Presentation on theme: "GOOD INTENTIONS, DEVILS AND DETAILS"— Presentation transcript:
1 GOOD INTENTIONS, DEVILS AND DETAILS Health Standards for children and youngpeople under guardianship of the MinisterLisa Henderson, Families SADr Diana Lawrence, Flinders Medical CentreSue Foster, Children, Youth and Women's Health ServiceLISA
2 GOOD INTENTIONSOur Best Investment: A State Plan to protect and advance the interests of children, Robyn Layton QC, Child Protection Review, 2003Keeping Them Safe: The SA Government’s Child Protection Reform Program, 2005Rapid Response: Whole of government services for Children and young people under guardianship of the Minister, 2005Health Standards for Children and Young People under Guardianship, 2007Quarterly monitoring by ‘Across Government Guardianship (Rapid Response) Steering Committee’LISA
3 SOUTHERN ADELAIDE EXPERIENCE Response to demand for health assessments of children in OOHC in Southern Adelaide regionGood relationships between CPS, Families SA and Paediatricians; service commenced 2003Regional demands: Mt Gambier, Riverland, Iron TriangleDI
4 IMPLEMENTATION Standards for assessment Principles:Substantially different from traditional medical model of paediatric consultation.Comprehensive assessments of health and well-being.Joint medical and psycho-social.Physical examination small component of overall assessment.Comprehensive history required from current carerDI
5 Management plan Children often require referral for: more comprehensive developmental/psychometric assessmentaudiology, speech and language assessmentChild Assessment TeamENT reviewother specialists as indicated.Joint report with psychosocial staff, with clear summary and recommendations.Entry into care does not necessarily result in resolution of health problems.DIThese children have ongoing unmet health needsPoor immunisation/catch up ratesInadequate oral healthDevelopmental disabilities remain prevalent (up to 60%)Ongoing chronic medical issues (45-76%)
6 Aim of assessment To formulate a comprehensive health plan health = physical, mental, social well-being AND absence of diseaserequires information from a number of sourcesrecognises complex, multidimensional factors contributing to the child’s current health status and presentationRecommendations made regarding:health needsdevelopmental and educational needsmental health / behavioural needsfollow up arrangementsclearly - a multidisciplinary approach and effective interagency communication is required.DI
7 DEVILS AND DETAILS Barriers to effective health care provision Multiple moves with no provision for permanent or accessible health recordsLack of specific health policies and utilisation of health services in ad hoc fashionEg. allied health, counselling servicesResource shortages in both health and child support servicesDiscourages routine screens and supportPromotes crisis managementLack of permanency in placement in OOHCExacerbates problemsDI
8 Barriers to effective health care provision Absence of informationPoor information about birth families, birth history, early health issues and developmental progress, learning profile.Difficult to interpret current health, learning and behavioural presentation without this information.Limited communication between agenciesEg. health, education, Families SA, CAMHS, parents.Medical information and recommendations need to be transferred to all involved in the care of children in OOHC.Change of placement (or caseworker)Change of GP, school contributes to poor communication and transferring of information.Ambiguity in who is coordinating health needs of the child?carer, ?caseworker, ?medical provider.DI
9 Alternative Care Trends Families SAChildren in Alternative Care PlacementSUEThe increase overall in the number of children in alternative care placement at the end of the financial year is 69% over the past six years.Since 2003/04, the increase has been in the vicinity of 10% to 11% per annum. The trend this financial year is for 9% increase.For Aboriginal children, there has been a 120% increase in the number of children in placement at the end of the financial yearFor Non-Aboriginal children, a 56% increaseFinalised Care and Protection Order Commencements July 1, 2010 to September 30, 2010 were 175 (GoM 12, GoM 18, Unaccompanied Refugee Minors At 30th September, 2010 Aboriginal children comprised 25% of all children on Care and Protection Orders.Compares with 24% in slightly higher growth rate in Aboriginal children on orders.
10 Age Profile of Children in Care Adolescents at RiskFamilies SAChildren in Alternative Care by age groupsSUESince 2005/06, there has been a 52% increase in the number of children on care and protection orders.A 53.5% increase in the number of children aged under 2 years.A 72% increase in the number of children aged 2 to 4 years.A 66% increase in the number of children aged 5 to 9 yearsA 31% increase in the number of children aged 10 to 14 years.A 53% increase in the number of children aged years.A 117% increase in the 2-4 year age group79% increase in 5 – 9 age group41% increase, both in years andA 60% increase in the number of young people aged years.In part, the increase in the number of children in care at a point of time is a result of children entering alternative care at a younger age, and remaining in care for a longer period of time.
11 MORE DEVILS!Referral pathways reliant on operational consistency, both Families SA and Health.Culturally appropriate responses to escalating percentage of Aboriginal children in OOHC.Focus on early childhood has reduced knowledge and skills and service access for young people in OOHC.Recognition of the service demand for transition from careIT systems – ‘speaking in tongues’.(eCHIMS; OASIS; HOMER; CHIS; CHIRON; RREN; C3MS, etc).Inconsistent implementation across state, and maintenance of knowledge with high staff turn over in both sectors.Access for children in rural and remote areas.Pressure of demand: number and age of children in OOHC – complexity, long term interventions, multidisciplinary interventions, therapy.SUE
12 CHALLENGESHow to drive a public health approach to intervention with these children?Health and well being is central to all other life domains.Burden of disease becomes exponential.Health has a major role and opportunity to break the cycle of trauma and abuse for these children.How can the Health and Child Protection sectors work in congruence to meet our statutory and ethical obligations to these children?SUE
13 HEALTH, HOPE AND RESILIENCE “Every system that touches the lives of children offers an opportunity to strengthen the foundations and capacities that make life long healthy development possible.”National Scientific Council on the Developing Child National Forum on Early Childhood Policy and Programs; Harvard University, July 2010Innovation and opportunityBuild carer and community capacity to strengthen the health of children and young peopleConcentric circles not silosHealth, healing and well beingSA’s Health Standards can be obtained from the DepartmentOf Health website:or from the Department for Families and Communitieswebsite:Thank youLISAEvery system that touches the lives of children offer an opportunity to strengthen the foundations and capacities that make life long healthy development possible.National scientific council on the developing child national forum on early Childhood policy and programs; Harvard university July 2010.