What is an IHA?

An IHA is an Initial Health Assessment which is a mandatory health check required by the government for all young people entering care, to be completed within 28 days of entry into care. The IHA is crucial in ensuring the child’s overall well-being across multiple areas, including:

• Listen to the young person - How they are coping and any concerns they may have.
• Physical health
• Mental health
• Medication and any ongoing treatments
• Vaccinations and immunisation records
• Education and developmental progress
• Sexual health and relationships
• Substance use
• Background and reasons for entering care

The IHA plays a key role in creating a comprehensive care plan to support the young person's physical and emotional needs.

Read more about what an Initial Health Assessment (IHA) involves here.

What is the Initial Health Assessment for Looked After Children?

An Initial Health Assessment (IHA) for Looked After Children is a mandatory health check required by the government for all young people entering care, to be completed within 28 days of entry into care. The IHA is crucial in ensuring the child’s overall well-being across multiple areas, including:

• Listen to the young person - How they are coping and any concerns they may have.
• Physical health
• Mental health
• Medication and any ongoing treatments
• Vaccinations and immunisation records
• Education and developmental progress
• Sexual health and relationships
• Substance use
• Background and reasons for entering care

The IHA plays a key role in creating a comprehensive care plan to support the young person's physical and emotional needs.

Read more about what an Initial Health Assessment (IHA) involves here.

What does IHA stand for?

IHA stands for Initial Health Assessment. It is a government-mandated health check required for all young people entering care and it must be completed within 28 days of their entry into the care system. The IHA helps assess and support the child’s overall health and well-being.

What happens at an Initial Health Assessment (IHA)?

At an Initial Health Assessment (IHA), a young person's well-being is evaluated across several key areas, including:

• Physical health
• Mental health
• Medication
• Vaccinations
• Education and development
• Sexual health and relationships
• Substance use
• Background and reasons for entering care

The IHA typically lasts around 1 hour and includes:

• Discussion of key areas: We talk about the topics listed above. We understand that some discussions may be sensitive and young people can indicate if a subject feels too emotional to continue.
• Carer’s Report: We review the carer's comments to understand their perspective.
• Physical examination: Lasting about 15 minutes, this includes checking height, weight, skin, ears, throat, chest, abdomen, spine and joints. Typically, underwear is left on (except for babies), unless further examination is needed. We handle these situations with great sensitivity, ensuring everyone feels comfortable and if they don't then we consider alternative options.
• Care Plan: The final 5 minutes focuses on creating a plan for the young person, addressing actions to support recovery and long-term well-being.

Find more information on IHAs based on your age group or role at the links below:

• Under 12 years
• 12-17 years

Are Chaperones Available for Medical Assessments?

Yes, we always provide the option of a chaperone during medical assessments to ensure comfort and professionalism.

• For older children, there is an opportunity during the appointment to discuss sensitive topics, such as relationships or substance use, privately without a carer present. If no other adult is present in the room, a chaperone will be there to support the young person and help them feel at ease.
• Typically underwear remains on (except for babies) unless a specific issue requires further examination. Intimate examinations are rare, but if needed, the use of a chaperone will be discussed beforehand to ensure everyone is comfortable.
• We approach these situations with sensitivity and if at any point you feel uncomfortable, alternative options will be considered. You can request a chaperone at any time during the appointment.

If you feel that a chaperone is necessary at any point during the appointment, please don’t hesitate to ask.

What is a Needs Assessment for Children in Care?

A Needs Assessment for Children in Care is known as an Initial Health Assessment (IHA). This assessment is vital in ensuring the young person’s overall well-being by evaluating various areas of their life, including:

• Physical health
• Mental health
• Medication
• Vaccinations
• Education and development
• Sexual health and relationships
• Substance use
• Background and reasons for entering care

The IHA helps create a personalised care plan, addressing actions to support recovery and long-term well-being.

Read more about what an Initial Health Assessment (IHA) involves for Under 12's, 12-17y and for Carers.

What is a health assessment for Children in Care?

A health assessment for Children in Care is known as an Initial Health Assessment (IHA).

Read more about what an Initial Health Assessment (IHA) involves for Under 12's, 12-17y and for Carers.

What if English is not the young person’s first language?

If English is not the young person’s first language or they aren’t confident speaking it, please inform us and the social worker in advance. The social worker will arrange an interpreter to ensure clear communication. We have extensive experience working with interpreters, helping young people feel comfortable and supported in expressing themselves fully.

There is a page of specialist information to support Unaccompanied Asylum Seeking Children (UASC) with resources in various other languages here.

