Who are you and what do you do?

Chris Chiplen}
Judith Bryon} Specialist nurse for Looked After Children, Cardiff

We have a twofold role. We have a statutory responsibility to visit young people over the age of 11 and up to the age of 18 (when they may be in independent living) to carry out the annual medical assessments. At these assessments we discuss health matters with young people and follow up any concerns they may have.
We also visit the residential units in Cardiff where we have weekly drop-ins for the young people. We visit on the same day at the same time so that young people know when to expect us.

As LAC nurses we aim to make ourselves available so young people can come to us for advice and information on health issues. We would continue to visit a young person if there were any ongoing health concerns. We often act as a health advocate for young people within multidisciplinary meetings.

Young people are given our contact cards, which includes our mobile phone numbers, so they can access us directly if they wish.

We are also able to advise young people over the age of 18 (who we would have previously worked with in the care system) on health issues. We would help in signposting these young people to relevant services.

What are the main issues young people looked after bring to you?

Many young people want to talk to us about sexual health issues. Other issues such as asthma and skin care are also of concern to young people.

One issue of concern to us is substance misuse and its effects on young people, but it is not necessarily something young people want to talk to us about.

What is your confidentiality policy?

1. We provide a confidential service for young people. The only occasions when we would not maintain confidentiality is if there were child protection issues.

2. We encourage young people to talk to their careers about health issues, but if they choose not to then it is their right.

3. Young people have a right to confidential medical advice and treatment, according to the Fraser Guidelines. (Mental Health Act 1983, Code of Practice 1999):

•That the young person understands the advice and has the maturity to understand what is involved;
•Provided that the doctor/health professional cannot persuade he young person to inform parents/careers with parental responsibility, nor allow the doctor to inform them;
•That the young person’s physical and/or mental health will suffer if they do not have treatment;
•That it is in the young person’s best interests to give such advice /treatment without parental consent, and
•That in the case provided that the of contraception or substance misuse, the young person will continue to put themselves at risk of harm if they do not have advice/treatment.

What support and help are you able to give to young people who may feel unhappy and depressed?

If the young person were happy we would make a referral to the CAMHS service, which offers specialist help to young people who are concerned about their emotional health. Firstly we would talk to the young person about exactly how they are feeling and what support they have.

If a young person were not keen for us to go down the health service route, then we would look at alternative services and would offer to accompany the young person to any appointment. We would support the young person in their decision.

What other issues are of concern to you?

When young people move out of county they can lose touch with services and their support networks. This concerns us in respect of health as it means health concerns are sometimes not followed-up. We would follow-up where the young person has moved to and keep in contact with them.

How can young people have more of a say about health issues and being looked after?

Young people could talk to different organizations, managers and advocates. We would talk to clinics and other places if young people told us they did not find them friendly places to attend. We have been successful in the past in pushing for changes in the menus in some of the residential units.

Thanks to the Cardiff LAC nurses for the above interview.

LAC Nurses Cymru

There are 19 LAC nurses in Wales. They have come into post within the last two years. Two of the local authorities, Powys and Ceredigion, do not yet have nurses in post. The roles of the LAC nurses vary from area to area, but generally they are responsible for carrying out the health assessments and preparing the health care plans of young people. All nurses aim to improve the health outcomes for children and young people who are looked after by identifying health needs, promoting healthier life styles and empowering young people to help them.

All the LAC nurses in Wales meet together every 3 – 6 months to share good practice, to look at how the service can be improved and to ensure that all young people in Wales are receiving a service of a similar standard.