3.8.5 Short Term Breaks - Medical and Clinical Procedures for Short Term Family Break Placements

Contents

  1. Introduction
  2. Family Placement Short Break Service
  3. Which Children the Policy Relates to
  4. Difficulties in Carrying out These Procedures
  5. Principles Underpinning the Family Placement Service
  6. Legal Entitlement
  7. Placement Services Policy and Standards of Service


1. Introduction

Various pieces of legislation (as will be outlined later) have pointed both recently and in the past to disabled children both having rights to receive services that meet their needs and be part of services that are inclusive of them.

This has quite rightly meant that children who have medical and/or clinical needs who require a family placement service should not only be entitled to be placed within a family environment as opposed to possible being inappropriately placed in a hospital or residential environment as has been the situation in the past but should also have their varied needs met within the foster homes.

In practice however, there has been some uncertainty and anxieties about foster carers providing such a service due to the level of risk involvement and how to manage this effectively. This has meant that in the past some young people have been excluded from the family placement services that they should have been entitled to.

This policy and the procedures contained within it will enable the Walsall Family Placement team to provide a service that will meet the needs of children requiring medical/clinical procedures and will then ultimately ensure a well informed quality service for all disabled children concerned.


2. Family Placement Short Break Service

Disabled children and their families may require access to a range of Support Services which could include short term breaks within a family setting. Historically there has been an insufficient amount of foster carers offering a service to children with specific health needs. Some of those carers within Walsall who have met the health/medical needs of children have done so unofficially often with little guidance training and support.

This practice would carry an element of risk for the child placed as carers were not adequately trained in the care and often didn’t record the processes carried out and medication given.

Others, through being interested in providing such a service may have been reluctant to do so due to the absence of training and clear policy.

This situation has led to some families having little choice in terms of which type of service they would like, children being denied a short term break service with a family, being inappropriately placed in a residential unit or having prolonged stays in hospital.

The Children Act 1989 and more recently the research completed by Shared Care Network for Quality Protects, has emphasised that short term care should be providing more opportunities for disabled children focusing upon their social and developmental needs and increasing the number of disabled children receiving short breaks. Thus emphasis therefore has to be upon how the short term break service can cater for such children’s needs effectively in order to provide efficient needs led provision.


3. Which Children the Policy Relates to

The groups of children this policy refers to are those who are disabled and/or have major medical conditions that require specific health care. These needs may be long term or relatively short term. Whatever the case their services need to be carefully planned. The children will generally be living either within the family home or with permanent carers prior to or at the same time as receiving a service. Examples of such children are those with e.g. Cystic Fibrosis, Epilepsy, Asthma who require a routine programme of Medication – orally, via Nebuliser or rectally and/or clinical procedures such as physiotherapy. Also young disabled people who have e.g. Cerebral Palsy, Hydrocephalus or other generic conditions that may require feeding via gastrostomy, oral or nasal Tubes.


4. Difficulties in Carrying out These Procedures

It is both good practice and required by Walsall Children's Services insurance brokers, that if medication or clinical procedures need to be administered during the time a young person is in the care of a foster carer, set procedures should be implemented in order for the carer to receive specific training by an identified person who is medically trained and holds authority to give the medical/clinical care needed.

It is impractical for anyone other than the carer e.g. community nurse, to carry out the processes as e.g. emergency treatments such as rectal medication for epilepsy need to be carried out immediately so cannot wait for a nurse to arrive. Routine procedures e.g. tube feeding would require too much precious time allocated by the nurse. It seems appropriate therefore, for carers to be trained to continue the care that ordinarily the child’s parents/permanent carers have been used to administering at home.

It is important that carers are able to perform these tasks with confidence and in an efficient way. Good practice in familiarising/training carers with such clinical/medical practices would minimise risk, prevent carers being subject to allegations of neglect and abuse and equally protect the children from negligence and a substandard level of care.

This will ultimately lead to parent/carers feeling more confident in using the service as they will know carers will be able to meet their children’s needs.

