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Description and evaluation of a pathway for unaccompanied asylum-seeking children
Alice Jane Armitage1,2, Jonathan Cohen3, Michelle Heys4
1Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK alicejanearmitage@nhs.net.
Insights
This study describes a new integrated health pathway for unaccompanied asylum-seeking children (UASC), finding high rates of abuse and unmet needs. The pathway successfully provided joined-up care, addressing significant health challenges in this vulnerable population.
Area of Science:
- Public Health
- Paediatrics
- Global Health
Background:
- Unaccompanied asylum-seeking children (UASC) face complex health challenges, including trauma and infectious diseases.
- Existing healthcare services may not adequately address the multifaceted needs of UASC.
- There is a need for integrated, multidisciplinary approaches to optimize care for UASC.
Purpose of the Study:
- To describe a novel integrated healthcare pathway designed for UASC.
- To evaluate the effectiveness and outcomes of this integrated pathway for a cohort of UASC.
Main Methods:
- A retrospective evaluation of an integrated pathway involving community paediatrics, infectious diseases (IDs), and sexual health (SH) services.
- Data collected from three NHS trusts in London for UASC engaged between January 2016 and March 2019.
- Utilized a multidisciplinary team including child and adolescent mental health services (CAMHS) and health improvement practitioners.
Main Results:
- 101 UASC were included; 67% reported physical abuse, 13% sexual abuse. Mental health symptoms affected 77%.
- Infectious diseases requiring treatment were found in 41%, including latent tuberculosis (25%) and schistosomiasis (13%).
- High need for interpreters (97%) and significant initial non-attendance rates (40-49%) highlight engagement barriers.
Conclusions:
- UASC experience high rates of abuse and significant unmet physical, mental, and emotional health needs.
- The implemented integrated pathway effectively delivered appropriate, coordinated care for UASC.
- This integrated model shows potential for improving health outcomes for this vulnerable population.
Objective:
(1) To describe a novel integrated pathway for unaccompanied asylum-seeking children (UASC).(2) To evaluate a population engaged with this service.
Design:
Description of the integrated pathway (objective 1) and retrospective evaluation, using data from community paediatrics, infectious diseases (IDs) screening and a sexual health (SH) service (objective 2).
Setting:
Unlinked data were collected from three services across three National Health Service (NHS) trusts in London.
Patients:
All Camden UASC engaged with the service from 01 January 2016 to 30 March 2019.
Interventions:
A multidisciplinary approach prioritising the health needs of UASC including a childre and adolescent mental health service (CAMHS) clinican and a health improvement practitioner. There are low thresholds for onward referral and universal asymptomatic screening of UASC for ID.
Main Outcome Measures:
Data on demographics, unmet health needs and known outcomes.
Results:
Data were available for 101 UASC, 16% female, median age 16 years (range 14-17). Physical assault/abuse was reported in 67% and 13% disclosed sexual assault/abuse, including 38% of female UASC. Mental health symptoms were documented in 77%. IDs warranting treatment were identified in 41% including latent tuberculosis (25%) and schistosomiasis (13%). Interpreters were required for 97% and initial non-attendance rates at follow-up were 40% (ID) and 49% (SH).
Conclusions:
These data demonstrate high rates of historical physical and sexual assault/abuse, unmet physical, mental and emotional health needs among UASC and significant barriers to engaging with services. An integrated pathway has been successfully implemented and shown to deliver appropriate, joined-up care for UASC, consistent with current recommendations, with the potential to improve outcomes.
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