Evaluation Of An Integrated Pathway For Unaccompanied Asylum-Seeking Children In Newham: Demographics, Baseline Health Needs, And Preliminary Health Outcomes (Alladi, 2023)

Bruce G., Armitage A., Salvo L., Heys M., Alladi S.

Archives of Disease in Childhood 2023;108(Supplement 2): A62-A63.

Objectives Unaccompanied asylum-seeking children (UASC) are a vulnerable population with high rates of trauma. Existing services for UASC are inconsistent and often fail to meet complex health needs.1 An 'integrated pathway' for UASC, developed in Camden, provides intensive and joined-up support for this group.2 An evaluation of this pathway, presented at RCPCH conference 2020, demonstrated a high level of need among UASC,3 but evidence of improved health outcomes among UASC was lacking. With charity funding this model was adapted and implemented in another London borough. We aim to present demographics and health needs among UASC engaging with the integrated pathway, and to compare preliminary health outcomes with data collected preimplementation.

Methods Demographic, health needs and preliminary health outcomes (immunisation, dental referral, infectious diseases screening and eye check) data were collected prospectively from initial health assessment reports from UASC engaging with the integrated pathway (January 2021 to January 2022). These were compared with data gathered from UASC seen in the service prior to implementation (October 2019 to October 2020). Results Data was available from 33 UASC seen following pathway implementation (97% male, age range 14-18). Most common countries of origin were Iran (36%) and Afghanistan (18%). 91% of UASC required an interpreter, with no native English speakers. 36% of UASC lived with foster carers and 55% in semi-independent accommodation. Data was available from 26 UASC seen over a year period prior to pathway implementation. On comparison, rates of all preliminary health outcomes improved following the implementation of the pathway (see graph 1). The majority of UASC seen following pathway implementation disclosed symptoms of poor mental health (82%), including sleep problems (52%), post-traumatic stress disorder (PTSD) symptoms (52%), suicidality (12%) and self-harm (12%). Nearly half of UASC reported historical physical abuse or assault (42%) and there was one disclosure of sexual assault. On examination, 9% had scars consistent with physical abuse or assault.

Conclusion This is the first data to demonstrate improvements in health outcomes following implementation of the integrated pathway model. The integrated pathway has been successfully implemented in a second London borough, and demonstrates a high level of physical and mental health needs consistent with previous evaluations of UASC specific services.2 4 An application for grant funding is currently underway to expand the integrated pathway model across seven boroughs in London, and will aim to deliver evidence and strategy for implementation at scale, including cost-effectiveness.