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We Had a Gap! Primary Health Screens for 5-11 year old Children Entering Out of Home Care (OOHC). Rebecca Hart, OOHC Coordinator, Western Sydney & Nepean Blue Mountains LHDs Lisa McCue, OOHC Coordinator, South Western Sydney & Sydney LHDs. Content of presentation.
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We Had a Gap! Primary Health Screens for 5-11 year old Children Entering Out of Home Care (OOHC). Rebecca Hart, OOHC Coordinator, Western Sydney & Nepean Blue Mountains LHDs Lisa McCue, OOHC Coordinator, South Western Sydney & Sydney LHDs
Content of presentation • Background to the development of the Model pathway for Health Assessment for children and young people in OOHC • Model pathway for health assessments • Gap in our systems
OOHC Health Assessment Model PathwayBackground - Wood Recommendations from Wood regarding health assessments for children in OOHC include: • 16.3- Within 30 days of entering OOHC, all children and young persons should receive a comprehensive multidisciplinary health and developmental assessment. For children under the age of 5 years at the time of entering OOHC, that assessment should be repeated at 6 monthly intervals. For older children and young persons, assessment should be undertaken annually. A mechanism for monitoring , evaluation and reviewing access and achievement of outcomes should be delivered by NSW Health and Community Services.
OOHC Health Assessment Model Pathway Background - Wood • 16.4- NSW Health should appoint an OOHC Coordinator in each Area Health Service and at the Children’s Hospital at Westmead.
OOHC Health Assessment Model Pathway Background – other supporting documents • Community Services & Health - MOU for Children in OOHC (NSW) (2006) now (2011) • Royal Australian and New Zealand College of Psychiatrists (Faculty of Child and Adolescent Psychiatry) (2008) • Development of Draft National Standards for Children in Out of Home Care (FaHCSIA – 2010) • NSW Standards for Statutory Out of Home Care (updated 2010)
OOHC Health Assessment Model Pathway Background – local research • 24% of children had incomplete immunisations. • 20% failed a vision screening test • 26% failed a hearing test • 60% required referral for formal developmental assessment. Nathanson, D & Tzioumi, J (2007) (CPU Sydney Children’s Hospital) • 45% of children aged under 5 yrs had speech delays. • 20% of other children had delayed language skills. • 14% of children abnormal growth • 54% of children had behavioural and emotional health problems
OOHC Health Assessment Model Pathway Background – local research Aboriginal & Torres Strait Islander Children • 53% with overdue immunisations • 43% hearing problems • 44% visual problems • 61% speech delays • 34% fine motor problems • 66% educational problems • 30% global developmental delays Reynolds, S (July 2008) “Kari Clinic”, KARI Aboriginal Resources Inc SNAICC News
OOHC Health Assessment Model Pathway Background – local research Psychosocial issues: • High rates of aggressive and oppositional behaviours, emotional dysregulation and relationship difficulties and high levels of carer stress (Chambers, Saunders, New, Williams & Starchuska, 2010) • Complex psychosocial issues such as attachment difficulties, relationship insecurity, sexualised behaviour, trauma-related anxiety, conduct problems and defiance, and inattention/hyperactivity, as well as self-injury and food maintenance behaviours (Tarren-Sweeney, 2008)
OOHC Health Assessment Model Pathway • Eligibility for the pathway: children and young people entering statutory OOHC who are likely to remain in care for longer than 90 days. Commenced 1st July 2010 with staged implemention across the state. • CS - Interagency Pathways Coordinators • Health OOHC Coordinators
OOHC Health Assessment Pathway – NSW model Step 2a Primary Health Screening/ Consultation (within 30 days) Step 1 Initiating a Health Assessment and gathering information Step 3 Development of a Health Management Plan Step 4 Targeted Service Intervention Step 5 Periodic Review and Assessment Prior to entry into Care Step 2b Comprehensive Assessment (Within 90 days)
