Description and evaluation of a pathway for unaccompanied asylum-seeking children

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.