Transcript Presentation title (Tahoma 30 Point)

Assessing the health needs of children in out-of-home
care in Victoria
Argiri Alisandratos,
Assistant Director, Placement & Family Services
Children in out-of-home care in Victoria
Number in care as of 30 June 2010
5,469
Number entering care in 2009-10
3,112
Number entering for the first time
(1 January 2009 to 28 February
2010)
1,498
Of the first time entrants approximately 40 per cent
entered foster care, 50 per cent kinship care and
10 per cent residential care.
2
Challenges for health assessment processes
•
If placement accompanies protective investigations the gathering of
information on children’s health needs is likely to be lower priority than
protection from harm, if there are no immediate health issues.
•
Short term, multiple or unstable placements bring uncertainty to planning.
Uncertainty about how long a child will remain in placement means that
referral for assessment may be deferred.
•
Changes of worker during placement because of the system’s
requirements as well as the movement of workers means that information
processes instigated by one worker are interrupted and information may
get lost.
•
Concerns about privacy and confidentiality with regard to the transfer of
information leads to complex referral systems with the risk of repeated
story telling by carers and children.
Adapted from: Clare, B. & Clare, M. (2000) Meeting the health care needs of children in out
of home care: guiding and ‘holding’ them through the care journey. Proceedings of Children
First World Forum 2000, Sydney July 2000.
3
Legislative mandate of the Children, Youth and Families Act 2005
S 16. Responsibilities of the Secretary
(1) Without limiting any other responsibility of the Secretary under this Act, the
Secretary has the following responsibilities—
(c) to work with community services to promote the development and adoption
of common policies on risk and need assessment for vulnerable children and
families;
(e) to work with other government agencies and community services to ensure
that children in out of home care receive appropriate educational, health and
social opportunities;
S 174. Secretary's duties in placing child
(1) In dealing with a child under section 173, the Secretary—
(a) Must have regard to the best interests of the child as the first and
paramount consideration; and
(b) Must make provision for the physical, intellectual, emotional and
spiritual development of the child in the same way as a good parent would;
and
(d) Must have regard to the treatment needs of the child.
4
Looking After Children (LAC)
The LAC framework considers the child's needs and outcomes in seven life
areas which cover the things that parents usually also pay attention to, as well
as being the critical areas identified from outcomes research, namely the
child's:
•
Health
•
Emotional and behavioural development
•
Education
•
Family and social relationships
•
Identity
•
Social presentation
•
Self-care skills.
LAC includes a set of practice tools that comprise the primary client records
kept by the community service organisation (CSO) providing the out of home
care placement and are transferred with the child if they move to a placement
provided by another CSO.
5
Current practice in health assessments
A comprehensive review of the outcomes of LAC processes was
reported in The Looking After Children Outcomes Data Project: Final
Report. Prepared for: The Department of Human Services, by the
Australian Institute of Family Studies (2007).
The Assessment and Action records of 614 children and young people were
analysed and under the heading of health:
•
80 per cent of children had had a recent medical review
•
54 per cent of children met all LAC health objectives
•
38 per cent of children did not meet all health objectives
•
56 per cent had received age-appropriate immunisations
•
The immunisation status of nearly 25 per cent of children was not known.
New LAC Assessment and Progress records have recently been introduced
which will allow better assessment and monitoring of outcomes along the LAC
domains.
6
Specialist programs: Therapeutic Foster Care (Circle)
Therapeutic Foster Care (Circle) program provides trauma and
attachment informed therapeutic care for up to 97 children at a time.
Carers are specially trained and have the ongoing support of a
Therapeutic Specialist.
All children entering this program have a comprehensive assessment that includes
•
General health history taken from family and child.
•
Comprehensive emotional behavioural and mental health assessment by
Therapeutic Specialist.
•
Health assessments.
o
Medical assessment by a GP
o
Paediatric assessment organised (via GP referral) for all children
under 5 years and for other children as discussed with the GP.
o
Dental assessment.
•
Other specialist assessments are sought as required.
•
Assessment is completed within 12 weeks of the placement commencing.
7
Specialist programs (cont’d)
Therapeutic Residential Care
Models of therapeutic residential care are being piloted throughout the State
providing trauma and attachment informed therapeutic care for up to 50
children and young people.
Each of 11 pilot sites has the support of a Therapeutic Specialist whose role
includes completion of a comprehensive emotional / behavioural and health
assessment similar to that completed for the children in the Circle program.
As the young people in residential care are predominantly over 12 years of age
a paediatric assessment may not be included.
8
Secure welfare health service
Victoria’s secure welfare service (SWS) provides two secure 10-bed, gender
specific residential units, staffed on a rostered 24 hour ‘stand up’ model for
children or young people who present a substantial and immediate risk of harm
to themselves or from others and existing community services cannot manage
the risk.
Children and young people may be placed in SWS for a period not exceeding
21 days. In exceptional circumstances, the period in SWS may be for one
further period not exceeding 21 days.
Currently the health needs of children and young people in SWS are addressed
by one full time therapeutic specialist and a GP and a drug and alcohol service
on a sessional basis.
Planning is underway to identify a suitable provider to establish, co-ordinate
and operate a multidisciplinary Health Service from 1 July 2011. The
multidisciplinary service will provide GP and nursing services for all children
and young people placed in the SWS, mental health and alcohol and drug
specialty support services where these are required and dedicated
administrative support for the Health Service overall.
9
Priority initiatives
•
In Victoria access to public dental care for children is a priority, and there
are no waiting lists. Treatment is free for children in out of home care and
all children in out of home care should be seen within a month of entry to
care. If problems are encountered the matter should be referred to the
Manager, Dental Health in the Department of Health.
•
Since 2007, Early Childhood Intervention Services (ECIS) have given
priority to eligible children who are referred to ECIS by Child Protection
within three months of entry to care.
•
As part of the Community health service (CHS) improvement strategy a
priority protocol recognises all clients of child protection and family
services as having high priority access to assessment for any service (e.g.
OT, physio, speech therapy, counselling) provided by a CHS.
•
The Victorian Immunisation Strategy 2009-2012 recognises children in out
of home care as high risk and will review and promote improved
immunisation services for this group.
10
Priority initiatives (contd.)
•
It is intended that in the near future Victorian area mental health services
will implement a policy to give priority to accepting streamed referrals from
child protection of children and young people in out of home care and
will adapt their service protocols and practices to ensure that this occurs.
•
One of the initiatives of the joint work now in place for improved
collaboration between Disability Services and Children, Youth and
Families divisions is to establish priority of access for children and young
people with a disability living in out of home care to:
o
Secondary consultation and information sharing from both Children
Youth and Families and DS
o
Allocation of disability case management where appropriate
o
Disability Services Behaviour Intervention Support (BIS) and specialist
services.
11
Interim health assessment and treatment model
•
Initial Health Assessment funding will be made available to regions to
assist children to access specialist and allied health services that may not
be available in a timely way from public health services.
•
In lieu of the electronic databases enhancements, systems will be put in
place to monitor children’s access to GP and dental assessments and
follow up treatments.
•
The new Assessment and Progress records will allow better assessment
and monitoring of outcomes along the LAC domains.
•
Work is planned to improve electronic recording and transfer of
information between the LAC tools and between child protection
practitioners and placement workers community service organisation. A
project to enhance care team practice will also recommence shortly.
•
Children, Youth and Families will work with the state health department to
develop a holistic model of health assessments that is consistent with the
National Clinical Framework for assessment of children and young people
in out of home care.
12