You should be provided with a child’s basic medical history when they are placed with you. If it is an emergency placement, this should happen as soon as possible.

A child/young person will have a Health Care Assessment which forms the Health Care Plan. If the child/young person does not have one, the child’s social worker will discuss this with you. Parents should have given consent to this happening.

The Health Care Assessment happens at particular times;

  • The first Assessment must be done before the first placement or, if not possible, before the child’s first Child in Care Review (unless one has been done within the previous 3 months);
  • For children under five years, further Health Care Assessments should occur at least once every six months;
  • For children aged over five years, further Health Care Assessments should occur at least annually.

You play an important role in looking after and promoting the health needs of children in your care. This means talking to them and providing them with information about doing the things that keep them healthy and well.

You should encourage children/young people to follow their interest and leisure activities.

You should help the child/young person to identify where they can access activities they are interested in and support them to attend. This may be linked to the educational setting they attend. It could be sporting activities or activities which they enjoy which make them feel good about themselves.

It is important that you keep a record of the child’s health and that you take the child for their health assessment and relevant appointments. You will be provided with a Health Care record (Red Book) for children and young people who are the responsibility of Kent County Council and have been in care after a year or more. The aim is to ensure that important health information regarding the time the child is in substitute care is not lost. Young people will be able to request a copy of their record if they wish at an appropriate age.

The information you hold about the child - including their daily routine, likes and dislikes, health issues etc - may need to be shared with other professionals (LAC nurse) and recorded within the Health Care record. Discuss with your social worker which pages can be dispensed within the Health Care record depending on the needs of the child or setting.

You should check whether you need to register a child with a GP, Dentist and Optician and whether you have delegated authority to take the child for any treatment. This will usually have been decided when completing the Placement Plan.

Each time a child is given medication, you must record when, how often and how much was given within the Health Care record.

All medicines should be stored securely and accessible for those who need it.

The Health Care record should move with the child/young person to the next setting. If the child/young person return home the record should be handed back to the child/young person’s social worker and a copy available to the child/young person if requested.

The Health Care record will be monitored via Placement Planning Meetings, the Child in Care Review and at Health Care assessments.

You should help children/young people to make informed decisions about their health and their views should be taken into account when making decisions.   

In the event of an accident or incident, you must record the details of what happened and inform your Fostering Social Worker and the child’s social worker as soon as possible.

You will receive appropriate training including health promotion, communicable diseases, hygiene and first aid.

Children can benefit from having access to a caring relationship with an adult such as a foster carer. In order to assist children and young people to develop an emotionally secure base it is important for you to model:

  • Reliability;
  • Honesty;
  • Trustworthiness;
  • Acceptance of the individual, if not the behaviour;
  • Respect for others;
  • The ability to listen to others’ point of view;
  • Acceptance of friendships, if not friends;
  • Endeavours to understand others;
  • Talking matters over without arguing/becoming defensive/coming to blows;
  • Problem-solving behaviour;
  • Recognition and building on strengths and attributes;
  • Asking for and accepting help and advice.

Other useful resources in considering the development of resilience include:

  • Gilligan R (1999) ‘Enhancing the Resilience of Children and Young People in Public Care by Mentoring their Talents and Interests’ - Child and Family Social Work 4:3 pp 187-196;
  • Fonaghy P and Steele H (1994) ‘The Theory and Practice of Resilience’ - Journal of Child Psychology 35:2 pp 231-57.

The Social Care Institute for Excellence has also produced a booklet entitled Promoting Resilience in Foster Children and Young People. This is aimed at child care professionals and focuses on what makes foster care work well for children and young people.

Developing Good Mental Health In Children and Young People

The Department of Health has produced a publication entitled ‘Fostering Good Mental Health in Young People’. This is a guide for looking after children and young people between the ages of 11 and 18 with mental health problems. It includes guidance on sleep problems, eating problems, aggressive behaviour, inappropriate sexual behaviour and personal neglect with practical suggestions for you.

Unfortunately it is no longer available for purchase, but a copy can be borrowed from the resource library.

Any concerns which you have with regard to a child/young person’s behaviour which may be an illustration of mental health difficulties - e.g. deliberate self-harm, eating disorders, etc. - should be reported immediately to the child’s social worker.

YoungMinds is a national charity committed to improving the mental health of all children and young people contains detailed information organised by topics relevant to children’s mental health. There is a resource pack for young people giving information about mental health services and other relevant issues.

Potential Mental Health Problems:

Although it is common for young people to experience mental health difficulties that require professional help, it is quite rare for adolescents to be affected by a serious mental disorder. However, the stigma of having a mental health difficulty, illness or disorder can often leave a young person frightened to talk about their problem and reluctant to access support.

Some of the mental health difficulties which young people may experience include (information taken from

  1. Anxiety and stress - may make young people feel low or sad, may lose their appetite or find it difficult to sleep. They may feel fearful, tense or panicky, which may lead to physical signs of shaking, sweating or palpitations. They may feel that life is not worth living and may become so desperate as to run away, feel unable to attend school, may consider taking an overdose or harming themselves. Young people may also develop phobias which can impact on their everyday lives.'

