Assessing the health needs of children in out-of-home care in Victoria Argiri Alisandratos, Assistant Director, Placement & Family Services

2 Children in out-of-home care in Victoria Of the first time entrants approximately 40 per cent entered foster care, 50 per cent kinship care and 10 per cent residential care.

3 Challenges for health assessment processes If placement accompanies protective investigations the gathering of information on children’s health needs is likely to be lower priority than protection from harm, if there are no immediate health issues. Short term, multiple or unstable placements bring uncertainty to planning. Uncertainty about how long a child will remain in placement means that referral for assessment may be deferred. Changes of worker during placement because of the system’s requirements as well as the movement of workers means that information processes instigated by one worker are interrupted and information may get lost. Concerns about privacy and confidentiality with regard to the transfer of information leads to complex referral systems with the risk of repeated story telling by carers and children. Adapted from: Clare, B. & Clare, M. (2000) Meeting the health care needs of children in out of home care: guiding and ‘holding’ them through the care journey. Proceedings of Children First World Forum 2000, Sydney July 2000.

4 Legislative mandate of the Children, Youth and Families Act 2005 S 16. Responsibilities of the Secretary (1) Without limiting any other responsibility of the Secretary under this Act, the Secretary has the following responsibilities— (c) to work with community services to promote the development and adoption of common policies on risk and need assessment for vulnerable children and families; (e) to work with other government agencies and community services to ensure that children in out of home care receive appropriate educational, health and social opportunities; S 174. Secretary's duties in placing child (1) In dealing with a child under section 173, the Secretary— (a) Must have regard to the best interests of the child as the first and paramount consideration; and (b) Must make provision for the physical, intellectual, emotional and spiritual development of the child in the same way as a good parent would; and (d) Must have regard to the treatment needs of the child.

5 Looking After Children (LAC) The LAC framework considers the child's needs and outcomes in seven life areas which cover the things that parents usually also pay attention to, as well as being the critical areas identified from outcomes research, namely the child's: Health Emotional and behavioural development Education Family and social relationships Identity Social presentation Self-care skills. LAC includes a set of practice tools that comprise the primary client records kept by the community service organisation (CSO) providing the out of home care placement and are transferred with the child if they move to a placement provided by another CSO.

6 Current practice in health assessments A comprehensive review of the outcomes of LAC processes was reported in The Looking After Children Outcomes Data Project: Final Report. Prepared for: The Department of Human Services, by the Australian Institute of Family Studies (2007). The Assessment and Action records of 614 children and young people were analysed and under the heading of health: 80 per cent of children had had a recent medical review 54 per cent of children met all LAC health objectives 38 per cent of children did not meet all health objectives 56 per cent had received age-appropriate immunisations The immunisation status of nearly 25 per cent of children was not known. New LAC Assessment and Progress records have recently been introduced which will allow better assessment and monitoring of outcomes along the LAC domains.

7 Specialist programs: Therapeutic Foster Care (Circle) Therapeutic Foster Care (Circle) program provides trauma and attachment informed therapeutic care for up to 97 children at a time. Carers are specially trained and have the ongoing support of a Therapeutic Specialist. All children entering this program have a comprehensive assessment that includes General health history taken from family and child. Comprehensive emotional behavioural and mental health assessment by Therapeutic Specialist. Health assessments. o Medical assessment by a GP o Paediatric assessment organised (via GP referral) for all children under 5 years and for other children as discussed with the GP. o Dental assessment. Other specialist assessments are sought as required. Assessment is completed within 12 weeks of the placement commencing.

8 Specialist programs (cont’d) Therapeutic Residential Care Models of therapeutic residential care are being piloted throughout the State providing trauma and attachment informed therapeutic care for up to 50 children and young people. Each of 11 pilot sites has the support of a Therapeutic Specialist whose role includes completion of a comprehensive emotional / behavioural and health assessment similar to that completed for the children in the Circle program. As the young people in residential care are predominantly over 12 years of age a paediatric assessment may not be included.

9 Secure welfare health service Victoria’s secure welfare service (SWS) provides two secure 10-bed, gender specific residential units, staffed on a rostered 24 hour ‘stand up’ model for children or young people who present a substantial and immediate risk of harm to themselves or from others and existing community services cannot manage the risk. Children and young people may be placed in SWS for a period not exceeding 21 days. In exceptional circumstances, the period in SWS may be for one further period not exceeding 21 days. Currently the health needs of children and young people in SWS are addressed by one full time therapeutic specialist and a GP and a drug and alcohol service on a sessional basis. Planning is underway to identify a suitable provider to establish, co-ordinate and operate a multidisciplinary Health Service from 1 July The multidisciplinary service will provide GP and nursing services for all children and young people placed in the SWS, mental health and alcohol and drug specialty support services where these are required and dedicated administrative support for the Health Service overall.

10 Priority initiatives In Victoria access to public dental care for children is a priority, and there are no waiting lists. Treatment is free for children in out of home care and all children in out of home care should be seen within a month of entry to care. If problems are encountered the matter should be referred to the Manager, Dental Health in the Department of Health. Since 2007, Early Childhood Intervention Services (ECIS) have given priority to eligible children who are referred to ECIS by Child Protection within three months of entry to care. As part of the Community health service (CHS) improvement strategy a priority protocol recognises all clients of child protection and family services as having high priority access to assessment for any service (e.g. OT, physio, speech therapy, counselling) provided by a CHS. The Victorian Immunisation Strategy recognises children in out of home care as high risk and will review and promote improved immunisation services for this group.

11 Priority initiatives (contd.) It is intended that in the near future Victorian area mental health services will implement a policy to give priority to accepting streamed referrals from child protection of children and young people in out of home care and will adapt their service protocols and practices to ensure that this occurs. One of the initiatives of the joint work now in place for improved collaboration between Disability Services and Children, Youth and Families divisions is to establish priority of access for children and young people with a disability living in out of home care to: o Secondary consultation and information sharing from both Children Youth and Families and DS o Allocation of disability case management where appropriate o Disability Services Behaviour Intervention Support (BIS) and specialist services.

12 Interim health assessment and treatment model Initial Health Assessment funding will be made available to regions to assist children to access specialist and allied health services that may not be available in a timely way from public health services. In lieu of the electronic databases enhancements, systems will be put in place to monitor children’s access to GP and dental assessments and follow up treatments. The new Assessment and Progress records will allow better assessment and monitoring of outcomes along the LAC domains. Work is planned to improve electronic recording and transfer of information between the LAC tools and between child protection practitioners and placement workers community service organisation. A project to enhance care team practice will also recommence shortly. Children, Youth and Families will work with the state health department to develop a holistic model of health assessments that is consistent with the National Clinical Framework for assessment of children and young people in out of home care.