This toolkit provides busy practitioners with an easily navigable resource to ensure excellence in safeguarding practice in Primary Care.
We are awaiting a review before updating this resource. Please use with caution.
Looked after Children
Looked after children are a particularly vulnerable group of children so it is essential that practitioners are aware of their particular needs and vulnerabilities. Children in care are removed from a situation that made them vulnerable. That doesn't mean they aren't vulnerable in care, but the whole reason for taking them into care is to make them safer.
A child who has been in the care of their local authority for more than 24 hours is known as a looked after child. Looked after children are also often referred to as children in care, a term which many children and young people prefer.
Each UK nation has a slightly different definition of a looked after child and follows its own legislation, policy and guidance. But in general, looked after children are:
- living with foster parents
- living in a residential children's home or
- living in residential settings like schools or secure units
Scotland's definition also includes children under a supervision requirement order. This means that many of the looked after children in Scotland are still living at home, but with regular contact from social services.
There are a variety of reasons why children and young people enter care:
- The child's parents might have agreed to this – for example, if they are too unwell to look after their child or if their child has a disability and needs respite care.
- The child could be an unaccompanied asylum seeker, with no responsible adult to care for them.
- Children's services may have intervened because they felt the child was at significant risk of harm. If this is the case the child is usually the subject of a court-made legal order.
A child stops being looked after when they are adopted, return home or turn 18. However local authorities in all the nations of the UK are required to support children leaving care at age 18 until they are at least 21 years old. This may involve them continuing to live with their foster family.
Needs of Looked After Children
Although looked after children and young people have many of the same health risks and problems as peers, the extent is often exacerbated due to their experiences of abuse. They may have complex emotional and mental health needs.
Experiences of children who are Looked After
Most children in care say that their experiences are good and that it was the right choice for them. However, there are particular experiences they may have to face whilst in care:
- The experiences of abuse and neglect can leave Looked After Children with an increased vulnerability to further abuse.
- More likely to go missing than their peers.
- May display behavioural problems and attachment difficulties. This can make it difficult to form positive relationships.
- When looked after children are compared with children in the general population, they tend to have poorer outcomes in a number of areas such as educational attainment and mental and physical health. However, research also demonstrates that maltreated children who remain in care have better long-term outcomes than those who are reunited with their families.
NSPCC research has identified five priorities for change to improve the emotional and mental health of looked after children:
- Embed an emphasis on emotional wellbeing throughout the system.
- Take a proactive and preventative approach.
- Give children and young people voice and influence.
- Support and sustain children's relationships.
- Support care leavers' emotional needs.
Supporting Looked After Children in Primary Care
There are a number of actions primary care can take to support Looked after Children:
- Ensuring that there is an appropriate and obvious flag on their medical records highlighting that a child is looked after.
- Ensuring that ALL staff are aware of the vulnerability of Looked after Children and that they can identify the Looked after Child flag in order to prioritise their healthcare such as availability of appointments and continuity of care.
- Provide proactive healthcare when a Looked after Child attends the surgery. Evidence highlights that where Looked after Children have access to specialist health practitioners their health outcomes improved.
- Ensuring that foster carers have an appropriate code on their records also so that clinicians are aware that additional support may be needed.