It is clearly dangerous practice for carers to carry out clinical/medical procedures without training as they may e.g. not recognise symptoms, danger signals, may give incorrect dosages of medication either by lack of understanding/recording or by actually administering the medication in incorrect manner e.g. lack of knowledge of us of nebuliser/inhalers.

Currently there seems no clarity about the responsibilities of the health authorities to provide the training needed for individual carers but there appears little difficulty within Walsall in obtaining agreement from General Practitioners or other health professionals to spend time training individual carers.


5. Principles Underpinning the Family Placement Service

Walsall Family Placement Service have a commitment to providing a needs led service wherever possible to the children mentioned in this policy. The policy has principles which clearly underpin it which will stated below.


6. Legal Entitlement

As mentioned in the introduction section of this policy disabled children have statutory rights to services.

The Children Act 1989 states that a disabled child is a child in need, disabled being defined as:

“If he is blind, deaf or dumb or suffers from a mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed”. (3)

Under (Schedule 2 paragraph 6) the local authority has particular responsibility to provide services and support for disabled children and their families which are designed to minimise the effects of disability and give opportunity to lead lives that are as “normal” as possible. (3)

In particular relation to family placements Section 23 (8) of the Children Act states that “where a local authority provide accommodation for a child whom they are looking after and who is disabled they shall so far as is reasonably practicable secure that the accommodation is not suitable to his particular needs”. (3)

The Chronically Sick and Disabled Person’s Act 1970 requires local authorities to make arrangements for a number of Children's Services if they are satisfied that it is necessary for them to do so to meet a disabled persons needs (1)

The Disability Discrimination Act 1995 states in Part III that disabled people must not be discriminated against by hose providing goods, facilities or services to the public.

It is now unlawful for service providers to:

  1. Refuse to provide a service to a disabled person which we provide to other members of the public.
  2. To provide a service of a worse standard.
  3. To provide a service on less favourable terms. Providers must also change any policy, practice or procedure which makes it impossible or unreasonably difficult for a disabled person to use the service. (1)

Finally the United Nations Convention on the rights of the child 1989 also states the rights of children and promotes the best interests of the child to be of primary consideration.


7. Placement Services Policy and Standards of Service

Aon Risk Services – insurance brokers that cover Walsall Children's Services have clearly indicated that they are prepared to provide insurance cover for respite/short break carers carrying out medical/clinical procedures as long as they follow the standards of practice outlined later.

7.1 Permitted Tasks/Prohibited Tasks

Carers may be requested to carry out the tasks below following consultation and training. Carers will only carry out these tasks when agreement has been reached by all associated parties and when the medication/clinical procedure has been prescribed/advised by a qualified medical practitioner.

It is very important that before agreeing to carry out such procedures carers are thoroughly confident and competent in the task.

a.

Permitted Tasks

  1. Administering prescribed medication routinely or emergency-orally, via nasogastric tube, rectally, via inhaler.
  2. Feeding through a nasogastric or gastrostomy tube.
  3. Tracheostomy suction and emergency change of tracheostomy tube.
  4. Giving injection with a pre-assembled pre-dose loaded syringe either intramuscular of subcutaneous.
  5. Care of catheter
  6. Inserting pessaries/suppositories
  7. Assisting with Oxygen administration.
  8. Basic life support/resuscitation
  9. Physiotherapy
  10. Any other specified emergency treatment

This list is not exhaustive. Therefore, if specific care is identified for a child that is not included in the list it may be considered following a planning meeting and discussion.

b.

Prohibited Tasks

  1. Non prescribed medication (carers may not know whether the medication will react with other medication being taken, or child may be allergic to it). If carers are requested to give such medication the parents/carers need to give written and signed instruction to the carer before it is given.
  2. Injections involving: controlled drugs, administering intravenously, assembling syringes.
  3. Programming of syringe drivers.
  4. Filling oxygen cylinders.

Should the need be identified that a child requires any of the above list a planning meeting will be held to gain full information and an identification of risk carried out before consultation takes place with Aon Risk Services. If it is still felt that carers should not be trained to provide the care, alternative support could be considered.

7.2 Medical/Clinical needs of the child – The process

Before a placement is agreed the family placement service should be provided with detailed up to date information about the child’s medical/health needs via referral.

a.

