An Audit of the Initial Health Assessment of Unaccompanied Asylum Seeking Children at a UK University Teaching Hospital

Background: Unaccompanied children are extremely vulnerable, currently accounting for 8% of UK asylum applications.

Objective: To examine if collective standards by RCPCH and a well-established expert UK region on the initial health assessment (IHA) of unaccompanied minors are being met.

Methods: We studied 25 retrospective consecutive patients seen in 2016. The electronic BAAF (British Association Adoption and Fostering) form, and subsequent referral letters were reviewed.

Results: All were male teenagers. In majority country of origin was Afghanistan, Iraq or Iran. Presence of the social worker in only one IHA, and absence of interpreters in five of 22 cases shows lack of interagency communication. Although information documented covered general health questions in 80%, with mental health screening reaching 96%, we fell short in sexual health history. Risks including blood born virus (BBV), sexually transmitted disease exposure and route of travel was only documented in half. Positive findings by system included dermatological (44%), emotional (40%), dental (36%), musculoskeletal and current smoker (28% each) and sleep disturbance (16%). Although BBV screening occurred in 88%, HIV screening only occurred in half, and only 41% of 24 haemoglobinopathy screens were performed. Of the five vitamin D levels checked, 80% required treatment. Tuberculosis and mental health referral occurred in 96%, however sexual education only occurred in 56%. Of the 23 patients requiring immunisations, all GP’s received detailed advice.

Conclusion: Despite clear guidelines, the use of BAAF forms allowed for vast individual interpretation in documentation. The review of these forms without correlation to the patient hospital notes is a limitation of this study. However, as these forms are used to instigate subsequent management plans, this is an important outcome. We developed a local guideline with flow charts and local service guide so staff completing IHAs were well equipped. We propose to re-audit this cohort in 12 months.