Healthy Care: Improving the Health and Emotional Wellbeing
of Looked After childrenHelen Jones
ACWA ConferenceSydney
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)
Living and working conditions
Work environment Unemployment
Education
Water & sanitation
Agriculture& food
production
Health care
services
HousingAge, sex and constitutional
factors
Source: Dahlgren C and Whitehead M (1991)
What affects our health?What affects our health?
1. 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%)
Prevalence of any mental disorder oflooked after children by age and sexPrevalence of any mental disorder oflooked after children by age and sex
50%
33%
55%
43%
38%40%
0
10
20
30
40
50
60
5-10 year olds 11-15 year olds 16-17 year olds
Boys Girls
Prevalence of conduct disorder oflooked after children by age and sexPrevalence of conduct disorder oflooked after children by age and sex
44%
27%
45%
35%32%
28%
0
10
20
30
40
50
60
5-10 year olds 11-15 year olds 16-17 year olds
Boys Girls
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
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
The Impact
• Chronic stress overdevelops areas related to anxiety and fear
• Stress hormone cortisol is produced at abnormal levels, evidence of altered activity in maltreated population
• Early trauma interferes with sub corticol & limbic development = extreme anxiety, depression, attachment difficulties, reduction in hippocampi,
• bio-regulation and stress response is impaired
Positive Mental Health
Regeneration in deprived
areas
Widen participation in education
Access to green open
spaces
Health promoting schools approach focused on whole
school environment, involving parents
and wider community
Positive Parenting
Promoting physical activity
BuildingResilience
Targeting depression
with outreach programmes and social
support
Enhancing social
networks
Encouraging voluntary
work
Building social capital:
community networks, local
involvement and identity, trust.C
OMMUNITY
LEVEL
Evidence-based approaches to promoting positive mental health
Adapted from
Key Topics in Public Health ed Ewles (2004)
INDIVIDUAL
LEVEL
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)
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
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
• 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
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
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
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 Plan6. Monitor and Evaluate7. Record, improve and celebrate success
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
Effective Partnerships• Are multi-agency building on existing children’s
local strategic partnerships or children’s 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
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
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 shouldn’t 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”.
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
Interventions
• Interventions must address the totality of the child’s life, providing frequent, consistent ‘replacement’ experiences so that the child’s brain can begin to incorporate a new environment, one that is safe, predictable, and nurturing.
(Perry, 2000)
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)
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 ofself esteem, and promote well-being
• Outcomes of creative participation are key to effective
service development
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)
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
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