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Melissa KaltnerSenior Research Officer
Child Advocacy Service
Royal Children’s Hospital, Brisbane
Health of Australian Children in Out of Home Care: Needs and Carer
Recognition
Study Background
• Child Advocacy Service: Our role
• Initial study into health needs of children in out-of-home care
• Presentation Overview:– Brief literature review– Methodology of study– Results– Implications – Further research
Health Needs of Australian Children in Care
• Children in out-of-home care documented to have high health needs– International Studies:
• 92% at least one health issue (Chernoff et al, 1994)
– Australian children in care• 3% had no identified health problems• Higher rates of emotional and behavioural
problems, vision problems, hearing loss, speech difficulty and poor immunisation rates as compared to general child population (Nathanson & Tzioumi, 2007)
Carer Recognition of Health Needs
• Carers well placed to identify health need– In areas with no mandatory health screen
responsibility with carer to identify need– Studies suggest carers desire:
• More health-related training• Improved communication• Improved access to medical records(Mayers Pasztor et al., 2006)
– Carers’ abilities in recognition of health need unclear
Current Study
• Examine health need in Qld children in out-of-home care– Contrast with NSW findings from Nathanson &
Tzioumi (2007)
• Examine foster carer’s perception of health need in contrast to need established via paediatric health assessment
• Methodology:– Study reviewing Child Health Passports completed by
Child Advocacy Service 2006 – 2007 (n = 63)
Results- Health Need Perception
• Over half (55%) of carers listed either no health concern or one concern only for the child at presentation
Concern Type %
Behaviour 25
Speech and language 16
Developmental 14
Dental 11
Hearing 8
Specific ADHD 6
Respiratory 6
Immunisation 5
Learning difficulty 5
Results- Referrals
• 70% of children required multiple (two or more) referrals to varying services
Number of Referrals
%
0 5
1 25
2 30
3 18
4 14
5 8
Results- Referrals
* Nathanson & Tzioumi, 2007
Child Health Referrals
QLD (%) NSW*(%)
Paediatrician follow-up (41%) Dental (71%)
Counselling (30%) Speech therapy (34%)
Audiology (26%) Counselling (29%)
Dental (21%) Developmental asses. (26%)
Speech pathology (21%) General paediatrician (25%)
Results- Immunisation
• Disadvantage in preventative health care utilisation– 68% of children fully immunised
• Similar rate to the 61% reported in NSW (Nathanson &
Tzioumi, 2007)
– General Queensland child population:• 87 percent of children fully immunised at their 5th
birthday (ACIR, 2008)
Implications
• High level of health need and poor preventative health utilisation
• Ability of carer to meet high numbers of referrals, given child load per carer– 1.9:1 children to approved carer ratio– 30% carers with 3+ children
centralised health service delivery
Implications
• Carer recognition of health issues– need for health education for carers and child
protection staff
• Necessity of comprehensive, multidisciplinary health screens for all children in care– Follow-up necessary to ensure referrals met
Long-term Outcomes for Health Screening
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5
Physician Visit/Yr
Dental Visit/Yr
Emergency RoomPresentation
Medicaid Children in Care
Relative odds ratios of healthcare service utilisation for Illinois children in care vs. children receiving Medicaid (Jaudes et al., 2010)
Nb. Odds ratios controlled for gender, ethnicity, age and region of state
*All significant at p < .0001.
Acknowledgments
• Royal Children’s Hospital Foundation Brisbane
• Co-author: Karin Rissel, CN & CPLO, CAS
Contact: [email protected]