What Should I Do Before the IHA Appointment?

Before attending the Initial Health Assessment (IHA) appointment, it’s important to complete any questionnaires sent to you at the time of booking. These provide crucial information to ensure a thorough assessment, including:

• Carer’s Report: A valuable opportunity to share any concerns or observations about the young person's health or well-being.
• SDQ (Strengths and Difficulties Questionnaire): For children aged 5-16, this helps identify areas where additional support may be needed. Learn more about the SDQ here.

We also recommend that the young person watch videos to help them understand what to expect during the appointment. These videos are available tailored to different age groups:

• Under 12 Years
• 12-17 Years

If you are a carer bringing a young person to an IHA, click here for more information.

What Should I Bring to an Initial Health Assessment (IHA)?

To ensure a smooth Initial Health Assessment (IHA) appointment, please bring the following items:

• Carer’s Report: A vital document to share any concerns or observations.
• SDQ Questionnaire: For children aged 5-16, this helps identify areas where additional support may be needed.
• Red Book: If available, bring the child’s health record for reference.
• Health information or appointment records: Any relevant health documents, such as past medical reports or treatment records.
• Refreshments or activities: If the young person may need something to occupy them during the appointment.

If you are a carer bringing a young person to an IHA, click here for more information.

How Can a Young Person Learn More About an Initial Health Assessment (IHA)?

To help young people understand what to expect during an Initial Health Assessment (IHA), we recommend watching age-appropriate videos. These videos explain the IHA process:

• Under 12 Years
• 12-17 Years

Watching these videos can help ease concerns and provide a clear understanding of the appointment.

There are also some resources available for Unaccompanied Asylum Seeking Children (UASC) with information interpreted into some of the languages commonly spoken by the young people.

If you are a carer bringing a young person to an IHA there is information for you on what to expect and what to bring.

Should Carers Attend Initial Health Assessments (IHAs)?

Yes, carers should attend Initial Health Assessments (IHAs) whenever possible. 

Their input, alongside that of the young person, is highly valuable during the assessment.Carers offer essential insights into the young person's health and well-being, which can significantly enhance the assessment process.

What If a Carer Can't Attend the IHA?

• Notify the social worker in advance. The social worker may attend the appointment instead, but make sure they are aware of any concerns you have.
• Make sure to communicate any concerns and complete the Carer's Report so that the social worker can pass along the necessary information.

For more detailed information about attending an Initial Health Assessment as a carer, click here.

What if multiple siblings need an appointment?

If multiple siblings require an appointment, there are two options to consider when booking the appointment:

• Individual appointments: Best for addressing complex or sensitive issues that may be difficult to discuss in front of siblings. This option is also ideal if the siblings are placed with different carers.
• Group appointments: Up to 3 consecutive appointments can be arranged. This approach is convenient when siblings share a lot of information, helping to create a comprehensive picture. Bringing snacks and activities for the children during the appointment can make the experience smoother.

Are Chaperones Available for Initial Health Assessments (IHAs)?

Yes, we always provide the option of a chaperone during Initial Health Assessments (IHAs) to ensure the comfort and professionalism.

How Are Chaperones Involved in IHAs?

• For older children, there is an opportunity during the appointment to discuss sensitive topics, such as relationships or substance use, privately without a carer present. If no other adult is present in the room, a chaperone will be there to support the young person and help them feel at ease.
• During children's medical assessments, typically underwear remains on (except for babies) unless a specific issue requires further examination. Intimate examinations are rare, but if needed, the use of a chaperone will be discussed beforehand to ensure everyone is comfortable.

Handling Sensitive Situations with Care:

• We handle intimate examinations and sensitive health discussions with great care and sensitivity. If a young person feels uncomfortable, we can consider alternative options.

If you feel that a chaperone is necessary at any point during the appointment, please don’t hesitate to ask.

What Should I Do if the Young Person Is Refusing to Attend the Initial Health Assessment (IHA)?

If the young person is refusing to attend the Initial Health Assessment (IHA), here are some steps you can take:

1. Put Them at Ease: Show the young person our videos (Under 12's or 12-17's) and discuss how the IHA can help address any concerns or issues they may have. Reassure them that it's a safe space to talk about their health and well-being.
2. Speak to the Social Worker: Social workers are experienced in helping children who may be hesitant or anxious. They can offer advice on how to handle the situation and work closely with you to encourage the young person to attend.
3. Consider a Remote IHA or a Planning Meeting: If the young person is still unwilling to attend, we can arrange a remote IHA or a "Planning Meeting" via Teams. This meeting can include the young person, their carer and the social worker to discuss next steps. The face to face appointment can also be quickly converted to a virtual consultation if needed with minimal notice. If the appointment needs changing please email appointments@bakerbakerhealth.com.

