GPV is a QIC accredited organisation General Practice Role and experience as key providers of comprehensive health assessment for children and young people entering out-of-home care Sonya Tremellen & Dr Hubert Van Doorn

Why is primary care best placed? GPs most readily accessible medically qualified professionals GPs first point of entry in Australian health system & can identify needs & refer appropriately GPs have medical skills to identify & manage breadth of health care needs across ages and stages Attending GP clinic is normal, non-stigmatising experience

Are GPs ready and willing? – Research Findings GPs not ready to undertake child health assessments without some changes in practice systems GPs positive about potential benefits, but have ethical concerns Epidemiology of child abuse and neglect not widely shared with general practice GPs would welcome further training and professional development support Links between the GP and child protection sector need improvement GPs are wary of red-tape burden & medico-legal complications Workforce and financial pressures have critical influence GPs prefer health assessment to be a first step in an ongoing therapeutic relationship Webster SM, Temple-Smith M. (in press) Children and young people in out-of-home care: are GPs ready and willing to provide comprehensive health assessments for this vulnerable group? Australian Journal of Primary Health

GP Engagement: Field testing 9 GP Advisors from across Victoria confirmed that: professional development module appropriate Commissioning letter from DHS required (along with medical history) Medical software template essential GP provides Summary Report & Recommendations $300 fee-for-service Require clarity re: consent for treatment Concern re: follow-up & continuity

Workshops held September 2008 & March 2009

The pilot – process findings General Practice successfully recruited 2 month turn-around is achievable Medical histories arrived Children & young people knew what they were there for GP assessment time: 45 + minutes (average) Practice Nurse assessment time: 30 minutes (average) GP Report time: 30 minutes + (average) GPs satisfied with remuneration The number of referrals to GPs made by Child Protection much lower than expected (27 over 14 months) Of the 13 GPs trained, 6 received a referral

Health assessments n=24 6 (25%) children under-immunised 3 (12%) required treatment for acute illness Important health issues identified 20 (83%) required referral (15 different service types) Paediatrician Dentist Renal Unit at Royal Children’s Hospital Orthopaedic and Plastics Unit at Royal Children’s Hospital Back X ray Wellbeing Coordinator at school Hepatitis C Screening test Optometry Audiology Psychologist Family Planning/sexual health Podiatry Educational support required for literacy and numeracy Hepatitis B immunisation Speech therapist

Who does what? PN and GP roles Nurses: set up appointments & entered medical history into General Practice medical record Checked immunisation, height, weight & some did more GPs: Established rapport Comprehensive physical & behavioural examination Practices work it out Team work

Focus Group discussion Recognised complexity of client group and time required for thorough assessment Highly valued the opportunity to participate given evident benefits to children & young people Demonstrated the role of the practice nurse and value of teamwork in the practice Identified effective ways to manage the consultation Organisational issues Concerns re: Follow-up

Addressing enduring concerns Initiate and sustain GP engagement – work through GP organisations Strengthen the link between health and child protection sectors Support clinical governance and continuity of care

GPV is a QIC accredited organisation Questions Final report available from: Contacts: Sonya Tremellen