Developmental health and
wellbeing of Australian Aboriginal
children in out-of-home care: Are
we making a difference?
Shanti Raman South Western Sydney Local Health
District
Phuong Tran KARI & SWSLHD
Stephanie Ruston KARI & SWSLHD
Paul Hotton South Western Sydney Local Health
District
Sarah Irwin KARI Aboriginal Resources Inc.
Shannon Thorne KARI Aboriginal Resources Inc.
Acknowledgement of Country
KARI
KARI Aboriginal Resources Inc.
Aboriginal
Child
Protection
OOHC
All
Community
Support
Programs
Community
Engagement
KARI
Intervention
and
Prevention
Services
Youth
Education
Services
Community
Capacity
Building
Cultural enrichment
Casework
&
supports
Services:
•
•
•
•
Cultural Care Plans
Genograms
Cultural Camps
Cultural Vacation
Care
• Cultural Training
Cultural
Unit
OOHC
Program
Carer
Recruitment
Clinic
What we know
Children in OOHC
• 40,549 Children in OOHC in Australia (13,952 Indigenous) (AIHW, 2013)
• Indigenous children in care 10.6 X the rate for non-Indigenous children
• Effects of trauma on health, development and wellbeing
Aboriginal Children
• Lag behind in health, developmental outcomes compared to non
Aboriginal children
• Compounded by poverty, dislocation and colonisation history
Urban Aboriginal Children
• Developmental lags at 3 years compared to typically developing children
• Health/development outcomes for those in care similar to non-Aboriginal
• Perform higher than remote counterparts in expressive language skills
Onsite Staff:
KARI’s Clinic
•
•
•
•
•
Casework
&
supports
Cultural
Unit
OOHC
Program
Carer
Recruitment
Clinic
Psychologists
Occupational Therapist
Speech Pathologists
Early Childhood Nurse
Dietitian
Liverpool Hospital MOU &
Partnership
• Provides Paediatrician &
Physiotherapy
• Supports onsite clinicians
Onsite Services:
• KAMAC
• Individual assessment &
therapy
• Group therapy (e.g.
playgroup, school
readiness)
• Carer education & training
When do we assess?
Primary Health Screen
• (Within 30 days)
• Completed by OOHC Child & Family Health Nurse
Comprehensive Health Assessment
• (Within 90 days)
• 2 or more health/developmental concerns
• Paediatrician & Allied Health
• Carer
• Caseworker
Therapies & Interventions
• Specialist consults (e.g. ENT)
• Hearing test
• Therapies (speech, occupational therapy, counselling)
• Carer training
Reviews
• 0-5yr olds every 6 months
• 6yrs+  every 12 months
Assessing Aboriginal children in
OOHC
− Working in collaboration with Aboriginal co-workers to create
and interpret Ax methods and results (Gould, 2008)
− Consider the role of standardised Ax
− Griffiths’ Mental Developmental Scale – valid for urban
Aboriginal infants (Bennet et al. 2010)
− What is the purpose of an initial assessment?
– Dynamic assessment
Trauma informed practice
Understanding trauma history
Establishing and maintaining a relationship
Providing safety in therapy through:
– Routine
– Consistency
– environment
– Being playful
Aims
Broad goal: to identify factors that promote resilience and cultural
wellbeing in Aboriginal children in care in the urban setting
− to determine health, developmental needs of a subset of
children in OOHC with KARI, who have been in stable care for
at least a year
− to identify child, carer and intervention characteristics that
contribute to children doing well
− to identify enablers and barriers to providing culturally
competent intervention using a trauma-informed lens.
