Developmental health and wellbeing of Australian Aboriginal
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.
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