Improving the Emotional Wellbeing of Children in Care. Policy and Guidance on the Strengths and Difficulties Questionnaire for Looked After Children.

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1 Improving the Emotional Wellbeing of Children in Care Policy and Guidance on the Strengths and Difficulties Questionnaire for Looked After Children. DOCUMENT CONTROL: Version: 1 Ratified by: Clinical Assurance Sub Group Date ratified: 01 September 2011 Name of originator/author: Senior Mental Health Clinician for Looked After Children; Specialist Nurse for Looked After Children; Senior Independent Reviewing Officer for Looked After Children DMBC Name of responsible Clinical Assurance Sub Group committee/individual: Date issued: 27 th September 2011 Review date: September 2014 Target Audience Clinical staff working with Looked After Children

2 CONTENTS SECTION PAGE NO 1. INTRODUCTION 3 2. PURPOSE 4 3. SCOPE 4 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES Assistant Directors Clinical / Area Managers Specialist Nurse for Looked After Children Lead Health Professional DCIS Children s Services CAYPMHS All staff 6 5. PROCEDURE/IMPLEMENTATION 6 6. TRAINING IMPLICATIONS 8 7 MONITORING ARRANGEMENTS 8 8. EQUALITY IMPACT ASSESSMENT SCREENING Privacy, Dignity and Respect 9 9. LINKS TO OTHER TRUST PROCEDURAL DOCUMENTS REFERENCES APPENDICES 10 Page 2 of 10

3 1. INTRODUCTION 1.1 Rotherham, Doncaster and South Humber NHS Trust aims to provide high quality, safe and effective services for all Looked After Children. 1.2 The Strengths and Difficulties Questionnaire (SDQ) is a screening tool which will be used to identify Looked after Children who are at risk of developing emotional and behavioural difficulties and who are likely to benefit from early intervention. Statutory Guidance on Promoting the Health and Well-being of Looked After Children (DCSF, DOH 2009) advocates that both local authorities and health trusts ensure that SDQ s are built into the annual health assessments for Looked After Children and are used when placements commence. 1.3 The white paper Care Matters: Time for Change (DfES 2007), highlighted the need to improve the mental health and well being of children and young people in care. It recommended that a new government indicator focusing on the psychological and emotional health of Looked After Children should be implemented. 1.4 Looked after children experience significantly worse mental health than their peers. An estimated 45% of Looked After Children aged 5 to 17 have mental health problems, over 4 times higher than all children. The SDQ will assess progress in improving the emotional and behavioural health of Looked After Children. 1.5 What is the Strengths and Difficulties Questionnaire? The Strengths and Difficulties questionnaire is a short behavioural screening tool. It has five sections that cover details of emotional difficulties; conduct problems; hyperactivity or inattention; friendships and peer groups and also positive behaviour, plus an impact supplement to assist in the prediction of emotional health problems. The Strengths and Difficulties Questionnaire (SDQ) provides a useful way of assessing the emotional well-being / mental health needs of both the overall population of Looked After Children (LAC) and of individual children and young people. It seeks to support planning both for individual children and service development for all Looked After Children. 2. PURPOSE 2.1 The use of the Strengths and Difficulties questionnaire in this context aims to: i. To identify Looked After Children who may need a mental health intervention. ii. To help identify risk and resilience factors in the Looked After Population. iii. To develop early interventions to minimize the likelihood of mental health problems. iv. To inform care plans. v. To provide strategies for carers to support the individual needs of children in their care. 2.2 The Strengths and Difficulties Questionnaire (SDQ) is an assessment tool. It is a standardised questionnaire used within the general Children and Young People s Page 3 of 10

4 Mental Health Service (CAYPMHS) in Doncaster as a screening tool, outcome measure and as part of a clinical assessment. 2.3 It provides coverage of the child s and young person s behaviour, emotions and relationships. Its main strength is its simplicity with tick box answers. It aims to help practitioners to think about the child s feelings (e.g. low, worried, upset) and how these can affect different areas of their life, such as making decisions, managing feelings or behaviour and coping with day to day living. 2.4 It provides scores which are basic pointers to potential difficulties across the 5 areas above. The scores give us pointers to identify what may be needed to help the child and support the carers. The scores do however need to be viewed in context of the overall experience and current situation of the child/young person and of their carers. 2.5 For children and young people in new placements, the SDQ will be used early to help decision-making about the needs of the child or young person. Referral to specialist mental health services must be considered in the context of the existing assessment of the health, social and educational needs of children and young people, as part of placing a child or young person in care. 2.6 Lead health professionals and social workers should consider the need to make a referral to specialist CAYPMHS or other specialist services which may have been set up in partnership with local mental health providers. Where health professionals / social workers are unsure of the need for referral they should contact CAYPMHS, who will also be a useful source of expertise in the use and interpretation of the SDQ. The local CAYPMHS partnership will want to be informed of the levels of mental health difficulties in the Looked After Children s population. 2.7 Consistent with the Statutory Guidance Promoting the health and well-being of Looked After Children (DCSF, DOH 2009) CAYPMHS are piloting a collaborative service in which a multi-agency group meet to discuss Looked After Children with high SDQ scores. As this is a new initiative the service from CAYPMHS is to be piloted for six months and will be subject to audit. 3. SCOPE This policy and guidance applies to Looked After Children aged 4-16 years and to staff working with Looked After Children within this age range. 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 Assistant Director for CAYPMHS, Assistant Director Children Young People and Families and Deputy Directors of Nursing are responsible for: Promoting and monitoring the implementation of the principles and procedures set out within this policy in order that the emotional and mental health needs of Looked After Children are identified at an early stage in their care history and that the appropriate interventions are provided in a timely manner. Page 4 of 10