Methods
− Identified children in KARI care who have been in stable OOHC
− Compared clinical measures and outcomes for these children
with results from previous audits (2009 and 2013)
− Key informant interviews with clinicians and caseworkers
− Identified risk and resilience factors in home and school functioning
for each child
− identified enablers and barriers to culturally competent intervention
– Triangulate findings of audit, interviews and guidelines for
culturally competent care
The Mob: 26 children identified
Avg. age
5.rs (1.1 – 14.3yrs)
Gender
14 male (55%),
Contact with family
Regular: 27 %
Inconsistent: 42%
No contact: 31%
Care type
7 (27%) in kinship care, rest in foster care
Consistent
caseworker
3 (12%)
Single carer
10 (38%)
Health issues: at initial assessment
KARI 1
(n=99)
KARI 2
(n=99)
Current cohort
% (n=26)
Vision
35
21
19
Hearing
44
43
42
Dental
36
19
24
Chronic health
concerns
40
-
58
Referral to specialist
30
-
42
Concerns
Other Health problems
− Enuresis, encopresis
− Asthma, Sleep disorders
− Investigation for seizures, FASD
− Congenital conditions, haematological
− Risk for Hepatitis C
− Referrals: Ophthalmology, Genetics, ENT,
Cardiology, Neurology
Developmental / Behavioural Issues
KARI 1 %
(n=99)
KARI 2 %
(n=99)
Current cohort %
(n=26)
Global Developmental
Delay
27
13
35
Speech Delay
54
65
81
Fine Motor
33
51
81
Behavioural
45
34
35
Educational*
64
57
54
Concerns
* Of those attending school
Therapeutic intervention
− Speech: 23 had SP with KARI, 2 outside
− OT: 10 had OT with KARI, 6 outside
− Psychological: 6 (gap in availability 2012-13)
− Cultural connectedness: 20
The good news!
− Overwhelming majority (25/26) made
measureable progress
− Majority of carers (22/26) were engaged with
KARI services
Risk and resilience factors: child
Strengths
Difficulties
Young age
“Cute”, bright, healthy, self-confident, High needs: behavioural,
healthy attachment
developmental
Siblings together*, kinship care*
Siblings together*
Connection to culture, KARI
Inconsistent contact with natural
parents
* Context dependent
Risk and resilience factors: carers/ home
Strengths
Difficulties
Carer understanding needs of child
Carers who don’t deal with trauma
Carers wanting to keep siblings
together
Kinship carers with family pathology,
guilt
Structure, routine, stability
Size of family group: for an Aboriginal
family “4” is small!
Two carer situation
Overbearing, over protective kinship
placement
Well supported
Not accessing intervention/therapy
Kinship carers that “don’t bend rules” Standard of assessment: kinship
carers lower than foster carers
Risk and resilience factors:
intervention /therapy
Strengths
Difficulties
Reparative parenting course
“Doesn’t matter what course they do”
Supporting attachment with children
Carers who have not dealt with own
trauma, mental health issues
Carers engaged with therapy
Carers not engaged
Good early education support,
especially Aboriginal specific
Carers struggling to carry through
with therapeutic advice at home
Culturally embedded
Risk and Resilience Factors:
KARI as service
Strengths
Difficulties
Everyone is “aunty” and “uncle”
Connecting with kinship carers
Good connection with some
Community Service* Centres
Carers transitioning from elsewhere
Rapport between workers and carers
Hazy lines of responsibility
Caseworker attachment with children Diversity of cultural background:
knowing where children belong
KARI seen as culturally “safe” place
* Statutory agency
Conclusions
–When children are in stable care: most improve
–Cultural engagement appears to be major factor in
children’s health, wellbeing, personal development
–Risk/resilience factors related to child, carer, and
service identified: some not amenable to change
–There are challenges to delivering a traumainformed, culturally embedded program in a large
metro: BUT IT CAN BE DONE!
Questions?
Acknowledgements
Shanti Raman
Community Paediatrician, South Western Sydney Local Health District
Stephanie Ruston
Speech Pathologist, KARI Aboriginal Resources Inc. & South Western Sydney Local Health District
Sarah Irwin
Psychologist, KARI Aboriginal Resources Inc.
Phuong Tran
Occupational Therapist, KARI Aboriginal Resources Inc. & South Western Sydney Local Health District
Paul Hotton
Fellow – Community Paediatrics, South Western Sydney Local Health District
Shannon Thorne
Clinic Co-ordinator, KARI Aboriginal Resources Inc.
Paul and Cheryl Ralph
CEO & Founders, KARI Aboriginal Resources Inc.
Casey Ralph
Chief of Operations, KARI Aboriginal Resources Inc.