Improving the health of looked after children in Scotland: 1. Using a specialist nursing service to improve the health care of children in residential accommodation
Adoption & Fostering, Winter, 2008
Introduction
It is recognised that children in residential care suffer from poor health outcomes both in absolute terms and relative to others (Saunders and Broad, 1997; Hill and Watkins, 2002; Philpot, 2004). Although the circumstances that have resulted in these children being cared for by local authorities are likely to be the main driver of these inequalities, it is also the case that they access health services at a disproportionately low rate compared to their health needs (Bundle, 2001; Williams et al, 2001; Hill and Watkins, 2002; Philpot, 2004). One potential route to improve the health outcomes of this group is to enhance the accessibility and quality of services provided for them (Meltzer, 2000; Hill and Watkins, 2002). This study was an attempt to investigate whether the introduction of a specialist nursing service could help meet the unmet health needs of children in residential care in West Dunbartonshire, Renfrewshire and Argyll & Bute (in West Central Scotland), as has been tried elsewhere (Hill et al, 2002). Renfrewshire has two specialised residential centres (the Kibble school and the Good Shepherd centre) that provide a specialist service for local authorities across Scotland. The study was funded by ‘Unmet Health Needs Fund’ monies from the Scottish Executive.
Methods
This study was a service evaluation using data collection before and after the introduction of a specialist nursing service. It took place in all child care units in Renfrewshire, West Dunbartonshire and Argyll & Bute. All of the children in residential care in these areas between August 2006 and March 2007 were included in the study. The vast majority of service users resided within Renfrewshire (n = 127 pre-intervention; n = 125 post-intervention), with West Dunbartonshire (n = 21 pre-intervention; n = 13 post-intervention) and Argyll & Bute (n = 14 pre-intervention; n = 14 post intervention) contributing similar numbers of service users.
The specialist nursing service comprised a research project manager, three whole-time-equivalent G-grade nurses and a clerical support officer. An existing specialist nurse who already worked within Renfrewshire in the residential care units worked alongside the project staff. Each nurse was responsible for:
* promoting the existence of the service within their designated locality;
* mapping existing service provision for children in residential care;
* responding to health-related requests from service users within their locality;
* providing health promotion advice and activities for children in residential care, foster carers and residential care home staff;
* liaising with health professionals and social care providers to ensure the health needs of the children were being met;
* highlighting locality-specific issues relating to health care needs;
* ensuring that the standard health recommendations were adhered to and that relevant documentation was complete;
* gathering evaluation data before and after the introduction of the service.
The project staff were also responsible for liaising with the local NHS IT department to create a password protected database containing the health information of the children in residential care within the study area.
The main outcome measures of the study were the proportion of children in residential care:
1. with carer-held health records (also known as BAAF health record booklets);
2. with complete and up-to-date carer-held health records;
3. receiving ‘reception into care’ medicals;
4. with all age-appropriate immunisations; 5. who had defaulted on attending an outstanding medical referral;
6. were registered with a dentist;
7. attended six-monthly dental check-ups;
8. had untreated dental problems;
9. with up-to-date health assessments (comprehensive medicals) using BAAF forms;
10. whose health needs had been reported to the appropriate key (social) worker.
Within the former NHS Argyll & Clyde, the BAAF health record booklet is issued (by social work departments) to every child (originally from within Argyll & Clyde) when the young person is taken into care, and every health appointment and all previous medical history should be documented therein. The BAAF booklets are used to aid the continuity of medical information for carers and health professionals. The booklet should be held by the carer and should accompany the child/young person throughout any placement moves