We Had a Gap! Primary Health Screens for 5-11 year old Children Entering Out of Home Care (OOHC). Rebecca Hart, OOHC Coordinator, Western Sydney & Nepean Blue Mountains LHDs Lisa McCue, OOHC Coordinator, South Western Sydney & Sydney LHDs

Content of presentation Background to the development of the Model pathway for Health Assessment for children and young people in OOHC Model pathway for health assessments Gap in our systems

OOHC Health Assessment Model Pathway Background

OOHC Health Assessment Model Pathway Background - Wood Recommendations from Wood regarding health assessments for children in OOHC include: Within 30 days of entering OOHC, all children and young persons should receive a comprehensive multidisciplinary health and developmental assessment. For children under the age of 5 years at the time of entering OOHC, that assessment should be repeated at 6 monthly intervals. For older children and young persons, assessment should be undertaken annually. A mechanism for monitoring, evaluation and reviewing access and achievement of outcomes should be delivered by NSW Health and Community Services.

OOHC Health Assessment Model Pathway Background - Wood NSW Health should appoint an OOHC Coordinator in each Area Health Service and at the Children’s Hospital at Westmead.

OOHC Health Assessment Model Pathway Background – other supporting documents Community Services & Health - MOU for Children in OOHC (NSW) (2006) now (2011) Royal Australian and New Zealand College of Psychiatrists (Faculty of Child and Adolescent Psychiatry) (2008) Development of Draft National Standards for Children in Out of Home Care (FaHCSIA – 2010) NSW Standards for Statutory Out of Home Care (updated 2010)

OOHC Health Assessment Model Pathway Background – local research  24% of children had incomplete immunisations.  20% failed a vision screening test  26% failed a hearing test  60% required referral for formal developmental assessment. Nathanson, D & Tzioumi, J (2007) (CPU Sydney Children’s Hospital)  45% of children aged under 5 yrs had speech delays.  20% of other children had delayed language skills.  14% of children abnormal growth  54% of children had behavioural and emotional health problems

OOHC Health Assessment Model Pathway Background – local research Aboriginal & Torres Strait Islander Children  53% with overdue immunisations  43% hearing problems  44% visual problems  61% speech delays  34% fine motor problems  66% educational problems  30% global developmental delays Reynolds, S (July 2008) “Kari Clinic”, KARI Aboriginal Resources Inc SNAICC News

OOHC Health Assessment Model Pathway Background – local research Psychosocial issues: High rates of aggressive and oppositional behaviours, emotional dysregulation and relationship difficulties and high levels of carer stress (Chambers, Saunders, New, Williams & Starchuska, 2010) Complex psychosocial issues such as attachment difficulties, relationship insecurity, sexualised behaviour, trauma-related anxiety, conduct problems and defiance, and inattention/hyperactivity, as well as self-injury and food maintenance behaviours (Tarren-Sweeney, 2008)

OOHC Health Assessment Model Pathway Eligibility for the pathway: children and young people entering statutory OOHC who are likely to remain in care for longer than 90 days. Commenced 1 st July 2010 with staged implemention across the state. CS - Interagency Pathways Coordinators Health OOHC Coordinators

Prior to entry into Care Step 1 Initiating a Health Assessment and gathering information Step 2a Primary Health Screening/ Consultation (within 30 days) Step 2b Comprehensive Assessment (Within 90 days) Step 3 Development of a Health Management Plan Step 4 Targeted Service Intervention Step 5 Periodic Review and Assessment OOHC Health Assessment Pathway – NSW model

South West Sydney & Western Sydney LHDs – primary health screens Both LHDs developed a model for a comprehensive primary health screen to provide a holistic picture of the child’s health at that time and allow the pathway to respond to the individual needs of the child or young person Children under 5 years - Child and Family Health Nursing Children and Young People 12 years and over – Youth Health Services

Primary health screens Physical examination, growth and development, vision/eye check, Hearing/ear check, Social and emotional screen Immunisation status Dental Nutrition Youth health also look at youth specific issues e.g., D&A, sexual health

South Western Sydney and Sydney Local Health Districts OOHC Referrals

WSLHD and NBMLHD OOHC Referrals

5-11 year olds No primary health screening services for this age group in public health services We wanted to provide an equivalent comprehensive screen to this age group We developed screening tools to address this gap The primary health screens are done by Nurses with child and family health or paediatric experience

