures inclusion and non discriminatory practice
• Supports the role of corporate parents
• Ensures joining up of strategies and services

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Effective Partnerships

• Are multi-agency building on existing childrens
  local strategic partnerships or childrens trust,
  and usually include, Social Services, PCTs,
  Education, Leisure Department and Voluntary
  Sector
• Have a strategic Healthy Care Champion
• and an Operational Officer
• Have sign up and commitment from
• Directors of all involved agencies
• Secure funding and clarify accountability
• Have effective communication and
• structures between partners
• looked after children and young people are
  partners too

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Practice

• Carers and staff are committed to the health and
  well being of looked after children and young
  people and are trained and supported
• Children and young people have consistent and
  caring relationships which support the
  development and transition into adulthood

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Participation of children and young people will

• Identify need and steer direction
• Develop partnerships
• Inform and monitor improved practice
• Creative participation is critical to success
• It should be somewhere you feel supported and
  encourage both emotionally andphysically. You
  shouldnt feel that you are
• responsible for everything as if you are alone.
• I never felt alone. There was always someone
  to turn to, they were really supportive.

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Key learning from early implementation

• Local, engagement and champion to deliver local
  targets
• Regional coordination and leadership
• National networking and strategic support within
  ECM agenda
• Provide evidence for joint inspection
• A framework for partnerships to improve outcomes
• Effective creative participation crucial
• Development for other vulnerable groups

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Interventions

• Interventions must address the totality of the
  childs life, providing frequent, consistent
  replacement experiences so that the childs
  brain can begin to incorporate a new environment,
  one that is safe, predictable, and nurturing.
• (Perry, 2000)

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Play, creativity and well-being for looked after
children

• Involvement in play and creative arts can
• Enhance self-esteem and resilience
• Promote social inclusion
• Improve sensory awareness
• Help to counteract the consequence of
• childhood abuse and neglect
• (Chambers 2004)

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Why should children and young people looked
after participate in policy and practice
development?

• It empowers young people to take responsibility,
  rather
• than experience learned helplessness
• Important to feel a sense of ownership and
  involvement
• in their own environment
• Activities that empower contribute to development
  of
• self esteem, and promote well-being
• Outcomes of creative participation are key to
  effective
• service development

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Play and creativity for health and well-being

• All young people 5-18 years should take part in
  at least one hour of moderate physical activity
  each day (DH 2004)
• Unstructured ball games and outdoor play is
  effective for physical activity (Mackett 2004)
• Physical activity can improve mental health and
  self-esteem (HDA 2003)
• Play and creative activities can promote cultural
  awareness and sense of personal identity and
• self-esteem (Gilligan (1999,2001) Goleman (1996)
• Participation and empowerment (Howell 2003)

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Creative Participation enables looked after
children and young people to

• develop their communication skills and interests
  in arts practice
• improve self esteem, raising aspirations and
  self confidence
• build sustainable relationships with carers and
  significant others
• improve physical health and activity
• engage with education and training opportunities
• contribute to service development and monitoring

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Creativity and play in practice

• Song writing in Southampton
• Circus skills in Sussex
• Creative attachment therapy in Telford
• Dramatherapy in a secure unit
• Music therapy in Leeds
• Artists in Walsall
• One Jam in Lincolnshire