The “best interests” of the child in health systems for children in OOHC - a Paediatric perspective Dr Maree Crawford Senior Staff Specialist Child Advocacy Service Royal Children’s Hospital, Brisbane

UN Convention on the Rights of the Child In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. (Article 3)

UN Convention on the Rights of the Child States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts.

What are principles of “best interest”? High quality - not just “good enough”

WHO definition of Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

What are principles of “best interest”? High quality - not just “good enough” Broad ranging physical, mental, social Involves all carers and professionals – across all disciplines Needs a focus on prevention, health promotion, development of resilience Targeted at disadvantaged groups, particularly indigenous children

Health Assessments in OOHC Clear evidence for need and benefit Quality most important Time to perform (hence reimbursement) Education of health providers re trauma impact and disordered attachment Use of standardised screening tools

Copyright ©2010 American Academy of Pediatrics Jee, S. H. et al. Pediatrics 2010;125: FIGURE 1 Percentage of children who were NFC and identified with possible DDs compared by clinical assessment in the baseline period versus the ASQ in the screening period

Health Assessments in OOHC Clear evidence for need Quality most important Time to perform (hence reimbursement) Education of health providers re trauma impact and disordered attachment Use of standardised screening tools Access to multi-disciplinary team

Accessibility of therapeutic services Deficits in high needs areas developmental services, mental health, educational supports, dental services Specific funding Need for a co-ordinator of health services Support and assistance for carers

Child or Young Person’s involvement Important that child’s views heard Consent Ownership of health issues Hand held record Particularly at transition out of care Education – health promotion Recognise desire for “normality”

Family and Cultural Linkage Majority of children in OOHC return to family Need for transfer of health information Need for involvement in management of identified problems Recovery slow – need long-term support Preventative health education for parents Indigenous cultural and health needs

Research and Evaluation Complex systems Need baseline data Ongoing evaluation to determine best practice

In summary “Best interests of child” in health for OOHC requires: Quality health assessment Co-ordinated care Fast-track access for therapeutic services Funding Emphasis on health promotion, development of resilience Child involved Family and cultural linkage Ongoing collection of evidence and evaluation of interventions