The Health Status of Children and Young People Who Come into Care

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

2. Profile of ChildrenWho come to the Attention of CYF

3. Children Who Come Into Care(Aged: pre-birth to 17th birthday) 2009-2010 Profile of Children in Care • 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 • 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 23 • 19% have parents with a MH history 1 • 54% for girls in a CYF residence • 43% of mothers of children under 23 • 25% of mothers have criminal convictions3 • 56% boys/ 26% girls hit >3 times last year2 • 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%) 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) Gang Culture Accidental Injury Family Transience Parental Offending Other Parental AoD Multiple School Placements Parental Mental Health Domestic Violence Multiple Caregivers Parental Separation Abuse & Neglect 0% 20% 40% 60% 80% 100%

5. ConsequencesOf Abuse and Neglect

6. Maternity, Disability & Chronic Disease

7. Mental Health

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 suicides6 • 30% have been in care6 • Up to 67% are mothers within 18 months of leaving care7 • 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. 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 Barriers to Accessing Health Services

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. Gateway Assessment Flow Chart Child Identified as likely to Benefit from a Gateway Assessment Social Worker/FGC Coordinator • Gain consent • Refer for health assessment • Refer for education profile Urgent health appointment if required Teacher/Principal (School or Early Childhood Centre) • Complete education profile • Identify issues affecting education Social Worker Gateway Assessment Coordinator • Collect existing health information • Family health history • Determine appropriate assessment Family Health (NZHIS) Well Child Provider ACC Health Assessor • Review history • Comprehensive health assessment • Write report and recommendations Health Referrals (with consent and consultation) 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 Health Education Social Worker Social Worker/FGC Coordinator • Prepare information for use at FGC • Complete child or young person’s plan • Monitor agreed recommendations

13. Mental Health Services 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

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