What Should I Do if I Need to Cancel or Change the Initial Health Assessment (IHA) Appointment?

We understand that unexpected situations may arise and sometimes you may need to cancel or change the Initial Health Assessment (IHA) appointment. 

1. Prioritise the Appointment: The IHA is a key part of the young person’s health evaluation,and it needs to be completed within 28 days of the young person entering care, so please try to keep the scheduled time if possible.
2. Speak to the Social Worker: Social workers may be able to help facilitate the appointment going ahead.
3. If Changes Are Necessary: If the appointment must be rescheduled, please email us at appointments@bakerbakerhealth.com as soon as possible to arrange a new appointment.

If the young person is refusing to attend the IHA click here for guidance 

For more details on bringing a young person to their Initial Health Assessment, click here.

What Are the Statutory Timescales for Looked After Children (LAC) Health Reviews?

The statutory timescales for Looked After Children (LAC) health reviews are important to ensure the well-being of children in care. These include:

Initial Health Assessment (IHA):

• Must be completed by a doctor within 28 days of the child entering care.
• To learn more about what an Initial Health Assessment (IHA) involves, click here.

Review Health Assessment (RHA):

• Usually conducted by a nurse, with different time frames depending on the child's age:
  • Under 5 years old:  At least every 6 months.
  • Over 5 years old: At least once a year.

Where does the information go after the Initial Health Assessment (IHA)?

Following the Initial Health Assessment (IHA), the report is shared with the social worker, birth parents, GP, school nurse and the local Children in Care team. A copy of the full report is added to the child’s medical records. The carer will receive a copy of the plan.

Older children are given to choice to either review the carers copy of the plan or they can request their own copy: 

• 16+ years old then it will be a full copy of the report 
• 13+ years old and they have capacity to make decisions for themselves then it will be a copy of the plan.

We will be conscious that the young person may be reading the report when we write it, but please be aware that sometimes there may be some information contained as they read it which they find traumatic. We'd be grateful if you could carefully support them through this please.

They may also request that certain information not be shared with specific individuals and we do our best to respect these wishes.

If referrals to other healthcare professionals are necessary, relevant information from the assessment will be shared to ensure the child receives appropriate care.

There may be times when information needs to be shared against the young person's consent if there is a Safeguarding concern eg if there are Child Criminal Exploitation or Child Sexual Exploitation concerns.

How often are Looked After Children (LAC) health assessments?

Health assessments for Looked After Children (LAC) are crucial to ensuring their overall well-being while in care. The frequency of these assessments is based on statutory guidelines:

Initial Health Assessment (IHA):

• Must be completed by a doctor within 28 days of the child entering care.

Review Health Assessment (RHA):

• Usually conducted by a nurse, with different time frames depending on the child's age:
  • Under 5 years old:  At least every 6 months.
  • Over 5 years old: At least once a year.

To learn more about what an Initial Health Assessment (IHA) involves, click here.

What Is an Initial Health Assessment (IHA) Report?

An Initial Health Assessment (IHA) report is a detailed document completed by the doctor following the IHA consultation. This report is filled out on  age-specific forms provided by CoramBAAF, known as "Form IHA".

These forms are due for updates soon to reflect any changes in assessment guidelines.

For further information on what an Initial Health Assessment (IHA) involves, click here.

What is a Care Plan for Children in Care?

A Care Plan is a detailed document outlining the arrangements for a child in care, focusing on how their individual needs—including health, education and wellbeing—will be met. Every child in care is required to have a Care Plan, which is created and regularly updated by the child’s social worker in collaboration with partner agencies, including the “Health Action Plan” from the Initial Health Assessment.

What is the “Health Action Plan” from the Initial Health Assessment (IHA)?

The Initial Health Assessment (IHA) is part of the care planning process as it evaluates the young persons needs from a health perspective. Following this assessment, a "Health Action Plan" is developed to address any concerns identified and to provide tailored support for the child or young person. The social worker then incorporates this into the child’s overall Care Plan.

What Is the Children in Care (CIC) Team in the NHS?

The Children in Care (CIC) team is a dedicated group of professionals within the NHS who specialise in supporting the health and well-being of Children in Care. This team works collaboratively to ensure that Looked After Children receive the medical attention and support they need. The exact composition of the CIC team may vary depending on the county.