When a child or young person under the age of 18 comes into the care of a local authority, they will have an IHA, or initial health appointment. This is a statutory (which means it is required) health appointment completed by a doctor who has specialist knowledge on children, known as a Paediatrician. 

IHAs need to be completed with 28 days (or 20 working days) of a child coming into care. A young person’s social worker should attend the IHA with them, and if a named social worker is unable to attend, then a duty social worker should be sent in their place.

In the HIYA project, we have been working with five North East London Borough’s to enhance the way IHA’s are done, so that young people’s physical, emotional and sexual health needs can all be assessed in one go. 

We are also passionate about making sure young people have as positive an experience as possible. This means we aim to be mindful of experiences of trauma and adapt our process to avoid any potential further harm. 

We do this by first collecting as much information as possible. Social workers are sent a Pre-IHA Questionnaire to complete which asks for information on the young person’s experiences, journey, and any health concerns. This helps the clinicians in the IHA avoid having to ask the young person questions they might have already been asked several times. 

Once we have received all the information from the social worker, the HIYA team and Paediatrician look through this information ahead of time to familiarise themselves with the young person.

• You and your carer will first meet with one of our Health Improvement Practitioners (HIP). They will talk to you about who will be in the room during the appointment, what you might be asked, and they will explain that information given during a health appointment is confidential and kept separate from any home office proceedings. While this happens, the paediatrician and CAMHS practitioner will speak to your social worker to get any important information about how you are getting on from then.
• We will then all meet as a larger group – you, the paediatrician, the CAMHS practitioner, the social worker, the HIP, an interpreter if you need one, and your carer. We will begin by getting to know you, how you are settling in and what you like to do for example.
• We will then ask about your health history, if you know it. We know there are a lot of people in the room, so we will then ask your social worker, your carer, and the HIP to leave the room. You can ask for any of these people to stay in the room if you would like.
• The CAMHS practitioner will also ask about your journey – you can share as much or as little as you feel is important. You might be asked about your emotional wellbeing, how you felt in your country of origin and how you feel now, as well as what is keeping you strong.
• The CAMHS practitioner will then leave the room to allow the paediatrician to carry out their physical exam, where they will examine your breathing, look at your skin, and a few other physical observations.
• The appointment will end with everyone back in the room; we will work with you to come up with a plan of how best to support you going forward and you will have time to ask any questions.
• This plan will be reviewed by the professionals who were in the IHA three months later.

We want to understand whether the HIYA project is helping the young people who access the service. We want to know whether delivering care in this way improves young people’s health outcomes and their experience of care. To do this, we plan to compare the health outcomes of young people seen before and after the HIYA project began. We want to see, for example, if more young people are now being screened for infectious diseases, receiving mental health support, or seeing a dentist. We are also using questionnaires, interviews and focus groups to find out what young people, foster carers, and health and social care professionals, think about the service and how it could be improved.

We are looking for people who have experience of seeking asylum as an unaccompanied minor to help our team. If you are aged between 16 and 30, and you came to the UK as someone seeking asylum without their parents, we would love to hear from you! We'd really value your help thinking about how we run the project and deliver care. We are setting up a project advisory group who can meet with us once every one or two months. We can pay you for your time and reimburse travel expenses. Please see our flyer or contact the team for more information (elft.nel-cypsar-project@nhs.net).