Expanding A Trauma-Informed Integrated Pathway For Unaccompanied Asylum-Seeking Children (Uasc) Across North East London (Alladi, Salvo, 2023)

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

Archives of Disease in Childhood 2023;108(Supplement 2): A329-A330.

Objectives Unaccompanied asylum-seeking children (UASC) are a vulnerable population with high rates of trauma including rape and torture. Existing services for UASC are inconsistent and often fail to meet their complex health needs(1). An 'integrated pathway' for UASC, developed in Camden, provides intensive and joined-up support for this group(2). With Barts Charity funding, this model was implemented in a second London borough (2020-2021) resulting in improvements in preliminary health outcomes. Following grant completion, funding for this service has been taken on by commissioners. Stakeholders across North East London (NEL) want to replicate this model. Implementation at scale requires more comprehensive evidence, including health economics. We aim to describe a plan to implement a sustainable model of care to improve health outcomes and experience of healthcare for UASC in NEL, and develop a national scale-up strategy. Specific objectives are to:*Implement the integrated pathway model across NEL*Assess feasibility and acceptability*Evaluate impact on health outcomes*Explore cost-effectiveness*Triangulate data to provide implementation strategy for scaleup

Methods We are seeking grant funding from the Barts charity to support this project. We will work with UASC and teams across NEL to implement the integrated pathway model. Taking a traumainformed-care approach the pathway involving longer assessments, multidisciplinary support and follow-up (CAMHS clinician and a Health improvement Practitioner), universal infectious diseases screening and workshops for UASC care. Quarterly patient and public involvement and stakeholder meetings will inform implementation and explore experience of care. Results A mixed-methods approach will be taken to assess feasibility and acceptability. Quantitative metrics to assess feasibility include recruitment of staff, success of implementing the components of the pathway and percentage of UASC attendance at clinic appointments and professionals at MDT sessions. Qualitative acceptability, feasibility and experience of care data will be gathered from UASC (n~10), care providers (n~30) and caregivers (n~10). Health outcomes and needs will be gathered from routine health records and compared before (n~180) and after implementation (n~250) (e.g. immunisation rates). Quality of life data prospectively gathered from UASC combined with National Cost Collection will inform health economics modelling.

Conclusion If successful, this project will improve the quality of care for ~250 UASC and ~200 care providers. We will deliver evidence and strategy for implementation at scale, including cost-effectiveness and detailed description of health needs for ~430 UASC.