Profile

Following referral, a link worker from the family placement service will visit the child and family in order to undertake a further assessment of the child. A profile – ‘All About Me’ will be completed which will be used to share information with an identified foster carer.

7.3 Training – Specific and General

a.

Specific

When the medical/clinical needs of the child have been identified and a suitable carer has been tentatively introduced/linked, a medically trained professional, e.g. General Practitioner, school nurse, specialist hospital worker who is familiar with the specific child, will be approached to provide training for the carer wherever possible in partnership with the child’s parent/carer. The trainer will be asked to complete forms which will indicate the following:-

WSS651 WSS653

WSS652 WSS654 and emergency protocol form (No. WSS to be confirmed).

  1. Details of the specific child’s medical condition/disability. The carer will not be asked to carry out the procedure on any other child.

  2. Details of any medication (routine or emergency) including dose, method of administration, side effects.
  3. Details of clinical procedures, time and frequency of administration, method.
  4. Emergency protocol for the condition where needed e.g. signs/symptoms – next course of action.
  5. Special requirements e.g. dietary needs.
  6. The competence of the carer in carrying out the identified tasks.

The training may consist of one session or may require a series of sessions over months.

The medical/clinical needs of the child and the competence of the carer will need to be reviewed either when any changes are introduced or annually, whichever is the sooner.

For services providing short term breaks, Children Act Regulations 1989 require the child to have a medical report at the time of placement or within three months. The report should be updated every six months for children aged 0 – 2 years and every twelve months for children over two years. However, it is widely recognised that should a child be medically examined for an alternative purpose e.g. school, hospital, confirmation of the child’s health from this or a copy of this would be sufficient, in order to prevent the child being subject to repetitive unnecessary examinations.

b.

General Training

General training should also be available to carers in the areas of health care. These should include: health and safety, first aid/resuscitation, moving and handling hygiene/infection control. Training should also be available to address issues such as intimate care, communication skills, child protection etc.

The carers log recording, which will include any observations about a child’s behaviour in relation to medication and/or issues related to their disability will be checked and signed during each supervision session with the link worker.

Also medical/clinical recording sheets will be signed at the same time.

7.4 Reference List and Bibliography

  1. Alison Rhodes with Christie Lenetianand Jan Morrison (1999)
    Supporting Disabled children who need invasive clinical procedures.
  2. Richard Servian, Vicky Jones, Christine Lenehan and Steve Spires for Shared Network (1998)
    Towards a Healthy future
  3. Richard White Paul Carr and Nigel Lowe (1990)
    A guide to the Children Act 1989
  4. Beth Prewett (1999)
    Short term-break – long term benefit

7.5 Pre-Placement Meeting

The purpose of the meeting would be to bring together all parties to ensure all are ready, confident and well prepared for the placement to proceed. It is of vital importance that the carer feels able to meet the child’s needs and the child and parents/carers feel confident that carers are suitable.

The meeting will also ensure that all necessary forms have been completed:

  1. Parental/child consent forms – WSS654
  2. Foster carer agreement – WSS634
  3. Family Link Service agreement
  4. Training forms – as mentioned previously

Finally a review date will be set.

7.6 Introduction and Placement

When the carers feel able, further introductions can continue which will include the carers being able to demonstrate to the child and parents/carers that they are confident in providing the medical care needed and fully understand the child’s preferred method of communication. This is not only important to ensure the child’s basic needs are met during placement but may also be vital should the child use any specific sign/word to indicate a problem during the administration of medical/clinical procedures.

Once the placement has begun any changes in the child’s needs should be conveyed to the foster carer by the parents/carers. Any changes in medication/clinical procedure should be confirmed in writing in order that the carer can keep this on file.

7.7 Recording

It is good practice for carers to keep records of medication given to children. This could provide carers with protection and proof that they have followed agreed guidelines instructions should any accidents happen or allegations be made. Carers concerned in these procedures will therefore be provided with a folder that will contain the child’s profile and recording sheets for them to complete, copies of the medical forms e.g. emergency protocol, medication to be administered etc.

End