High risk groups

Looked after children and care leavers are at increased risk of maltreatment.

Definitions vary slightly across the UK but 'looked after children' LAC is a diverse group that includes children and young people (CAYP) in local authority homes, foster care, unaccompanied asylum seekers and those accommodated compulsorily for their own protection or those around them (eg under the criminal justice system).

See the RCPCH resources for more information.

Care leavers

Those young people who have been under the care of the local authority for a period of 13 weeks which spans their 16th birthday.

Designated professionals

This role involves professionals with special responsibilities for Looked after CAYP. It varies across the UK as to who fulfils the nominated and designated roles with GPs and nurses in some cases providing medical advice to fostering and adoption services. Lead Paediatricians for LAC will often provide strategic advice for commissioners and planners.

Facts

• Numbers of LAC have steadily increased since 1985 and is now at an all time high. The majority relate to abuse and neglect but there are also an increasing number of unaccompanied asylum seekers who have been trafficked.
• Guidance applies up to age 25 years.
• The 2015 Intercollegiate Safeguarding document on Looked After Children describes 5 levels of training cf. the safeguarding competences listed in the current general framework (2014). What does this mean for anaesthetists? The key knowledge, skills and competences are outlined on page 13. The key skill is to know to refer high risk CAYP to the relevant safeguarding professionals and/or the LAC team locally.

In terms of training there are no radical changes for anaesthetists who need as a minimum maintain level 2 competencies by relevant annual updates. However, it will be important to understand the background to this patient group. It is likely that routine annual safeguarding training will include scenarios which include local authority children and young people. There is no requirement for leads for safeguarding to undertake specific additional training. However, it may be useful to consider including scenarios which involve a looked after child/young person or a care leaver so that these issues are raised with anaesthetists, re-enforcing the need to be aware of increased risk.

Further information is available on the Royal College of Paediatrics and Child Health website.