Clinical guidance for paediatric staff
This section contains a range of resources which have primarily been developed by consultant paediatricians and Designated Professionals in Kent to support assessing and addressing the health needs of unaccompanied asylum seeking children.
There are clinically validated tools, templates and guidance which will support paediatricians and assessors through the Initial Health Assessment process feel more confident that they are meeting the health needs of unaccompanied children.
A number of documents and resources have been created or collated to support clinicians who are undertaking health assessments (Fitness to Transfer FTT, Initial Health Assessments (IHA) and Review Health Assessments (RHA), of UASCs). These consist of guidance documents, clinical and admin tools and training resources.
The Hospital Communication Book
This is a tool that has been designed by The Clear Communication People Ltd and originally developed on behalf of the Learning Disability Partnership Board in Surrey, to support communication in situations where there may be a barrier, by language, hearing or visual impairment etc. It is an A4 sized book that contains over 300 original illustrations. Uses include:
- Checking understanding, consent and promoting choice
- Enabling patients to communicate their needs, wants, signs and symptoms
- Explaining procedures
This tool can help UAScs to make informed choices. Our primary care colleagues have found this particularly useful and some paediatricians have used this to support the IHA process. Copies can be purchased or downloaded from www.communicationpeople.co.uk.
Dr Manjari Tanwar, Specialist Registrar in Community Paediatrics has developed body maps that can be used to document any physical injury signs.
Moods and Feelings Questionnaire
This was developed by Adrian Angold and Elizabeth Costello in 1987 and consists of a series of descriptive phrases regarding how the subject has been feeling or acting recently. The young person completes this in the clinic with the help of a translator. It serves a similar purpose to the SDQ but is much shorter and is easier to administer. There are no prescribed cut off points but we have noted concern if young people score above 10.
Strengths and difficulties questionnaires
A number of health actions are likely to arise following the IHA and in Kent we requested that the young person’s GP arranged some of these, including immunisations. This template was devised upon which a letter to the YP’s GP could easily be created to request such actions and accompany the IHA summary report.
Letter to personal adviser template
Some health actions required the support of the YP’s personal adviser so a template was devised upon which a letter could easily be created to request such actions.
Letter to social services re. IHA template
Some health actions required the support of the YP’s social worker so a template was devised upon which a letter could easily be created to request such actions.
This was developed by the local TB team.
Quality assurance of IHAs
An IHA audit tool has been amended to reflect the additional IHA areas for UASCs and guidance developed into how to quality assure the IHAs undertaken for UASCs.
Some new UASC specific guidance has been developed. Country information has been collated and other relevant guidance has been signposted.
Clinical guidance for assessing and addressing the health needs of UASCs
This was developed in Kent for as a tool for clinicians undertaking Initial and review health assessments. It is based on RCPCH UASC guidance with practical steps added in.
Handbook for clinicians undertaking Fitness to Travel FTT assessments
This was developed in Kent as a support for clinicians who would be undertaking FTT medicals for UASCs who are due to be moved under the National Transfer Scheme.
Vaccination of individuals with uncertain or incomplete immunisation status
Clinicians were instructed to immunise individuals according to this Public Health England advice.
Guidance on Blood Borne Infections
This was developed to assist clinicians in Kent.
- Blood Borne Infection Testing GUIDELINES
- Blood Borne Infections Information and Consent Form – TIGRINYA
- Blood Borne Infections Information and Consent Form – PASHTO
- Blood Borne Infections Information and Consent Form – ARABIC
- Blood Borne Infections Information and Consent Form – ENGLISH
Many YP arrived in the UK with scabies so this protocol was developed.
Sexual health, asylum seekers and refugees – a handbook for people working with refugees and asylum seekers in England.
Comprehensive information on countries of origin of our UASCs has been created by Dr. Katie Nicholls, Specialist Registrar in Community Paediatrics.
The National Transfer Protocol was put in place on 1st July 2016 and this meant that all newly arriving UASCs in Kent were to be transferred to new areas. To mitigate against health risks for them a fitness to transfer medical scheme was developed. There are a number of resources to support this process.