5 Promoting collaborative working between health and social care services in order that the emotional and mental health needs of Looked After Children remain at the centre of this process. 4.2 Service / Clinical Managers are responsible for: Making their staff aware of the principles and procedures set out within this policy. Working collaboratively with colleagues in CAYPMHS, in order that the emotional and mental health needs of Looked After Children remain at the centre of the process. Ensuring that the SDQ becomes part of the Looked After Children s health assessment undertaken by the Lead Health Professional. Ensuring the appropriate health representation at the independent reviews for Looked After Children, to ensure that the holistic health needs of Looked After Children are considered and acted upon. 4.3 The Specialist Nurse for Looked After Children is responsible for: Coordinating and monitoring the initial and review health assessment for Looked After Children. Acting as a central point to receive SDQ scores from social care and co-ordinate their distribution to the Lead Health Professional to inform the holistic health assessment of Looked After Children. Working collaboratively with colleagues in social care, CAYPMHS and Lead Health Professionals in order that the emotional and mental health needs of Looked After Children remain at the centre of the process. Supporting and attending the monthly multi-agency panel meetings facilitated by CAYPMHS. 4.4 The Lead Health Professional (Health Visitor / School Nurse) is responsible for: Working collaboratively with colleagues in Social Care and CAYPMHS in order that the emotional and mental health needs of Looked After Children remain at the centre of the process. Implementing this policy and guidance and incorporating the SDQ results into the holistic health assessment for Looked After Children. Discussing the SDQ results with the child / young person and carer at the health assessment and discussing options when scores indicate moderate to high risk. Liaising with the allocated social worker regarding possible referral to CAYPMHS, completing referral to CAYPMHS as required. Recording actions taken as per trust policy. Page 5 of 10

6 4.5 CAYPMHS are responsible for: The children referred to CAYPMHS with high SDQ scores (above 17): If the child is already known to CAYPMHS and receiving a service the score will be discussed with the lead professional. If the child is not known to CAYPMHS then the children with the highest scores will be discussed at a multi-agency meeting hosted by CAYPMHS re: appropriate intervention. This process does not replace the case for urgent and or routine referral to CAYPMHS. CAPYMHS will organise monthly panel meetings to address the needs of Looked After Children and Young People whose SDQ scores are 17 and above. CAYPMHS will take responsibility for the administration of the work of the SDQ panel form the point at which the SDQ scores and the completed paperwork are received. The social worker and / or key health professional of Looked After Children who s SDQ score is 17 or above who are not subject to a panel discussion will be invited to refer the child or young person through the routine referral system. CAYPMHS to audit and review this system after 6 months (March 2012) 4.6 All staff It is the responsibility of each individual member of staff to: Adhere to the requirements set out within this policy 5. PROCEDURE / IMPLEMENTATION 5.1 The Process for undertaking and using the Strengths and Difficulties Questionnaire At the first Looked After Child Independent Review which takes place within 28 days of a child entering care, the Independent Reviewing Officer (IRO) will request that the social worker provides a Strengths and Difficulties Questionnaire to the carer, either a foster carer or residential key worker. They will ensure the carer knows how to complete the form and will request that it is completed within the next 7 days and returned to the social worker. On return of the questionnaire the social worker will score the SDQ for each domain and calculate the total score. A copy of the completed questionnaire and the total score will be forwarded to the Specialist Nurse for Looked After Children; this will ensure a central point for return of all SDQ questionnaires. The Specialist Nurse for Looked After Children will ensure that the SDQ results are shared with the relevant Page 6 of 10

