1. The Health Status of Children and Young People Who Come into Care Dr David Rankin Child, Youth and Family 2 September, 2011 Royal New Zealand College of General Practitioners

2. Profile of Children Who come to the Attention of CYF

3. Children Who Come Into Care (Aged: pre-birth to 17 th birthday) 124,921 notifications to CYF –13% increase on 08/09 –8,326 from health practitioners 55,494 required further action –21,025 findings of maltreatment 12,535 emotional abuse 4,403 neglect 2,886 physical abuse 1,201 sexual abuse 3,178 individuals brought into custody CYF involved with 21,357 families 5,446 individuals in custody of CE 2009-2010 53% of children are Maori < 53% have parents with AoD issues 1 –67% for YP in a CYF residence 2 –71% of mothers of children under 2 3 19% have parents with a MH history 1 –54% for girls in a CYF residence –43% of mothers of children under 2 3 25% of mothers have criminal convictions 3 56% boys/ 26% girls hit >3 times last year 2 50% have breakfast (Youth Health 07 = 90% 4 ) –54% of girls always have an evening meal (99.6%) 76% have a family doctor –Only 56% see the same doctor each time 44% see a dentist each year (79%) Profile of Children in Care 1 Results reported from the Needs Identification Prompt 2 McKay & Bagshaw. Health needs of YP in CYF residential care, 2010 – Survey of 94 x 12 – 18 yo YP in YJ and C&P residences 3 Research by CYF on 400 children under 2 in care. Completed in 2010 4 Youth Health Survey ‘07

4. Adverse life experiences (report on Children in High and Complex Needs Unit, 2010) 0%20%40%60%80%100% Abuse & Neglect Parental Separation Multiple Caregivers Domestic Violence Parental Mental Health Multiple School Placements Parental AoD Other Parental Offending Family Transience Accidental Injury Gang Culture

5. Consequences Of Abuse and Neglect

6. Maternity, Disability & Chronic Disease Maternity (Conception) Disability Support Intellectual Disability AsthmaDiabetes Non-CYF13%1% 17%1% Notification35%2% 25%1% Investigation41%3%2%25%1% Entry to Care45%6%4%23%1% YSS51%8%5%24%1% Residence63%10%6%28%2%

7. Mental Health Inpatient Events Outpatient Events CostsLife-time Incidence Non-CYF0.010.26$10813% Notification0.040.71$43731% Investigation0.020.99$39939% Entry to Care0.051.49$71842% YSS0.122.28$1,32558% Residence0.354.51$2,06284%

8. Outcomes Children Known to CYF >30% need education support >29% end up with a corrections sentence 5 >Make up 67% of the adult justice population >50% of completed youth suicides 6 >30% have been in care 6 >Up to 67% are mothers within 18 months of leaving care 7 >Extreme high risk behaviours (YP in residence) 2 >65% drive after drinking (Youth ’07 = 8%) >7% more than 4 times in the last month >38% never or hardly ever used seatbelts >92% sexually experienced (36%) >35% boys and 18% girls >10 partners >80% of boys (68% girls) use cannabis (16%) 5 Recent work by CYF on Drivers of Crime 6 Brown (2000), confirmed through TWB research 7 Report from Victoria. NZ stats are unknown

9. Barriers to Accessing Health Services >Children cannot advocate effectively for themselves >Parental capacity >mental illness, AoD, finances, offending histories >Transience >Placement stability >Social worker skills and training in mental health >Language between professionals >Responsiveness from mental health services >Inter-sectoral relationships >Health service funding >Exclusions and interpretation >Lack of integration between services >Recognition of infant mental health issues >Lack of primary care based child service (particularly mental health) >Workforce constraints

10. Solutions

11. Government Investment Budget 2011 announced the Government’s commitment to addressing the health & education needs of children who come to the attention of Child, Youth and Family Gateway Assessments –$3.8 million a year Primary mental health –Building to $2.5 million per year over 3 years Intensive Clinical Support Service –Building to $2.5 million per year over 4 years

12. Child Identified as likely to Benefit from a Gateway Assessment Gateway Assessment Coordinator Collect existing health information Family health history Determine appropriate assessment Health Assessor Review history Comprehensive health assessment Write report and recommendations Social Worker/FGC Coordinator Prepare information for use at FGC Complete child or young person’s plan Monitor agreed recommendations Education Health ACC Social Worker Health (NZHIS) Social Worker Well Child Provider Family Teacher/Principal (School or Early Childhood Centre) Complete education profile Identify issues affecting education Health Referrals (with consent and consultation) Gateway Assessment Flow Chart Urgent health appointment if required Social Worker/FGC Coordinator Gain consent Refer for health assessment Refer for education profile Gateway Assessment Coordinator Collate information from CYF, family, Health and Education Drafts Interagency Child Development Agreement with social worker Facilitate Interagency Case Conference (if required) Follow-up on implementation of recommendations at 3 months

13. Primary Care >Referrals from Gateway Assessments >Mild to Moderate mental health = emotional and behavioural conditions >Provided in the community >Builds on current adult mental health initiatives >1,600 children a year >“Packages of Care” valued at $1,550 per child >Includes services for the child and the parent >Implementation over 3 years Mental Health Services

14. Focus on the Child Identify the issue –Recognise the consequences –Gain skills in detecting mental health of infants and children Recognise the environment –Family issues (mental health, AoD, disability, skills) –Barriers to engagement Every contact is an opportunity to make a difference –Identify intervention options –Bridge silos of specialisation –Ensure engagement (not service provision) Solution focus –Move beyond the diagnosis Be a “concerned Kiwi”, not a technician

15. Discussion & Questions