Development of the Fitness to Transfer Health Assessment
This explains how and why the Fitness to Transfer process was developed.
The FTT cover letter to Designated professionals
The Fitness to Transfer Assessment form
This is an assessment tool be completed with the young person.
This is a clinical guide to help staff in undertaking the fitness to transfer screens.
Analysis of first 35 Fitness to transfer assessments undertaken
This has been designed to complement the IHA assessment form and is intended for use as the assessment format for review health assessments of UASCs.
A leaflet was written by our UASC health team and translated into Arabic, Pashtu and Tigrinya to explain about the IHA process, consent and confidentiality. There are videos to accompany each leaflet, recorded in the above languages. The actors in the videos are reading the text which is in English and translated versions of the IHA information and consent forms.
In Kent, we would advise the paediatrician to show the young person the video alongside the translated leaflet, and get them to sign the consent within the leaflet.
A leaflet was created and translated into Arabic, Pashtu and Tigrinya to explain about Blood Borne Infections and testing and there is accompanying video in each language. The actors in the videos are reading the text which is in English and translated versions of the BBI information and consent form.
An immunisation consent form was created by Jackie Nudd, UASC Nurse
Relevant leaflets for UASCs, produced by other agencies have been collated – see Public Health page.
Various training resources have been developed:
A one day training resource was created and delivered in Kent for paediatricians delivering IHAs to UASCs.
A half day training resource was created and delivered in Kent for nursing colleagues in undertaking Fitness to Travel medical assessments.
A one hour talk was prepared and delivered across Kent to GP groups to raise awareness of UASC health needs.
A film was made for a wide ranging audience to raise awareness of health needs for UASCs.
There is a handbook for clinicians undertaking FTT medicals and guidance for doctors undertaking IHAs and many links to other useful training resources.
Completed example of an IHA summary report
A model IHA summary has been produced to help guide clinicians into how to write up the summary report and health action plan.
Questions to consider
The Designated Doctor and Designated Nurse for Looked after Children within your CCG areas will have a role in ensuring that there is enough provision within the local area to meet the needs of any UASC placed within the CCG.
They will also work closely with the Named doctor and nurse within your provider organisation to deliver the service.
There will be a Director of Children’s Social Services who will have the overall responsibility for the care of UASC. There is likely to be Assistant Directors with specific areas of responsibility. There is likely to be a LAC/UASC Service Manager and the young person’s social worker.
This will depend on what type of appointment you have with the child/young person.
For example it is important to have a translator at the initial health assessment, but it may not be possible when a young person is accessing emergency care. If you do not have a translator available, you can use language lines or the hospital communication book.
You will need to liaise with your contact within the Local Authority, to confirm whether they have a duty to provide an interpreter. In Kent, interpreters were provided for all Fitness to travel, Initial and Review Health Assessments. There is a section on working with interpreters in the clinical guidance document.
A UASC is a Looked after Child and is afforded the rights as any LAC.
This means that all aspects of promoting the health and wellbeing of LAC (statutory guidance) applies.
Consent needs to be sought for UASC in the same way as for any Looked after Child, but ensuring that information has been given to them in an accessible format. See Initial Health Assessment Consent translated materials and videos.
If they are Gillick Competent, they can provide their own consent, as long as this has been informed. Otherwise the Local Authority responsible for the child would give consent.
Information about Blood Borne Infection consent and immunisation consent is also available on this website.
This should be discussed/referred via your local safeguarding team in just the same way for any other child/young person. You need to pay particular attention to child sexual exploitation, trafficking and human slavery, missing, female genital mutilation and PREVENT policies for your area.
As any Looked after Child, an unaccompanied child is eligible for free treatment.
For further information please see the clinical guidance for clinicians undertaking IHAs.
This is allocated through GP registration and all UASC are eligible to register with a GP Practice using the Family Doctor Service registration Form (GMS1). We recommend that this is undertaken as soon as they arrive in the UK and prior to any move under the National Transfer Scheme.
The child’s social worker should complete the HC1 form which will enable the young person to have support to pay for dental treatment, glasses or contact lenses or travel to receive NHS treatment.
