The Health Status of Children and Young People Who Come into Care Dr David Rankin Child, Youth and...
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Transcript of The Health Status of Children and Young People Who Come into Care Dr David Rankin Child, Youth and...
The Health Status of Children and Young People
Who Come into Care
Dr David RankinChild, Youth and Family
2 September, 2011
Royal New Zealand College of General Practitioners
Profile of ChildrenWho come to the Attention of CYF
Children Who Come Into Care(Aged: pre-birth to 17th birthday)
• 124,921 notifications to CYF– 13% increase on 08/09
– 8,326 from health practitioners
• 55,494 required further action– 21,025 findings of maltreatment
• 12,535 emotional abuse• 4,403 neglect• 2,886 physical abuse• 1,201 sexual abuse
• 3,178 individuals brought into custody
• CYF involved with 21,357 families• 5,446 individuals in custody of CE
2009-2010
• 53% of children are Maori
• < 53% have parents with AoD issues 1
– 67% for YP in a CYF residence 2
– 71% of mothers of children under 23
• 19% have parents with a MH history 1
– 54% for girls in a CYF residence– 43% of mothers of children under 23
• 25% of mothers have criminal convictions3
• 56% boys/ 26% girls hit >3 times last year2
• 50% have breakfast (Youth Health 07 = 90%4)– 54% of girls always have an evening meal
(99.6%)
• 76% have a family doctor– Only 56% see the same doctor each time
• 44% see a dentist each year (79%)
Profile of Children in Care
1 Results reported from the Needs Identification Prompt2 McKay & Bagshaw. Health needs of YP in CYF residential care, 2010 – Survey of 94 x 12 – 18 yo YP in YJ and C&P residences3 Research by CYF on 400 children under 2 in care. Completed in 2010 4 Youth Health Survey ‘07
Adverse life experiences(report on Children in High and Complex Needs Unit, 2010)
0% 20% 40% 60% 80% 100%
Abuse & Neglect
Parental Separation
Multiple Caregivers
Domestic Violence
Parental Mental Health
Multiple School Placements
Parental AoD
Other
Parental Offending
Family Transience
Accidental Injury
Gang Culture
ConsequencesOf Abuse and Neglect
Maternity, Disability & Chronic Disease
Maternity
(Conception)
Disability Support
Intellectual Disability
Asthma Diabetes
Non-CYF 13% 1% 1% 17% 1%
Notification 35% 2% 2% 25% 1%
Investigation 41% 3% 2% 25% 1%
Entry to Care 45% 6% 4% 23% 1%
YSS 51% 8% 5% 24% 1%
Residence 63% 10% 6% 28% 2%
Mental Health
Inpatient Events
Outpatient Events
Costs Life-time Incidence
Non-CYF 0.01 0.26 $108 13%
Notification 0.04 0.71 $437 31%
Investigation 0.02 0.99 $399 39%
Entry to Care 0.05 1.49 $718 42%
YSS 0.12 2.28 $1,325 58%
Residence 0.35 4.51 $2,062 84%
Outcomes Children Known to CYF
> 30% need education support> 29% end up with a corrections sentence 5
> Make up 67% of the adult justice population> 50% of completed youth suicides6
> 30% have been in care6
> Up to 67% are mothers within 18 months of leaving care7
> Extreme high risk behaviours (YP in residence)2
> 65% drive after drinking (Youth ’07 = 8%)> 7% more than 4 times in the last month
> 38% never or hardly ever used seatbelts
> 92% sexually experienced (36%)
> 35% boys and 18% girls >10 partners
> 80% of boys (68% girls) use cannabis (16%)
5 Recent work by CYF on Drivers of Crime6 Brown (2000), confirmed through TWB research7 Report from Victoria. NZ stats are unknown
Barriers to Accessing Health Services
> Children cannot advocate effectively for themselves> Parental capacity
> mental illness, AoD, finances, offending histories> Transience> Placement stability> Social worker skills and training in mental health> Language between professionals> Responsiveness from mental health services> Inter-sectoral relationships> Health service funding> Exclusions and interpretation> Lack of integration between services > Recognition of infant mental health issues> Lack of primary care based child service (particularly mental health)> Workforce constraints
Solutions
Government Investment
Budget 2011 announced the Government’s commitment to addressing the health & education needs of children who come to the attention of Child, Youth and Family
• Gateway Assessments– $3.8 million a year
• Primary mental health– Building to $2.5 million per year over 3 years
• Intensive Clinical Support Service– Building to $2.5 million per year over 4 years
Child Identified as likely to Benefit from a Gateway Assessment
Gateway Assessment Coordinator
• Collect existing health information• Family health history
• Determine appropriate assessment
Health Assessor
• Review history• Comprehensive health assessment• Write report and recommendations
Social Worker/FGC Coordinator• Prepare information for use at FGC
• Complete child or young person’s plan• Monitor agreed recommendations
Education
Health
ACC
Social Worker
Health (NZHIS)
Social Worker
Well Child Provider
Family
Teacher/Principal(School or Early Childhood Centre)
• Complete education profile• Identify issues affecting education
Health Referrals(with consent and consultation)
Gateway Assessment Flow Chart
Urgent health appointment if
required
Social Worker/FGC Coordinator• Gain consent
• Refer for health assessment• Refer for education profile
Gateway Assessment Coordinator • Collate information from CYF, family, Health and Education
• Drafts Interagency Child Development Agreement with social worker• Facilitate Interagency Case Conference (if required)
• Follow-up on implementation of recommendations at 3 months
Primary Care> Referrals from Gateway Assessments> Mild to Moderate mental health = emotional and behavioural
conditions> Provided in the community > Builds on current adult mental health initiatives> 1,600 children a year> “Packages of Care” valued at $1,550 per child> Includes services for the child and the parent> Implementation over 3 years
Mental Health Services
Focus on the Child
• Identify the issue– Recognise the consequences– Gain skills in detecting mental health of infants and children
• Recognise the environment– Family issues (mental health, AoD, disability, skills)– Barriers to engagement
• Every contact is an opportunity to make a difference– Identify intervention options– Bridge silos of specialisation– Ensure engagement (not service provision)
• Solution focus– Move beyond the diagnosis
Be a “concerned Kiwi”, not a technician
Discussion & Questions