1. 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.

2. .. A reflection on the interactions of Health and Child protection sectors

3.  Doctors often assume adults accompanying children to a consultation are familiar with the child’s history….sadly they are often wrong.

4.  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!....

5. Better information might make the consult go better!

6. oo Fragmentation of care means multiple care givers. Sometimes the task is overwhelming

7.  Complex situations which require sophisticated conversations and responses may be abbreviated to a nonsense.

9.  Doctors are not able to trust medical histories taken or recorded by non medically trained people.

11.  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.

12.  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?

13.  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

14.  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

15.  Ackerman, Newton, McPherson, Jones, Dykman (1998) - 364 abused children primary diagnoses ◦ 58% separation anxiety/overanxious disorders ◦ 36% phobic disorders ◦ 35% PTSD ◦ 22% ODD

16.  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

17.  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

18.  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

19.  Can We Get Along??  Yes We Can !!! ~ Raeleen, Clare and Obama