Improving the Health of Looked after Children in Scotland: 1. Using a Specialist Nursing Service to Improve the Health Care of Children in Residential Accommodation

Abstract

The first of two studies reported here by Donna Hunter, Gerry McCartney, Susan Fleming and Fiona Guy investigated whether a specialist nursing service could improve the health care of 162 children in residential care in Renfrewshire, West Dunbartonshire and Argyll & Bute. It found that after the introduction of the service, the proportion of children with completed carer-held health records (BAAF health record booklets) increased from three per cent to 77 per cent; the proportion receiving a ‘pre-admission medical’ increased from 38 per cent to 48 per cent; the proportion adequately immunised increased from nine per cent to 56 per cent; the proportion with at least one outstanding medical referral decreased by at least four per cent; the number registered with a dentist increased from 14 per cent to 62 per cent and the proportion who received a ‘comprehensive health assessment’ increased from 17 per cent to 58 per cent. Thematic analysis of free text journals suggested that universal health services were much more accessible in Argyll & Bute due to well-developed interagency working, low numbers of children in residential care and low rates of staff turnover. In the more urban areas, the main advantage of the service was thought to be in the facilitation of interagency working. The service was received positively by residential care workers and children in residential establishments. This study suggests that the provision of a specialist nursing service can improve the health care of children in residential accommodation.

Vaccine coverage of children in care of the child welfare system

“…As found previously (Ashton-Key and Jorge 2003), providing information to social services on children's vaccination needs does not in itself improve vaccine coverage. This study and others (Jaudes et al 2012;Hunter et al 2008) suggest that improved coverage may be achieved through coordinated and integrated care between social services and health departments. Research is also needed to explore the perspectives of children, guardians, health providers, and child intervention staff regarding perceived barriers and proposed strategies to improve immunization service delivery.…”

“…If several appointments are required to complete a multi-dose vaccine series, there may be a greater likelihood of an appointment not being attended. The literature suggests that lack of awareness of required vaccinations and current contact information by both social services and health service providers means that vaccination may be seen as someone else's responsibility, thus affecting interagency co-ordination (Hunter et al 2008). In addition to circumstances while in care, children may experience medical neglect prior to entering care (Canadian Paediatric Society 2008) and require several catch-up vaccines upon entry into care.…”

“…The literature suggests that a lack of coordination and information sharing between health and social services, as well as discontinuity of care, may lead to gaps in service provision for children in care. This may result in subpar delivery of immunization services and/or poor record-keeping of vaccinations administered, leading to lower vaccine coverage that becomes exaggerated over time (Hunter et al 2008;Croft 2009;Rodrigues 2004). An additional issue is that anecdotal reports from clinicians in our study setting noted that the lower coverage we observed in children in care may partially be explained by difficulties in obtaining informed consent to proceed with vaccination for children in care.…”

Immunization Coverage of Children in Care of the Child Welfare System in High-Income Countries: A Systematic Review

“…The characteristics of included studies are presented in Appendix Table 1, (available online). The studies primarily came from the United Kingdom (n=15), 18,20,24,26,28,[30][31][32][33]36,38,39,41,43,46 the U.S. (n=9), 19,22,23,29,37,40,42,48,49 and Australia (n=6), 17,27,35,44,45,47 with a smaller number from Italy (n=1), 21 and Sweden (n=2). 25,34 They included 29 peer-reviewed journal publications, three government reports, and one thesis.…”

“…Study designs included cross-sectional (n=22), 17−22,24−28,30−37,44,47,49 case-control (n=1), 23 prospective and retrospective cohort (n=2), 29,40 retrospective cohort with pre-/post-intervention assessments (n=3), 38,41,43 mixed methods (n=3), 42,45,46 mixed methods with pre-/post-intervention (n=1), 39 and qualitative (n=1). 48 A variety of data sources were used to determine immunization status of children, including caregiver or self-report (n=5), 19,29,31,32,37 caregiver or self-held record (n=1), 42 child welfare data (n=6), 17,28,36,39,43,47 community health records (n=2), 25,38 electronic health database (n=5), 18,20,23,40,46 medical records (n=4), 21,22,27,34 electronic immunization databases (n=1), 24 and mixed data sources (n=7). 26,30,33,35,41,44,45 Very few studies (n=7) 18,21,24,…”