1. Melissa Kaltner Senior Research Officer Child Advocacy Service Royal Children’s Hospital, Brisbane Health of Australian Children in Out of Home Care: Needs and Carer Recognition

2. Study Background Child Advocacy Service: Our role Initial study into health needs of children in out- of-home care Presentation Overview: –Brief literature review –Methodology of study –Results –Implications –Further research

3. Health Needs of Australian Children in Care Children in out-of-home care documented to have high health needs –International Studies: 92% at least one health issue (Chernoff et al, 1994) –Australian children in care 3% had no identified health problems Higher rates of emotional and behavioural problems, vision problems, hearing loss, speech difficulty and poor immunisation rates as compared to general child population (Nathanson & Tzioumi, 2007)

4. Carer Recognition of Health Needs Carers well placed to identify health need –In areas with no mandatory health screen responsibility with carer to identify need –Studies suggest carers desire: More health-related training Improved communication Improved access to medical records (Mayers Pasztor et al., 2006) –Carers’ abilities in recognition of health need unclear

5. Current Study Examine health need in Qld children in out-of- home care –Contrast with NSW findings from Nathanson & Tzioumi (2007) Examine foster carer’s perception of health need in contrast to need established via paediatric health assessment Methodology: –Study reviewing Child Health Passports completed by Child Advocacy Service 2006 – 2007 (n = 63)

6. Results- Health Need Perception Over half (55%) of carers listed either no health concern or one concern only for the child at presentation Concern Type% Behaviour25 Speech and language16 Developmental14 Dental11 Hearing8 Specific ADHD6 Respiratory6 Immunisation5 Learning difficulty5

7. Results- Referrals 70% of children required multiple (two or more) referrals to varying services Number of Referrals % 05 125 230 318 414 58

8. Results- Referrals * Nathanson & Tzioumi, 2007 Child Health Referrals QLD (%)NSW*(%) Paediatrician follow-up (41%)Dental (71%) Counselling (30%)Speech therapy (34%) Audiology (26%)Counselling (29%) Dental (21%)Developmental asses. (26%) Speech pathology (21%)General paediatrician (25%)

9. Results- Immunisation Disadvantage in preventative health care utilisation –68% of children fully immunised Similar rate to the 61% reported in NSW (Nathanson & Tzioumi, 2007) –General Queensland child population: 87 percent of children fully immunised at their 5th birthday (ACIR, 2008)

10. Implications High level of health need and poor preventative health utilisation Ability of carer to meet high numbers of referrals, given child load per carer –1.9:1 children to approved carer ratio –30% carers with 3+ children  centralised health service delivery

11. Implications Carer recognition of health issues –need for health education for carers and child protection staff Necessity of comprehensive, multidisciplinary health screens for all children in care –Follow-up necessary to ensure referrals met

12. Long-term Outcomes for Health Screening Relative odds ratios of healthcare service utilisation for Illinois children in care vs. children receiving Medicaid (Jaudes et al., 2010) Nb. Odds ratios controlled for gender, ethnicity, age and region of state *All significant at p <.0001.

13. Acknowledgments Royal Children’s Hospital Foundation Brisbane Co-author: Karin Rissel, CN & CPLO, CAS Contact: Melissa_Kaltner@health.qld.gov.au