Susan Webster Dr Meredith Temple-Smith ACWA Conference 2008

1. Can General Practitioners better assess the health of children and young people entering out-of-home care? CAN GPs BETTER ASSESS THE HEALTH OF CHILDREN AND YOUNG PEOPLE IN OUT-OF-HOME CARE? Susan Webster Dr Meredith Temple-Smith ACWA Conference 2008 Susan Webster Meredith Temple-Smith ACWA Conference 2008

2. Background - 2007 • Department of Human Services, Victoria • Entry to Care • Child health assessment initiative

4. Aim • Explore and explain factors which influence GP readiness and willingness to provide comprehensive health assessment for children and young people entering out-of-home care

5. Method • Literature review • 5 key informant interviews • Ethics approval • Qualitative study with 20 GPs • 60 minute, semi-structured interviews • Transcripts sent to participants • Thematic coding using NVIVO7

6. Can GPs better assess health? • “....one of the advantages of our training is this ... true, bio/psycho/social perspective...the biology is important but one thing general practice gives you... it crosses both the medical and social paradigms..... • other professions are good at their bit of the body, but the true generalist approach brings it all together...” ( interview 16)

7. Key findings • Epidemiology not shared with GPs • Professional development and training needed • Readiness depends on changed practice systems • GP financial and workforce pressures

8. Key findings • ‘Red-tape’ • Medico–legal issues • Ethical concerns • Links with child protection sector • Continuity of GP/child relationship

10. Continuity: what did GPs say? • “perhaps the best thing you can do is just provide some consistency in their life...maybe you can help them cross the bridge...” ( interview 7) • “continuity is really vitally important in general practice....if, as a GP, you can see them over time and you develop a trusting relationship with good communication, it just transforms you...” ( interview 13)

11. Continuity in primary medical care Saultz J W. Defining and Measuring Interpersonal Continuity of Care. Annals of Family Medicine. 2003;1 (3): 134-143

12. Informational continuity

13. Informational continuity • “The medical history is everything” • Underwood P, Clare M, Gillieatt S, Clare B and Paley G. Understanding and improving the provision of general practice services to children in state care. General Practice Evaluation Program ( GPEP) 1999,Project 705. from phcris@flinders.edu.au

14. Longitudinal Continuity

15. Every child needs a medical home

16. Interpersonal continuity • “This is going to be your GP and they will be looking after you” ( Interview 11) • “I think a thorough health assessment is really good but it is only as good as the follow up. If you .....don’t have any other contact, then its value immediately evaporates” (Interview 13)

18. Implications • Invest in communication between sectors • Share knowledge about effects on health • Identify and support willing GPs • Clarify medico-legal issues • 5. ‘Medical home’ for each child and young person

19. Acknowledgements • Dr Meredith Temple-Smith • University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of General Practice, Primary Care Research Unit. • Department of Health & Ageing • PHCRED Fellowship

20. Acknowledgements • Bill Newton, CEO, • General Practice Victoria • Geoff Jende & Tony Lunken, • Victorian Department of Human Services • Child, Youth and Family Services Division

21. For further details of the study • Download the research report • Factors that influence general practitioner willingness and readiness to provide comprehensive health assessments to children and young people entering out-of-home care. • www.gpv.org.au • Contact the researcher • s.webster@pgrad.unimelb.edu.au