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A Strengths based approach to meeting the Health Needs of Aboriginal Children in Out of Home Care

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Sandra Reynolds, Psychologist. Casey Ralph, Casework Manager ... Of these almost 1/3 had mod to severe delay/disorder. Fine motor probs: 33% of those assessed ... – PowerPoint PPT presentation

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Title: A Strengths based approach to meeting the Health Needs of Aboriginal Children in Out of Home Care


1
A Strengths based approach to meeting the
Health Needs of Aboriginal Children in Out of
Home Care
  • KARI Aboriginal Resources Incorporated
  • Sandra Reynolds, Psychologist
  • Casey Ralph, Casework Manager

2
Children in Out-of-home-care Australia
  • Every year 12-13,000 children enter care
  • 28,441 children in care in June 2007
  • Approx 40 under 5yrs (10 under 1yr), 25
    5-9yrs, 25 10-14yrs, 10 15-17yrs
  • Indigenous (Aboriginal) children over-represented
    7 times
  • Aboriginal population vulnerable, poorest health
    outcomes in Australia

3
Background Children in OOHC
  • Vulnerable group of children
  • High health needs
  • Unrecognised health needs
  • Unmet health needs
  • Recent interest to address these needs
  • RACP Policy, State initiatives

4
Health problems of foster kids US data
  • 40-80 have some chronic health problems
  • 33 untreated health problems
  • 40-60- increased exposure to alcohol, tobacco,
    illicit drugs- which can cause brain impairment
  • Mental health problems 30-80
  • Abnormal growth, poor nutritional status-15-25
  • 34 inadequate immunisation coverage
  • gt 15 have no routine health care

Simms, Dubowitz Szilagyi, Paediatrics 2000
5
Mental health of children in foster and kinship
care in Australia
  • Levels/ rates of disturbance for children in
    foster care worse than prior estimates
  • 53 ? and 57 ? scored in clinical range CBCL
  • Significantly higher rates than community sample
  • Characteristic problems elimination (toileting),
    sexual and conduct problems
  • Boys worse than girls on severity

Tarren-Sweeney Philip Hazell, JPCH 2006
6
Identified Health Problems SCH OOHC Clinic
(Sydney)
  • Incomplete immunisation 24
  • Abnormal vision screen 30
  • Abnormal hearing test 28
  • Dental problems 30
  • Failed dev screen 60
  • Speech delay 33
  • Abnormal growth 14
  • Infections 12
  • Behavioural/emotional problems 54

Nathanson Tzioumi, JPCH 2007
7
The KARI Clinic
  • Program Commenced late 2003
  • Comprehensive Health Developmental Assessments
    for Aboriginal Children Entering Foster Care in
    SWS
  • A Partnership between KARI Aboriginal Resources
    Inc (NGO) South Western Sydney Area Health
    Service DoCS NSW (Welfare)

8
KARI Clinic
  • Culturally appropriate, active involvement of
    KARI staff and foster parents
  • Multidisciplinary Paediatric, SP, OT, PT, SW,
    others as required
  • Attempts made to identify strengths first
  • Monitoring and evaluation built into Clinic
  • - quarterly management meetings of key
    stakeholders

9
KARI Organisation
  • Co-ordinates OOHC program for Aboriginal Children
    across SWS
  • Role- recruit and train quality Aboriginal foster
    parents to provide culturally appropriate care.
  • Full case management of children and carers

10
Aims
  • To identify the health needs of Aboriginal
    children entering care in SWS
  • To identify strengths in these children and
    characteristics that promote resilience
  • To determine if identified health needs were met
    with available services
  • To identify barriers to appropriate care

11
Methods
  • Analysed records of 139 children attending KARI
    clinic
  • Information collected clinic outcomes,
    strengths, defects identified, treatment and
    recommendations
  • Reviews To monitor progress and identify if
    recommendations implemented
  • Service providers, carers interviewed about
    barriers to care by independent evaluators

12
Methods
  • Data entered routinely into Access database
  • Analysis of frequencies, cross tabs performed on
    SPSS V15
  • Subgroup analysis unable to be performed due to
    small numbers

13
Results
  • Complete data on 99 children
  • Age range 2 months 12.5 years,
  • average age 4.5 yrs, 60 lt 5yrs
  • Boys 54
  • Majority neglect, PA and exp to DV, 20 sexual
    abuse concerns
  • Parental history Substance use, incarceration,
    ID, 23 known psychosis

14
Health Problems -1
  • Immunisation 49.5 UTD
  • Hearing problems 44 concerns, 9 already had
    impaired hearing
  • Vision 35 had visual concerns
  • 18 had decreased vision or squints
  • Dental 36 had probs (caries, pain, abscess)
  • 6 needed urgent dental extraction

15
(No Transcript)
16
Health problems- 2 Developmental/Behavioural
  • Speech delay 66 of those assessed
  • Of these almost 1/3 had mod to severe
    delay/disorder
  • Fine motor probs 33 of those assessed
  • Behaviour problems 45 (internalising and ext)
  • Education problems 66 of school age children
  • Overall development 73 WNL
  • 27 global delay

17
Other Health problems
  • Skin problems scabies, eczema, impetigo
  • Investigation for seizures, FAS
  • Short stature, Obesity, FTT
  • Risk for Hepatitis C
  • Referrals Ophthalmology, Genetics, ENT,
    Cardiology, Endocrinology, Dermatology

18

What about Strengths?
  • 16 of children were doing well at first visit!
  • 34 of children reviewed showed improvement with
    stable care
  • Characteristics of children doing well or
    improving no sig diff on demographics (eg.
    gender, age)
  • but noted by clinicians to be positive, have
    pleasing temperament, good at recruiting adults

19
Progress in Care
  • Improved 34
  • Stable 30
  • Declined 13
  • (70 Male between 5-13years)
  • Not reviewed 23

20
Independent Evaluation Qualitative research
Carers Views 2005
  • Children are receiving health and developmental
    assessments
  • Potential model for all children in OOHC
  • Good quality reports carers have copies
  • Carers empowered

Centre for Health Equity, Training Research,
2005
21
Independent Evaluation Carers and Service
Providers
  • But
  • Recommendations not followed up
  • Children identified with problems not treated
  • Not enough resources

22
Barriers to providing comprehensive assessments
  • Obtaining available relevant information
  • Changes in caseworkers
  • Natural parents unknown
  • Children changing addresses, names
  • Medicare number unavailable
  • Consents for obtaining information

23
Barriers-2
  • Caseworkers relying on foster parents to follow
    up recommendations
  • Foster parents reluctant to attend clinic or
    follow up on recommendations
  • Cultural identity
  • Placement breakdown and changes-
  • clinic staff not informed

24
Discussion/Challenges
  • How to measure and focus on strengths
    appropriately
  • Not easy to measure strengths in standardised
    manner
  • Data analysis difficult small numbers,
    categorical variables
  • Many systems issues prevent prioritising these
    children
  • Qualities of carers may be very imp in
    determining outcomes
  • Cultural Identity

25
Conclusion
  • KARI kids similar rates of problems identified
    as other studies
  • Comprehensive paed/developmental assessment early
    in childs placement CAN facilitate appropriate
    intervention
  • Significant barriers to appropriate care for
    these children persist
  • Using a strengths model possible to identity
    factors promoting resilience in these children

26
Our Children Our Future! .….and they need our
help.
  • Acknowledgements
  • KARI Aboriginal Resources Inc
  • Paul Ralph - Chief Executive Officer
  • DoCS - Metro South West Region
  • Sydney South West Area Health Service
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