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

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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

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Children in Out-of-home-careAustralia

• 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

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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

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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
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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
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Identified Health ProblemsSCH 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
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The KARI Clinic

• Program Commenced late 2003
• Comprehensive Health Developmental Assessments
  for Aboriginal Children Entering Foster Care in
  SWS
• A Partnership betweenKARI Aboriginal Resources
  Inc (NGO)South Western Sydney Area Health
  ServiceDoCS NSW (Welfare)

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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

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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

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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

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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

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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

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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

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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

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Health problems- 2Developmental/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

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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

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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

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Progress in Care

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

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Independent EvaluationQualitative research
Carers Views2005

• 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
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Independent EvaluationCarers and Service
Providers

• But
• Recommendations not followed up
• Children identified with problems not treated
• Not enough resources

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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

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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

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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

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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

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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