7 health professional (Health Visitor / School Nurse). This will then be integrated into the holistic health assessment for Looked After Children. If the carer does not return the SDQ, the social worker will arrange to collect the SDQ from the carer, addressing any difficulties through the fostering link worker. Where an SDQ completed by a carer suggests there may be a difficulty, it will be important to seek completion of the SDQ by the child and the child s teacher (where applicable), to obtain further perspectives. This will be coordinated by the social worker and copies forwarded to the Specialist Nurse for Looked After Children who will distribute to the Lead Health Professional. The Lead Health Professional will discuss the SDQ score with the child / young person and foster carer / residential key worker at the Looked After Children s health assessment. The scores do however need to be viewed in context of the overall experience and current situation of the child/young person and of their carers. The Lead Health Professional will discuss appropriate interventions with the carer and child. This will lead to a judgment being made about referral to CAYPMHS or other services. If the total score is within the high risk category of 17 and above, a referral to CAYPMHS will be discussed and made as necessary. If it is decided due to the child s current circumstances that a referral is not made at that time, a discussion will take place with the social worker and/or CAYPMHS and a repeat SDQ will be completed within an agreed timescale. When a referral has been made to CAYPMHS, the child / young person s case will be discussed at the next Looked After Children s panel meeting. Consideration will then be given as to whether a service is required and what the nature of the intervention is likely to be. The result of panel meeting will then be shared with the social worker and Lead Health Professional. The social worker will make the necessary arrangements with foster/ residential workers for attending appointments where required. The social worker will then ensure that the total score is entered onto the child s Care first record. Whenever the questionnaire is repeated this record will be updated. All health interventions will be documented in the child / young person s health records as per trust policy. The SDQ score will be repeated as and when it is felt that it is required to reassess the emotional needs of the child. This may be at the end of CAYPMHS intervention to consider impact of the intervention or when/ if the child s emotional wellbeing seems to be deteriorating or improving to further assess levels of distress or improvement. If neither of the above situations leads to an earlier repeat completion, the SDQ will be completed at least annually to link into the Looked After Children s annual review health assessment. At each Looked After Children s Independent Review the IRO will ensure appropriate discussion about the emotional needs of the child, and where these are not being met will consider whether there is a need to complete a new SDQ. Page 7 of 10

8 5.2 Out of Authority Placements For children placed outside of Doncaster, the SDQ will be sent directly to the carer by the Social worker. This will be returned to the social worker who will score the SDQ and will discuss the findings with the Specialist Nurse for Looked After Children. The Specialist Nurse for Looked After Children will ensure that the SDQ results are shared with the relevant health professional in the out of authority placement. The social worker will ensure a referral to local CAYPMHS is then made where required. 6. TRAINING IMPLICATIONS 6.1 Multi-agency briefing sessions have been arranged to inform staff of the policy and each professional s key roles and responsibilities. 6.2 Staff will also be made aware of this policy via Line Manager, Team Meetings/Briefings, Trust Policy intranet 6.3 Monitoring A clinical audit as to the effectiveness of the SDQ process as a screening tool for the Looked After Children will be undertaken in March The policy will be reviewed by the authors in April May MONITORING ARRANGEMENTS Area for monitoring How Who by Reported to Frequency Compliance with the standards set out in this policy Audit of referrals via SDQ process Clinical records audit Senior mental health clinician for Looked After Children Specialist Nurse for Looked After Children The relevant business divisions leadership and quality group The Safeguarding Forum 6 monthly Looked After Children s Implementation Group Local Authority Performance Group Page 8 of 10

9 Any complaints received in relation to SDQ s Quarterly complaints analysis Senior mental health clinician for Looked After Children Specialist nurse for looked after children The relevant business divisions leadership and quality group The Safeguarding Forum Quarterly Looked After Children s Implementation Group Local Authority Performance Group 8. EQUALITY IMPACT ASSESSMENT SCREENING The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website click here 8.1. Privacy, Dignity And Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around individual, not just clinically but in terms of respect. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore all procedural documents will be considered if relevant to reflect to reflect the requirement to treat everyone with privacy, dignity and respect. There are no additional requirements with regards to the SDQ policy in relation to privacy, dignity and respect. 9. LINKS TO OTHER TRUST PROCEDURAL DOCUMENTS Safeguarding Children Policy, Clinical Policies section Policy for Children and Young People who do not attend appointments and/or disengage/who are at risk of disengaging from services, Clinical Policies section Transition Protocol: Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services, Clinical Policy section Page 9 of 10

10 10. REFERENCES DCSF, DOH (2009) Statutory Guidance on Promoting the Health and Well-being of Looked After Children DfES (2007) Care Matters: Time for Change DOH (2008) High Quality Care for All 11. APPENDICES Appendix 1- The Strengths and Difficulties Questionnaire Appendix 2 Guidance on scoring the SDQ Page 10 of 10

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