Children and young people in Out of Home Care (OOHC) have poorer health than other children and young people. This consultation will inform the development of a new Victorian Out of Home Care Health Strategy. cohealth’s submission identifies a range of features of providing effective services to these children, particularly emphasising the importance of ongoing care coordination. Community health services are well placed to provide a systematic response to the health and primary care needs of children in OOHC.
Looking after Children’s Health in OOHC Consultation
Prof Lena Sanci
Department of General Practice
University of Melbourne
Dear Professor Sanci,
Re: Looking after children’s health in Out of Home Care
Thank you for the opportunity to contribute to the consultation to inform the development of a new state-wide Out of Home Care (OOHC) Health Strategy.
Children and young people in OOHC experience higher rates of physical and mental health conditions, including developmental delays and disabilities, than other children and young people. They often have limited and/or sporadic access to preventative or coordinated care, which contributes to increased risk of chronic disease, mental health issues, substance abuse and other ‘potential-limiting’ health concerns later in life.
Children and young people in OOHC sometimes relocate frequently and their lives are often shaped by change and instability. The OOHC system is designed to prioritise the safety of children and young people and address their basic survival needs such as housing and supervision. This can mean that there is limited ongoing or consistent focus on their health and wellbeing needs beyond ensuring basic health checks and responding to urgent care, which leads to potentially high unmet health needs. Even when a more comprehensive plan is developed by a general practitioner, responsibility for coordination and sequencing this support falls between providers, meaning that accountability is unclear. The complex needs of these children and young people mean that a much more coordinated and comprehensive approach is required.
Research and clinical practice guidelines now recognise that most children in OOHC need high-quality, well-coordinated health care to redress the health impacts of past maltreatment and minimise the impacts on their future health and wellbeing. Improving the health of children in OOHC will support them to realise their potential and participate fully in education, employment and community life into the future.
cohealth recognises the pressing physical and mental health needs of children and young people in OOHC and is committed to improving the care provided to this particularly vulnerable group. In line with the Community health integrated program guidelines, Child health services: guidelines for the community health program and priority access to public dental services, children in OOHC are a priority group for a range of our services. A such they access a variety of cohealth health and social support services. Beyond this, however, our specific responses to date for children in OOHC has been limited to a small number of programs.
A particular example is the Koolin Balit Out of Home Care Clinic that has been run from our Braybrook site since 2016. This clinic provides culturally safe health care specifically for Aboriginal and Torres Strait Islander children aged 0-18 living in out of home care. The service aims to improve the health of Aboriginal and Torres Strait Islander children by looking at each child’s physical health, growth, speech and psychological wellbeing. Once the holistic needs of each child are understood a health and development management plan is created for child protection workers and carers.
The Koolin Balit health care team is made up of a paediatrician, an Aboriginal and Torres Strait Islander health worker, a speech therapist and a mental health worker. The team works with each child and their carer and/or case manager to develop a health management plan. The team approach, incorporating physical and mental health and developmental status in a culturally safe setting, reflects the importance of a multi-disciplinary response to provide holistic care for children in OOHC.
Our experience with the Koolin Balit clinic has highlighted a number of challenges with ensuring that children and young people in OOHC receive the health care they need, including:
Key features of providing effective services to children in out of home care include:
Ongoing care coordination is critical to ensuring children in OOCH receive the health services they need. Over time, many children experience changes in care arrangements – moving between home and OOHC, between foster carers, and residential care – which can result in a loss of continuity of knowledge about their health needs and plans. Changes with the child protection workers assigned to the child compounds this situation. As a result, referrals to specialised health, allied health and mental health services may not occur, and treatment plans cannot be followed.
The missing role in responding to the health needs of children in OOHC is someone who has long-term oversight of their physical and mental health needs, responsibility to ensure these are met and an ability to support carers and families in their understanding of health needs and assist them to meet these needs. A health care coordinator (a role that could also be known as a clinical care coordinator, health navigator or case coordinator) would be able to navigate systems on behalf of children in OOHC and ensure health needs are addressed over time.
Traditional medical and allied health services are devolved and separate, with limited ability for information sharing or integration of services. In contrast, community health services provide many key services within the one organisation, improving integration of care and information sharing. cohealth sees significant potential for community health services to play a key role in the delivery of healthcare to children in OOHC.
As described above, cohealth provides a wide range of medical, nursing, allied health, child health, mental health, oral health, health promotion and social support services. We have strong links to external services such as paediatric specialists, hospital services, and other specialised services such as optometry, audiology and maternal and child health. We have an explicit commitment to working with people who experience disadvantage, and as such have lengthy experience working with those with complex needs. Other organisational experience relevant to meeting the health needs of children in OOHC includes: care coordination; goal directed care planning embedded across the organisation; working with diverse communities; developing partnerships with other organisations to maximise health outcomes; chronic disease care coordination; and a commitment to codesigning programs with consumers and communities.
While recognising that community health services all offer a different range of physical health, allied health, mental health and social supports services, they each provide a range of services that mean they are well positioned to provide a systematic response to the health and primary care needs of children in out of home care. The multidisciplinary approach and internal linkages enables more effective care planning, and services have strong links with a range of external health and social support services. Community health services can provide training to all their staff involved in providing health care to children in OOHC, ensuring all practitioners have a sound understanding of the needs of this group.
As such, community health services are well placed to provide a ‘child-centred health home’ for children in OOHC, whereby an integrated health system wraps around the child and uses a team-based approach to fulfil their care. The state-wide coverage of community health services also has the potential to be the foundation for a systemised, consistent network of care across the state.
Providing integrated care for children in OOHC requires investing in the capacity of the system to provide the necessary health care coordination. Coordinating health assessments and appointments, tracking care plans, following up on referrals, maintaining the relationships between the child, child protection, health providers, carers and family members is work that is not resourced in current funding arrangements for any of the key sectors – child protection workers, medical or allied health practitioners.
In addition to investing in care coordination/navigation, effectively meeting the needs of children and young people in OOHC requires adequate resourcing for:
I would welcome the opportunity to discuss this submission with you and can be contacted on Nicole.Bartholomeusz@cohealth.org.au.
Interim Chief Executive