Implementation Of An Integrated Pathway For Unaccompanied Asylum-Seeking Children In Newham: Service-Users, Carers And Healthcare Providers' Views (Salvo, Alladi, 2023)

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

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

Available online at this link 

Objectives Unaccompanied asylum-seeking children (UASC) are a vulnerable population; existing services are inconsistent and often fail to meet their complex needs(1). An 'integrated pathway' for UASC, developed in Camden, provides intensive and joined-up support for this group(2). With Barts Charity funding, a similar model was implemented in a second borough (2020-2021). Features include CAMHS clinicians joining paediatricians in initial health assessments (IHAs) and a new feature of multi-disciplinary meetings involving social workers and carers 6-8 weeks after IHA. Here we present mixed-methods results exploring service-users, carers and healthcare providers' attitudes towards, and experiences of, the integrated pathway model. 

Methods Feedback forms were used to directly gather feedback from UASC engaging with the integrated pathway model. A survey using statements with likert scales, multiple choice questions and open questions was used to explore paediatricians' views before and after undertaking an IHA jointly with a CAMHS clinician. Semi-structured interviews were carried out with social workers and carers for UASC, focussing on the CAMHS MDT (4-6 weeks after IHA) which the carers and social workers attended. 

Results UASC feedback forms (n=10) indicate that they felt the staff were friendly and listened to them; there was overall satisfaction with the pathway. Results from paediatricians (n=5) show before joint-IHA, 40% expressed poor confidence in their existing skills/ability to assess/respond to the emotional, social and behavioural needs of UASC. After joint-IHA, 100% reported learning new skills regarding the needs of UASC and were satisfied with the role of CAMHS. Free-text answers suggest paediatricians would appreciate further training on assessing emotional well-being, communication techniques, and techniques to help promote resilience. CAMHS presence was felt to be helpful and helped formation of action plans. Social workers (n=2) felt that MDTs were helpful for gaining insight into caring for UASC, and that the mental health focus was necessary. Re-discussion of UASC needs a few weeks after IHA was felt to be helpful as at IHA 'the trauma they had been through was still very fresh'. UASC carers (n=2) described improved insight into their hobbies and interests, and that it helped to highlight anything the carers needed to do to support UASC. 

Conclusion The integrated pathway has been successfully implemented in a second borough and is acceptable to service-users and professionals. Results indicate positive experiences among service-users and carers with reciprocal learning demonstrated among health-professionals looking after UASC, but need to be replicated in a larger sample size.