GOOD INTENTIONS, DEVILS AND DETAILS Health Standards for children and young people under guardianship of the Minister Lisa Henderson, Families SA Dr Diana Lawrence, Flinders Medical Centre Sue Foster, Children, Youth and Women's Health Service LISA

GOOD INTENTIONS Our Best Investment: A State Plan to protect and advance the interests of children, Robyn Layton QC, Child Protection Review, 2003 Keeping Them Safe: The SA Government’s Child Protection Reform Program, 2005 Rapid Response: Whole of government services for Children and young people under guardianship of the Minister, 2005 Health Standards for Children and Young People under Guardianship, 2007 Quarterly monitoring by ‘Across Government Guardianship (Rapid Response) Steering Committee’ LISA

SOUTHERN ADELAIDE EXPERIENCE Response to demand for health assessments of children in OOHC in Southern Adelaide region Good relationships between CPS, Families SA and Paediatricians; service commenced 2003 Regional demands: Mt Gambier, Riverland, Iron Triangle DI

IMPLEMENTATION Standards for assessment Principles: Substantially different from traditional medical model of paediatric consultation. Comprehensive assessments of health and well-being. Joint medical and psycho-social. Physical examination small component of overall assessment. Comprehensive history required from current carer DI

Management plan Children often require referral for: more comprehensive developmental/psychometric assessment audiology, speech and language assessment Child Assessment Team ENT review other specialists as indicated. Joint report with psychosocial staff, with clear summary and recommendations. Entry into care does not necessarily result in resolution of health problems. DI These children have ongoing unmet health needs Poor immunisation/catch up rates Inadequate oral health Developmental disabilities remain prevalent (up to 60%) Ongoing chronic medical issues (45-76%)

Aim of assessment To formulate a comprehensive health plan health = physical, mental, social well-being AND absence of disease requires information from a number of sources recognises complex, multidimensional factors contributing to the child’s current health status and presentation Recommendations made regarding: health needs developmental and educational needs mental health / behavioural needs follow up arrangements clearly - a multidisciplinary approach and effective interagency communication is required. DI

DEVILS AND DETAILS Barriers to effective health care provision Multiple moves with no provision for permanent or accessible health records Lack of specific health policies and utilisation of health services in ad hoc fashion Eg. allied health, counselling services Resource shortages in both health and child support services Discourages routine screens and support Promotes crisis management Lack of permanency in placement in OOHC Exacerbates problems DI

Barriers to effective health care provision Absence of information Poor information about birth families, birth history, early health issues and developmental progress, learning profile. Difficult to interpret current health, learning and behavioural presentation without this information. Limited communication between agencies Eg. health, education, Families SA, CAMHS, parents. Medical information and recommendations need to be transferred to all involved in the care of children in OOHC. Change of placement (or caseworker) Change of GP, school  contributes to poor communication and transferring of information. Ambiguity in who is coordinating health needs of the child ?carer, ?caseworker, ?medical provider. DI

Alternative Care Trends Families SA Children in Alternative Care Placement SUE The increase overall in the number of children in alternative care placement at the end of the financial year is 69% over the past six years. Since 2003/04, the increase has been in the vicinity of 10% to 11% per annum. The trend this financial year is for 9% increase. For Aboriginal children, there has been a 120% increase in the number of children in placement at the end of the financial year For Non-Aboriginal children, a 56% increase Finalised Care and Protection Order Commencements July 1, 2010 to September 30, 2010 were 175 (GoM 12, GoM 18, Unaccompanied Refugee Minors [21] At 30th September, 2010 Aboriginal children comprised 25% of all children on Care and Protection Orders. Compares with 24% in 2006 - slightly higher growth rate in Aboriginal children on orders.

Age Profile of Children in Care Adolescents at Risk Families SA Children in Alternative Care by age groups SUE Since 2005/06, there has been a 52% increase in the number of children on care and protection orders. A 53.5% increase in the number of children aged under 2 years. A 72% increase in the number of children aged 2 to 4 years. A 66% increase in the number of children aged 5 to 9 years A 31% increase in the number of children aged 10 to 14 years. A 53% increase in the number of children aged 15-17 years. A 117% increase in the 2-4 year age group 79% increase in 5 – 9 age group 41% increase, both in 10-14 years and A 60% increase in the number of young people aged 15-17 years. In part, the increase in the number of children in care at a point of time is a result of children entering alternative care at a younger age, and remaining in care for a longer period of time.

MORE DEVILS! Referral pathways reliant on operational consistency, both Families SA and Health. Culturally appropriate responses to escalating percentage of Aboriginal children in OOHC. Focus on early childhood has reduced knowledge and skills and service access for young people in OOHC. Recognition of the service demand for transition from care 18-25. IT systems – ‘speaking in tongues’. (eCHIMS; OASIS; HOMER; CHIS; CHIRON; RREN; C3MS, etc). Inconsistent implementation across state, and maintenance of knowledge with high staff turn over in both sectors. Access for children in rural and remote areas. Pressure of demand: number and age of children in OOHC – complexity, long term interventions, multidisciplinary interventions, therapy. SUE

CHALLENGES How to drive a public health approach to intervention with these children? Health and well being is central to all other life domains. Burden of disease becomes exponential. Health has a major role and opportunity to break the cycle of trauma and abuse for these children. How can the Health and Child Protection sectors work in congruence to meet our statutory and ethical obligations to these children? SUE

HEALTH, HOPE AND RESILIENCE “Every system that touches the lives of children offers an opportunity to strengthen the foundations and capacities that make life long healthy development possible.” National Scientific Council on the Developing Child National Forum on Early Childhood Policy and Programs; Harvard University, July 2010 Innovation and opportunity Build carer and community capacity to strengthen the health of children and young people Concentric circles not silos Health, healing and well being SA’s Health Standards can be obtained from the Department Of Health website: www.health.sa.gov.au or from the Department for Families and Communities website: www.dfc.sa.gov.au/pub/kts Thank you LISA Every system that touches the lives of children offer an opportunity to strengthen the foundations and capacities that make life long healthy development possible. National scientific council on the developing child national forum on early Childhood policy and programs; Harvard university July 2010.