1 / 26

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

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. Children in Out-of-home-care Australia. Every year 12-13,000 children enter care

ron
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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-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

  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 • > 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 betweenKARI Aboriginal Resources Inc (NGO)South Western Sydney Area Health ServiceDoCS 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% < 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. 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

  16. 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

  17. 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

  18. Progress in Care • Improved: 34% • Stable: 30% • Declined: 13% • (70% Male & between 5-13years) • Not reviewed: 23%

  19. 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

  20. Independent Evaluation:Carers and Service Providers But • Recommendations not followed up • Children identified with problems: not treated • Not enough resources

  21. 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

  22. 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

  23. 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

  24. Conclusion • KARI kids: similar rates of problems identified as other studies • Comprehensive paed/developmental assessment early in child’s 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

  25. 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

More Related