Why Doctors and Child Protection Workers Infuriate Each Other – The War on the Telephone Dr Clare Roczniok Secure Welfare Services and Ms Raeleen McKenzie Take 2 Berry Street.
.. A reflection on the interactions of Health and Child protection sectors
Doctors often assume adults accompanying children to a consultation are familiar with the child’s history….sadly they are often wrong.
Don’t assume the people accompanying the child are familiar with them or their story Is this really a consult or a request or a demand? Are the right people talking to each other ? respectfully. Don’t just blame it on the resi worker!....
Better information might make the consult go better!
oo Fragmentation of care means multiple care givers. Sometimes the task is overwhelming
Complex situations which require sophisticated conversations and responses may be abbreviated to a nonsense.
Doctors are not able to trust medical histories taken or recorded by non medically trained people.
For a medical history to be of any use someone has to: ◦ have time to read it ◦ familiarise themselves with it and put it into the present context. ◦ have time and the necessary authority to act on it.
Child in foster care referred by Case Manager because of behaviour problems, sleep problems School confirms child is difficult to manage, doesn’t concentrate, can’t sit still, is demanding, aggressive with peers and adults History of this with previous carers, at previous schools Where would you go from here?
Emotional abuse and neglect, sexual abuse, and physical abuse Witnessing domestic violence Ethnic cleansing or war ◦ Results in disrupted development of secure attachment within the primary care-giving system ◦ Loss of core capacities for self-regulation and interpersonal relatedness ◦ Can lead to life long problems
Many children who experience inadequate care-giving meet criteria for multiple diagnoses Where no diagnostic options to capture the reality of the presentation leads to - no diagnosis, unrelated diagnoses, emphasis on behavioural control without recognition of the interpersonal trauma and developmental disruption experienced
Ackerman, Newton, McPherson, Jones, Dykman (1998) abused children primary diagnoses ◦ 58% separation anxiety/overanxious disorders ◦ 36% phobic disorders ◦ 35% PTSD ◦ 22% ODD
What is the evidence that it works? In whose interest is it prescribed? Can it be managed effectively? How will it interact with other substances? Effect on developing brain? Where capacity to understand and integrate experience is impaired will it further isolate and/or exacerbate? What is the message to the child if medicated when the system around them at fault
Streamlined information Conversations with the right people at the time of the consultation Less fragmentation, less delegation,more child protection workers and case managers, who have more time and are more accessible. If the right people can’t be there written questions and written answers More investment by government in providing appropriately resourced personnel Facilitation of better understanding and relationships between health and welfare sectors. More time for consultations kids in out of home care
Forums that bring together the knowledge of child welfare professionals, psychology, psychiatry and general practice Opportunities to develop relationships, acknowledge the contributions of all and build respect Recognition of the complexity of protecting children and ensure their optimal development – Care is not enough
Can We Get Along?? Yes We Can !!! ~ Raeleen, Clare and Obama