    Therapeutic support is recommended when anxiety and stress is affecting a young person’s everyday life. It is important that they have the opportunity to gain support from someone who will listen to and understand them, and who can also help them to find alternative ways to cope with their feelings;
  2. Depression - for a diagnosis to take place, at least five of the following symptoms must be in place:
    • Low mood;
    • Loss of interest or pleasure;
    • Feeling sad or empty;
    • Experiencing a marked change in appetite;
    • Sleep difficulties;
    • Loss of energy;
    • Feelings of worthlessness or guilt;
    • Difficulties in concentrating;
    • Recurrent thoughts of death or suicide.

Therapeutic services can again be useful for young people experiencing moderate, significant or acute depression. For more sever cases, medication may be recommended in conjunction with therapy. It may help adolescents to know that 1 in 4 people will experience depression at some point in their life - it is the most commonly diagnosed mental health problem in the UK;

  1. Deliberate self-harm - some young people may have experiences that may leave them with feelings that they cannot manage, they may not know how to reduce the tension these feelings cause and believe there is no one from whom they can access support.

    They may feel ashamed, guilty, or bad about previous experiences. They may have relationship problems and have thoughts of harming themselves. Young people can harm in various ways - through the use of drugs or alcohol, overdose or poison themselves, pick, cut, slash or burn their skin. Many young people have thoughts of self harm, and more than 10% act on these thoughts. Such behaviour puts a young person at risk.

    Such young people need therapeutic support, as not accessing such support could result in them deliberately self-harming as a strategy for coping with difficult feelings in the future, which could increase their risk of causing intentional or accidental injury or death;
  2. Obsessive Compulsive Disorder - Some people have thoughts which repeatedly come into their minds, which can feel silly or scary - these are known as obsessions. Young people may have obsessions about:
  • Dirt or contamination;
  • Worrying about themselves or others coming to harm;
  • Feeling angry or violent towards others for no reason;
  • Unwanted sexual thoughts;
  • Worrying about religion or morality;
  • Thoughts about doing something embarrassing or forbidden;
  • Worrying about ’evening up’ or if things are symmetrical;
  • Needing to tell, ask or confess;

These worries may lead to needing to do something in response, such as:

  • Washing;
  • Repeating;
  • Checking;
  • Touching;
  • Counting;
  • Ordering/arranging/tidying;
  • Hoarding;
  • Praying.

These may be indications that a person is suffering from OCD. There are some treatments that are useful - see this useful website developed by staff at the Maudsley Trust. This website offers more information about OCD, its treatment and sources of support for young people and carers;

  1. Psychosis - Individuals with psychosis hear voices in their head with the same clarity as if someone were having a conversation with you. This is an ‘auditory hallucination’. Individuals with psychosis may also have ‘visual hallucinations’.

    Symptoms of psychosis appear in episodes lasting a few hours, days or weeks at a time. Those who are developing this condition may begin to neglect themselves, lose motivation and display bizarre behaviour. They may have disordered or distorted thoughts.

    An increasing number of professionals are concerned at the rise in reported psychotic episodes experienced by young people with substance misuse problems.

    The most common form of psychosis is schizophrenia - it affects 1% of the population and is most likely to start between the ages of 15 and 35 years. Those who develop psychosis require specialist psychiatric treatment, which may involve them being prescribed medication to help alleviate the most distressing symptoms of the illness. The earlier such psychotic episodes are recognised the better so that symptoms can be treated.

    If you are concerned that a child in your care is suffering from mental health difficulties, this should be discussed with the child’s social worker in order that the evidence can be considered and discussed and an appropriate referral made if necessary.

Valuing Diversity and Emotional Well-Being:

We know that the emotional development and well being of children is dependent on them having secure attachments. Factors which may influence the development for Children in Care of healthy attachments with you may include:

  • Appropriate matching of children with foster carers who can meet their assessed needs. The fostering service ensures that children and young people, and their families, areprovided with foster care services which value diversity and promote equality. Fostering placement decisions which consider the children’s assessed racial, ethnic, religious, cultural and linguistic needs and match these as closely as possible with those of the foster family;
  • Where trans-racial placements are made, you can accessg additional training, support and information to enable the child to be provided with the best possible care and to develop a positive understanding of his/her heritage;
  • Where possible a planned period of introductions, so that the child can express a view about the placement and become familiar with you, your family, any other children in placement, the home, neighbourhood and family pets, before moving in.

The Fostering Service has a responsibility to ensure that you provide care which respects and preserves each child’s ethnic, religious, cultural and linguistic background. There is also a requirement that you support and encourage children in your care to deal with discrimination.

There is little evidence to show that children from minority ethnic groups are more likely than the white population to have mental health problems. However, higher levels of social deprivation mean that for some minority ethnic families, the risks will be greater. For the children of refugee families, there is the strong likelihood that they will have witnessed or been involved in violence, and may have seen others abused, tortured or killed. Many refugees suffer from post traumatic stress disorder.

Unaccompanied asylum seeking children may have experienced:

  • War and terrorism;
  • Civil unrest;
  • Ethnic persecution;
  • Political persecution;
  • Religious persecution.

Research has shown that human-made violence, like war and terrorism tends to have a longer-lasting and more serious impact than natural disasters. This is partly because the reasons are harder to accept. Accepting what has happened is particularly difficult for children who are often more psychologically damaged than adults by these events.

You need to ensure that Disabled Children receive those services which will ensure that they are able to maximise their potential and to lead as full a life as possible.