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Healthcare Standards for Children and Young People in Secure Settings

The Royal College of Paediatrics and Child Health (RCPCH), the Royal College of General Practitioners (RCGP), the Royal College of Nursing (RCN), the Royal College of Psychiatrists (RCPsych), the Faculty of Public Health (FPH) and the Faculty of Forensic and Legal Medicine (FFLM) have worked together to develop these standards which we believe will facilitate the provision of equitable and high quality health services for young people in secure settings across the UK.

Over 2200 young people are held in secure settings in the UK at any one time and over the course of a year an estimated 9900 young people will spend time there (based on figures from 2011/12). These young people have significantly greater, and often previously unidentified and unmet, physical, mental and emotional health needs than other young people their age.

1. Safeguarding and risk of harm
Everyone working with or in a secure setting has a responsibility to safeguard and promote the welfare of the young people sent there. Healthcare professionals have a duty to ensure that any risks of harm are identified and to provide care and support to young people, particularly at difficult times, for example, on entry or after a restraint. Officers and care staff must be supported by healthcare professionals to ensure that they are able to recognise warning signs and take appropriate action.

2. Window of opportunity
Young people in secure settings have significantly greater physical, mental and emotional health needs than their peers in the non-secure community. Any time spent in a secure setting is an opportunity to reach out to this vulnerable population and a chance to improve their health outcomes. An early and accurate assessment of health needs must be followed by prompt care and intervention and services must, at least, be equivalent to those available in the community.

3. Continuity of care
Young people are often only in a secure setting for a short period of time. There must be an emphasis on preparing for their return to the community and ensuring that they will receive the right care and support there. Planning for release must begin at entry and be taken into account in healthcare plans and referrals. All interactions with healthcare professionals are an opportunity to develop confidence and trust and build a strong foundation for self-care and effective use of health services in the future.

4. The voice of the young person
Young people must be involved in decisions about their healthcare. Their views need to be listened to and incorporated into their healthcare plan for it to work. Every young person must be treated as an individual, with respect, in a professional and caring manner. The standards should be applied using a developmentally sensitive approach; the needs of a 12 year old girl on a welfare placement will be significantly different from the needs of a 16 year old boy presenting a high risk to others.

5. Working together
Services must work collaboratively, in the best interests of the young person. Information must be shared to ensure that the team around the young person has the information they need to meet the young person’s health and wellbeing needs. A named lead healthcare professional takes responsibility for each young person’s healthcare but all staff need a shared understanding of the key factors affecting young people’s health and wellbeing.

6. Health promoting environment
Healthcare professionals, alongside everyone working in a secure setting, have a responsibility to ensure that the secure setting actively promotes the physical, mental and emotional health and wellbeing of the young people there. This includes supporting young people to make positive choices about their health and lifestyle and ensuring that they have access to healthy food, a gym and fresh air. Every secure setting must be a young person centred, therapeutic and health promoting environment.