1. 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

2. 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

3. 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

4. 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

5. 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%)

6. 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

7. 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

8. 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

9. 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 slightly higher growth rate in Aboriginal children on orders.

10. 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 years.
A 117% increase in the 2-4 year age group
79% increase in 5 – 9 age group
41% increase, both in years and
A 60% increase in the number of young people aged 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.

11. 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
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

12. 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

13. 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:
or from the Department for Families and Communities
website:
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.