In our experience, UASC have missed immunisations and therefore should be immunised according to the UK Vaccination of Individuals with Uncertain or Incomplete Immunisation Status Schedule.
Up to date guidance should be sought from Public Health England, but in Kent we recommended universal screening for TB and blood borne infections in light of the needs assessment. There is information available for young people in relation to screening requirements on the Public Health page.
The Kent needs assessment also found a high prevalence of vision and dental needs within the population. We would recommend developing pathways to screening services with local providers and commissioners within NHS England.
There are no validated screening tools for UASC. We have devised the distress screening tool which is part of our fitness to travel work; this can be found on the website. In our Initial health assessment we have been using the moods and feelings questionnaire and the SDQ as these are generic tools used by CAMHS.
In the work we have done with UASC in reception centres, we found that many were experiencing re-feeding symptoms due to being semi-starved on the journey thought Europe. For further information on how to manage these symptoms, please see the Early Intervention Framework section of the emotional health and wellbeing pages.
Generally it will be the responsibility of the CCG that covers the area in which the child or young person has declared their arrival in the UK.
However, if the UASC is to be moved under the National transfer Scheme, the receiving CCG will be responsible.
At this stage there is no additional funding for Health.
The health needs assessment was undertaken by Rachel Coyle, Public Health Registrar and Samantha Bennett, Public Health Consultant in Kent County Council. The health needs assessment was supported by the Kent UASC Project Team. The assessment is the most detailed and in-depth research into the health needs of the current population of UASC in Kent. The findings have helped to inform and focus current and future resourcing and commissioning.
The Kent Transformation Plan for Children, Young People and Young Adults outlines how all partners in Kent will transform emotional wellbeing and mental health services between 2015 and 2019. The transformation programme across Kent has funded the Emotional Health and Wellbeing Action Research Project – so that we can better understand the emotional health and wellbeing needs of our UASC population.
Landing In Dover
The immigration process undergone by unaccompanied children in Kent. A report of findings undertaken in 2011 focussing on the immigration procedures to which unaccompanied children arriving in Kent are subject to.
Fact of Age
In the immigration context, age also determines how the immigration authorities treat the young person. Under the Immigration Rules, children are provided with specific procedural safeguards in asylum interviews and the manner in which their evidence and credibility are assessed is different to that of adults. Policy also requires that separated children are not normally detained and separated children are not returned to their county of origin in the absence of suitable reception arrangements.
The Refugee Council Children’s Section works directly with separated children, as well as giving advice to those involved in their support. The Children’s Section has operated since 1994, and is the only national service of its kind. The team employs around 14 fully supported Advisers, many of whom speak the languages of the children they are working with.
Freedom from Torture, formerly the Medical Foundation for the Care of Victims of Torture, has been working for more than 30 years to provide direct clinical services to survivors of torture who arrive in the UK, as well as striving to protect and promote their rights.
Since its inception, over 50,000 individuals have been referred for help. Thanks to the dedication of staff and volunteers – as well as scores of passionate supporters and funders – thousands of torture survivors have been able to rebuild their lives in incredibly difficult circumstances.
Latent TB Testing and Treatment for Migrants
The Collaborative TB Strategy for England 2015−2020(2) recommends LTBI testing and treatment for 16 to 35 year olds who recently arrived in England from high incidence countries, where TB incidence is 150/100,000 population or over. This guide aims to support the implementation of local LTBI testing and treatment, and provide practical advice as part of a robust local and regional TB control programme.
Vaccination of individuals with uncertain or incomplete immunisation status
This single page reminder based on Immunisation against infectious disease: the Green Book helps health professionals vaccinate people correctly to protect them and their families from disease.
An equivalent screening algorithm is available.
CoramBAAF Adoption & Fostering Academy is the leading membership organisation dedicated to improving outcomes for children and young people in care by supporting the agencies and professionals who work with them.
Coram Voice enables and equips children and young people to hold to account the services that are responsible for their care. They uphold the rights of children and young people to actively participate in shaping their own lives.
JCWI is an independent national charity established in 1967. We work to ensure justice and fairness in immigration, nationality and asylum law and policy and we provide direct legal advice and assistance to those affected by UK immigration control.