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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. . A reflection on the interactions of Health and Child protection sectors.
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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.
. A reflection on the interactions of Health and Child protection sectors
Are the appropriate people talking to each other? • Doctors often assume adults accompanying children to a consultation are familiar with the child’s history….sadly they are often wrong.
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!....
Fragmentation of care .Who should the doctor be ringing? Sometimes the task is overwhelming. • o Fragmentation of care means multiple care givers. Sometimes the task isoverwhelming
Delegation=oversimplification • Complex situations which require sophisticated conversations and responses may be abbreviated to a nonsense.
Medical practitioners need reliable health information • Doctors are not able to trust medical histories taken or recorded by non medically trained people.
Are we wasting our time? • 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.
What is in the child’s best interests? • 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?
Complex Trauma (Cook et al 2005) • 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
Capturing the reality of clinical presentation • 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
Abused & Neglected Children and Diagnosis • Ackerman, Newton, McPherson, Jones, Dykman (1998) - 364 abused children primary diagnoses • 58% separation anxiety/overanxious disorders • 36% phobic disorders • 35% PTSD • 22% ODD
The role of medication • 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
Suggestions for the way forward. • 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
Suggestions for the way forward • 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
Everything that irritates us about others can lead us to an understanding of ourselves. ~Carl Jung • Can We Get Along?? • Yes We Can !!! ~Raeleen, Clare and Obama