Fixing out-of-home care

Volume 6 Number 11 November 8 - December 12 2010

The number of children and young people living in out-of-home care in Australia has increased by 117% since 1999. PhD candidate Susan Webster from the General Practice and Primary Health Care Academic Centre has dedicated her research studies to improving understanding of why our health system is failing this vulnerable group. Emma O’Neill reports.

Parents notice things. They notice when their child is coming down with something, and they notice when their child ‘just isn’t themselves’. This is a skill born from a daily investment in their child’s health and well-being. But who is looking out for the health of these young people when this watchful eye is not available and a child or young person is taken into out-of-home care?

Technically, responsibility falls to the state and according to PhD candidate Susan Webster the states – despite good intentions – are proving to be a clumsy and inattentive parent when it comes to assuring appropriate health services for those in out-of-home care.

Out-of-home care is a service provided by all state and territory governments for children and young people up to the age of 18 who are unable to live with their parents, often following child abuse or neglect. Ms Webster says many children who enter out-of-home care have been affected by significant trauma.

 “Traumatic experiences can adversely affect a child’s growth and development; their concentration and learning; their physical and emotional health, and their ability to form healthy relationships with those around them,” Ms Webster says.

“These adverse effects can be both short and long-term, and may persist into adulthood if not addressed.”

Despite the obvious need for focused attention on the health and wellbeing of young people in out-of-home care, Ms Webster says the issue is often in the shadows behind a challenging, and at times overwhelming web of complex decision-making about the removal of children from their parents; family reunification, and maintaining sufficient numbers of out-of-home places.

Yet Ms Webster finds it hard to accept that the issue should remain in back room discussions at child protection conferences, or that providing improved health care is unsolvable. Inspired by a vision of the late Dr Peter Waxman – a well respected Victorian General Practitioner – who advocated that all children in out-of-home care should have their own GP who understands their specific health needs, Ms Webster decided to take this particular piece from the puzzle of improving outcomes for those in out-of-home care, and focus on improving it.

As fate would have it, Associate Professor Meredith Temple-Smith – who has three adopted children of her own – had just commenced at the University in 2006 when she came across Ms Webster’s initial Master of Primary Health Care application and she immediately became interested in supervising her research.

“As soon as I read what Susan wanted to focus on, I was interested. These kids in out-of-home care aren’t just falling through cracks in the system when it comes to their health; it’s more like they’re falling into a chasm,” she says.

“A lot of people are put off researching this area because it’s too hard; but it shouldn’t be ignored and Susan has refused to accept that nothing can be done to improve the situation.”

Ms Webster’s PhD research focuses on a practical assessment of barriers and enablers to comprehensive health needs assessment for Australian children and young people in out-of-home care.

“I want to understand what factors are currently making it so difficult for Australian states and territories with statutory responsibility for the health and well-being of children and young people in out-of-home care to assure that there is a comprehensive picture of each individual child or young person’s health needs,” she says.

 “This is the right of every child in out-of-home care under the 1989 UN Convention on the Rights of the Child, to which Australia is a signatory.”

Ms Webster says that while some state and territories have hospital-based clinics where those in out-of-home care can be referred for comprehensive screening, only some children in care are referred and many clinics cannot offer follow-up treatment.

“In Victoria, the present system is that a carer will initially take a child to a local GP to check that they have no current infections or illnesses. However, no centralised records are kept of this visit, a medical history is seldom available to the doctor and these visits have no agreed format or report. As the usual GP consultation time is about 14 minutes, this system provides an important initial health check for current infections but is not comprehensive and does not go far enough.”

The Royal Australasian College of Physicians recommends that everyone entering out-of-home care should have a complete, comprehensive health assessment within the first month.

As a preliminary step in establishing the scope of Ms Webster’s PhD research, last month she collaborated through the University with two important organisations to convene a national symposium dedicated entirely to sharing knowledge about ways of addressing the health of children and young people in out-of-home care.

General Practice Victoria and the Victorian Office of the Child Safety Commissioner played an important role in sponsoring and helping to develop the symposium. Their support represented a significant contribution to further research in this challenging area.

 “These issues are complex and decision-making is not necessarily evidence-informed but may be strongly influenced by policy or financial considerations.

“The underlying premise of the symposium was that there is no current monopoly on wisdom about how to achieve better health for those in out-of-home care in Australia. From that standpoint, published research was not privileged over papers drawing on direct clinical or professional experience.”

More than 100 delegates, including representatives from paediatrics, general practice, psychology, social work, academia and child protection registered to discuss a variety of current research and program initiatives, and identify current barriers and practical solutions.

Ms Webster said she was pleased that the spotlight is now shining towards addressing the health needs of children and young people living in out-of-home care and is hoping that Australian research can contribute to understanding about sustainable options for building better health in the future.

“It’s a complex problem, but these children and young people are blameless. They have a right to the best health care our nation has to offer.”