South West Sydney & Western Sydney LHDs – primary health screens • Both LHDs developed a model for a comprehensive primary health screen to provide a holistic picture of the child’s health at that time and allow the pathway to respond to the individual needs of the child or young person • Children under 5 years - Child and Family Health Nursing • Children and Young People 12 years and over – Youth Health Services
Primary health screens • Physical examination, • growth and development, • vision/eye check, • Hearing/ear check, • Social and emotional screen • Immunisation status • Dental • Nutrition • Youth health also look at youth specific issues e.g., D&A, sexual health
South Western Sydney and Sydney Local Health Districts OOHC Referrals
5-11 year olds • No primary health screening services for this age group in public health services • We wanted to provide an equivalent comprehensive screen to this age group • We developed screening tools to address this gap • The primary health screens are done by Nurses with child and family health or paediatric experience
Addressing the gap • Similar approaches to developing the tools • Working group with multiple disciplines including Child & Family Health Nursing, Paediatricians, Community Health Counselling, Child Protection Counselling Services, Redbank Alternate Care Clinic, Speech Pathology, Occupational Therapy and Physiotherapy. • Department of Education OOHC Coordinators
5-11 year OOHC Primary Health Screen Tool • Physical: based on the: • Aboriginal and Torres Strait Islander Child Health Check • the 4 year old Healthy Kids Check
5-11 year OOHC Primary Health Screen Tool • Developmental • Questions developed by clinicians in the working group (Speech Pathologists, Occupational Therapists, Physiotherapists and Paediatrician’s) • Screening tool only
5-11 year OOHC Primary Health Screen Tool • Psychosocial: • Questions developed by Psychosocial clinicians in the working group as well as from work completed by Redbank Alternate Care clinic (themes arising from assessment completed in a pilot clinic that align with Tarren-Sweeney’s work on the Assessment Checklist for Children) • Screening tool only
5-11 year OOHC Primary Health Screen Tool • Health screens are attended either in local Community Health /Early Childhood Centres or home visits • Child is present and participates in the appointment, however, sensitive issues may be discussed with Carer and/or Caseworker at another time
5-11 year OOHC Primary Health Screen Tool Challenges: • Tool is yet to be validated • Capacity • Non-recurrent funding at present • Walking the fine line between a ‘normal’ trauma reaction early in the care journey and pathology
5-11 year OOHC Primary Health Screen Tool Strengths: • Comprehensive, holistic screen, including liaison with other agencies as needed • Individualises the pathway for children and reduces probability of unnecessary appointments/assessments • Equity of service provision with other age groups (0-4 year olds and Youth) • Access to information on outcomes of the primary health screen
5-11 year OOHC Primary Health Screen Tool Strengths continued: • Nurses who do the screen coordinate the development of the health plan and referrals for those children • Nurses have been provided training and ongoing supervision to support their understanding of the neurobiology and impacts of trauma
Acknowledgements • Stacey Baird, OOHC Coordinator, Western and Far West Local Health Distrists • Beth Fulton, OOHC Advisor, Children’s Hospital Westmead
References • Chambers, Saunders, New, Williams, Starchuska (2010). Assessment of children coming into care: processes, pitfalls and partnerships. Clin Child Psychol Psychiatry, 15(4): 511-527. • Nathanson & Tzioumi (2007). Health needs of Australian children living in out-of-home care. Journal of Paediatrics and Child Health, 43:695-699 • Reynolds (July 2008). “Kari Clinic”. KARI Aboriginal Resources Inc SNAICC News • Tarren-Sweeney (2008). The mental health of children in out-of-home care. Current Opinion in Psychiatry, 21:345-349. • Tarren-Sweeney (2007). The Assessment Checklist for Children – ACC: A behavioural rating scale for children in foster, kinship and residential care. Child and Youth Services Review, 29: 672-691
Thankyou • Lisa McCue- OOHC Coordinator, South Western Sydney & Sydney LHD. Lisa.mccue@sswahs.nsw.gov.au 9828 6073 • Rebecca Hart- OOHC Coordinator (former), Western Sydney and Nepean Blue Mountains LHD. rebecca_hart@wsahs.nsw.gov.au