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-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

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

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

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

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 54Nathanson & Tzioumi, JPCH 2007

The KARI Clinic

Program Commenced late 2003Comprehensive Health & Developmental Assessments for

Aboriginal Children Entering Foster Care in SWS

A Partnership betweenKARI Aboriginal Resources Inc (NGO)

South Western Sydney Area Health Service

DoCS NSW –(Welfare)

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

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

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

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

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

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

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

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

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

• 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

What about Strengths?

Progress in Care

• Improved: 34%

• Stable: 30%

• Declined: 13% • (70% Male & between 5-13years)

• Not reviewed: 23%

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

Independent Evaluation:Carers and Service Providers

But

• Recommendations not followed up • Children identified with problems: not

treated • Not enough resources

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

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

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

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

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