A Strengths based approach to meeting the Health Needs of Aboriginal Children in Out of Home Care KARI Aboriginal Resources Incorporated Sandra Reynolds, Psychologist Casey Ralph, Casework Manager

Children in Out-of-home-care Australia Every year 12-13,000 children enter care 28,441 children in care in June 2007 Approx 40% under 5yrs (10% under 1yr), 25% 5-9yrs, 25% 10-14yrs, 10% 15-17yrs Indigenous (Aboriginal) children over- represented – 7 times Aboriginal population: vulnerable, poorest health outcomes in Australia

Background: Children in OOHC Vulnerable group of children High health needs Unrecognised health needs Unmet health needs Recent interest to address these needs: –RACP Policy, State initiatives

Health problems of foster kids: US data 40-80% have some chronic health problems 33% untreated health problems 40-60%- increased exposure to alcohol, tobacco, illicit drugs- which can cause brain impairment Mental health problems: 30-80% Abnormal growth, poor nutritional status-15-25% 34% inadequate immunisation coverage > 15% have no routine health care Simms, Dubowitz & Szilagyi, Paediatrics 2000

Mental health of children in foster and kinship care in Australia Levels/ rates of disturbance for children in foster care worse than prior estimates 53% ♀ and 57% ♂ scored in clinical range CBCL Significantly higher rates than community sample Characteristic problems: elimination (toileting), sexual and conduct problems Boys worse than girls on severity Tarren-Sweeney &Philip Hazell, JPCH 2006

Identified Health Problems: SCH OOHC Clinic (Sydney) Incomplete immunisation 24% Abnormal vision screen 30% Abnormal hearing test 28% Dental problems 30% Failed dev screen60% Speech delay 33% Abnormal growth 14% Infections 12% Behavioural/emotional problems 54 Nathanson & Tzioumi, JPCH 2007

The KARI Clinic Program Commenced late 2003 Comprehensive Health & Developmental Assessments for Aboriginal Children Entering Foster Care in SWS A Partnership between KARI Aboriginal Resources Inc (NGO) South Western Sydney Area Health Service DoCS NSW –(Welfare)

KARI Clinic Culturally appropriate, active involvement of KARI staff and foster parents Multidisciplinary: Paediatric, SP, OT, PT, SW, others as required Attempts made to identify strengths first Monitoring and evaluation built into Clinic: - quarterly management meetings of key stakeholders

KARI Organisation Co-ordinates OOHC program for Aboriginal Children across SWS Role- recruit and train quality Aboriginal foster parents to provide culturally appropriate care. Full case management of children and carers

Aims To identify the health needs of Aboriginal children entering care in SWS To identify strengths in these children and characteristics that promote resilience To determine if identified health needs were met with available services To identify barriers to appropriate care

Methods Analysed records of 139 children attending KARI clinic Information collected: clinic outcomes, strengths, defects identified, treatment and recommendations Reviews: To monitor progress and identify if recommendations implemented Service providers, carers interviewed about barriers to care by independent evaluators

Methods Data entered routinely into Access database Analysis of frequencies, cross tabs performed on SPSS V15 Subgroup analysis unable to be performed due to small numbers

Results Complete data on 99 children Age range: 2 months – 12.5 years, –average age: 4.5 yrs, 60% < 5yrs Boys: 54% Majority: neglect, PA and exp to DV, 20% sexual abuse concerns Parental history: Substance use, incarceration, ID, 23% known psychosis

Health Problems -1 Immunisation: 49.5% UTD Hearing problems: 44% concerns, 9% already had impaired hearing Vision: 35% had visual concerns –18% had decreased vision or squints Dental: 36% had probs (caries, pain, abscess) –6 needed urgent dental extraction

Health problems- 2 Developmental/Behavioural Speech delay: 66% of those assessed –Of these almost 1/3 had mod to severe delay/disorder Fine motor probs: 33% of those assessed Behaviour problems: 45% (internalising and ext) Education problems: 66% of school age children Overall development: 73% WNL –27% global delay

Other Health problems Skin problems: scabies, eczema, impetigo Investigation for seizures, FAS Short stature, Obesity, FTT Risk for Hepatitis C Referrals: Ophthalmology, Genetics, ENT, Cardiology, Endocrinology, Dermatology

16% of children were doing well at first visit! 34% of children reviewed showed improvement with stable care Characteristics of children doing well or improving: no sig diff on demographics (eg. gender, age) –but noted by clinicians to be positive, have pleasing temperament, good at recruiting adults What about Strengths?

Progress in Care Improved: 34% Stable: 30% Declined: 13% (70% Male & between 5-13years) Not reviewed: 23%

Independent Evaluation Qualitative research: Carers Views 2005 Children are receiving health and developmental assessments Potential model for all children in OOHC Good quality reports: carers have copies Carers empowered Centre for Health Equity, Training & Research, 2005

Independent Evaluation: Carers and Service Providers But Recommendations not followed up Children identified with problems: not treated Not enough resources

Barriers to providing comprehensive assessments Obtaining available relevant information –Changes in caseworkers –Natural parents unknown –Children changing addresses, names –Medicare number unavailable Consents for obtaining information

Barriers-2 Caseworkers relying on foster parents to follow up recommendations Foster parents reluctant to attend clinic or follow up on recommendations Cultural identity Placement breakdown and changes- –clinic staff not informed

Discussion/Challenges How to measure and focus on strengths appropriately Not easy to measure strengths in standardised manner Data analysis difficult: small numbers, categorical variables Many systems issues prevent prioritising these children Qualities of carers may be very imp in determining outcomes Cultural Identity

Conclusion KARI kids: similar rates of problems identified as other studies Comprehensive paed/developmental assessment early in child’s placement CAN facilitate appropriate intervention Significant barriers to appropriate care for these children persist Using a strengths model: possible to identity factors promoting resilience in these children

Our Children Our Future !.…. and they need our help. Acknowledgements KARI Aboriginal Resources Inc –Paul Ralph - Chief Executive Officer DoCS - Metro South West Region Sydney South West Area Health Service