Addressing the gap Similar approaches to developing the tools Working group with multiple disciplines including Child & Family Health Nursing, Paediatricians, Community Health Counselling, Child Protection Counselling Services, Redbank Alternate Care Clinic, Speech Pathology, Occupational Therapy and Physiotherapy. Department of Education OOHC Coordinators

5-11 year OOHC Primary Health Screen Tool Physical: based on the: – Aboriginal and Torres Strait Islander Child Health Check –the 4 year old Healthy Kids Check

5-11 year OOHC Primary Health Screen Tool Physical Known medical historySkin Family medical historyToileting habits MedicationsEating & nutrition habits AllergiesPhysical activity ImmunisationSleep Weight/height/BMIEnergy levels Oral healthCarer/child concerns VisionD&A hearingSexual health GP & Paediatrician details

5-11 year OOHC Primary Health Screen Tool Developmental –Questions developed by clinicians in the working group (Speech Pathologists, Occupational Therapists, Physiotherapists and Paediatrician’s) –Screening tool only

5-11 year OOHC Primary Health Screen Tool Developmental Articulation Receptive & Expressive language Stuttering Voice Gross motor Fine motor Self-help skills Sensory processing Learning abilities School performance

5-11 year OOHC Primary Health Screen Tool Psychosocial: –Questions developed by Psychosocial clinicians in the working group as well as from work completed by Redbank Alternate Care clinic (themes arising from assessment completed in a pilot clinic that align with Tarren-Sweeney’s work on the Assessment Checklist for Children) –Screening tool only

5-11 year OOHC Primary Health Screen Tool Psychosocial Settled in placementOther: anxious behaviours, aggressive and oppositional behaviours, somatic complaints, disordered thoughts, emotional regulation, pseudo-mature traits, difficulties with relationships, sexualised behaviours, attention/concentration difficulties, how child expresses feelings, child’s perception of self. Strengths & positive behaviours Present concerns & impact Strategies for managing concerns Contact with family of origin Risk of harm (self & others) School

5-11 year OOHC Primary Health Screen Tool Health screens are attended either in local Community Health /Early Childhood Centres or home visits Child is present and participates in the appointment, however, sensitive issues may be discussed with Carer and/or Caseworker at another time

5-11 year OOHC Primary Health Screen Tool Challenges: Tool is yet to be validated Capacity Non-recurrent funding at present Walking the fine line between a ‘normal’ trauma reaction early in the care journey and pathology

5-11 year OOHC Primary Health Screen Tool Strengths: Comprehensive, holistic screen, including liaison with other agencies as needed Individualises the pathway for children and reduces probability of unnecessary appointments/assessments Equity of service provision with other age groups (0-4 year olds and Youth) Access to information on outcomes of the primary health screen

5-11 year OOHC Primary Health Screen Tool Strengths continued: Nurses who do the screen coordinate the development of the health plan and referrals for those children Nurses have been provided training and ongoing supervision to support their understanding of the neurobiology and impacts of trauma

Acknowledgements Stacey Baird, OOHC Coordinator, Western and Far West Local Health Distrists Beth Fulton, OOHC Advisor, Children’s Hospital Westmead

References Chambers, Saunders, New, Williams, Starchuska (2010). Assessment of children coming into care: processes, pitfalls and partnerships. Clin Child Psychol Psychiatry, 15(4): Nathanson & Tzioumi (2007). Health needs of Australian children living in out-of-home care. Journal of Paediatrics and Child Health, 43: Reynolds (July 2008). “Kari Clinic”. KARI Aboriginal Resources Inc SNAICC News Tarren-Sweeney (2008). The mental health of children in out-of-home care. Current Opinion in Psychiatry, 21: Tarren-Sweeney (2007). The Assessment Checklist for Children – ACC: A behavioural rating scale for children in foster, kinship and residential care. Child and Youth Services Review, 29:

Thankyou Lisa McCue- OOHC Coordinator, South Western Sydney & Sydney LHD Rebecca Hart- OOHC Coordinator (former), Western Sydney and Nepean Blue Mountains LHD.