Being a young carer can significantly affect a pupil’s education and mental health with little time to do homework, coursework or socialise with friends. In Leeds routine screening of pupils has begun to identify those who have caring responsibilities and to support them a dedicated pathway has been established to improve links between school nurses and other services. This case study showcases the important role of school nurses in the education system.
Why it’s important to keep asking
It has become routine for school nurses and health visitors to ask questions about domestic violence in their contact with children and families. But in Leeds this approach has been extended to help identify and support young carers.
Since March 2022 the 0-19 Public Health Integrated Nursing Service (0-19 PHINS) – run by Leeds Community Healthcare NHS Trust – has been routinely asking questions and engaging pupils in conversation to see if they have caring responsibilities at every contact. Where caring responsibilities are identified the nurses carry out a full health needs assessment.
To aid practitioners within the service, two hours of training have been provided to staff. The key question that triggers further investigation if answered yes is: “Some people your age provide help or support to people who are physically or mentally ill, disabled or misusing drugs or alcohol. This could be a parent, brother, sister, another relative or someone else. Is there anyone who you have to look after on an ongoing basis? This could include people who you live with and people who you do not.”
Amanda Jackson, one of the Clinical Team Managers for 0-19 PHINS, said: “We have always asked about caring responsibilities, but what is different about this approach is that it is done at each and every contact and there is a now a systematic approach to it.
“The issue for young carers is that not everyone recognises they have caring responsibilities or have only recently developed caring responsibilities so by asking about it we are raising awareness and helping people recognise when they have caring responsibilities.
“Caring responsibilities change over time – parents may have suffered a sudden illness or injury for example. That has been particularly the case during the pandemic so that is why it is important to keep asking.”
We can help find solutions
Mrs Jackson said the new way of working was already having an impact. “We are identifying more carers, but quite often they don’t know what support is available to help them or are just trying to manage on their own.
“For example, in one recent case study discussed in the training, a child was arriving half-an-hour late to school every day because they needed to help their mum with medication she needed to take at 9am.
“The school were happy to accommodate it, but that child was missing two-and-a-half hours of school every week. That would have soon started to have an impact.
“The multi-disciplinary team around the child were able to talk to the pharmacy about getting the mother a dosette box, which indicates when each medication needs to be taken. It meant she could take more responsibility for taking the medication and the child could get to school on time.
“Sometimes there are relatively simple solutions to help young carers, but even when it is more complex, and our 0-19 Specialist Public Health Nurses are well connected to find a way forward.”
As part of an initiative 0-19 PHINS has developed a pathway with local organisations that can provide support. The key service is Family Action Leeds, which is commissioned by the council to provide support to young carers. It has a support group for young carers and can arrange extra support so young carers can have more freedom if they want it.
There is also an app that has been developed and is used regionally for young carers.
“We find most young carers want to continue providing care, but sometimes it is about just unlocking a little time for the young person – maybe allowing them to do an after-school club or activity,” added Mrs Jackson.
Part of a wider push to better support families
It is not just school nurses who are working to identify hidden and new young carers though. Health visitors also ask the parents they come into contact with whether anyone in the family has caring responsibilities.
It is part of a wider push to better identify and support those families that need help. As well as the young carers pathway, there is also one for the youth justice system to identify those at risk of becoming involved in criminality.
Again, there are a range of organisations school nurses can involve, including the youth offending team and Getaway Girls, a local charity that works to empower girls
Each pupil identified as in need is given a named school nurse to work with although for the most complex cases there are what are known as differing fields practitioners. These are specialist community public health nurses who have been trained as both health visitors and school nurses to provide a holistic range of support across the age range. The service has a number of these in place and are committed to continuing the opportunity for more nurses to complete the differing fields module.
Mrs Jackson added: “The 0-19 service is ideally placed for this work. Our staff are trusted and are linked in with services. It is helping us better support young people and families.”