The available literature widely acknowledges that children and young people in out-of-home care (OOHC) are a highly vulnerable group with increased physical, mental and social health needs and with limited access to resources.1 They are also more likely to have significant, often unrecognised and unmet health needs, increased rates of developmental difficulties and are less likely to access preventative health services such as immunisation. The development of a National Clinical Assessment Framework for Children and Young People in OOHC [the Framework] is a key component of the Child Health and Wellbeing Subcommittee2 (CHWS) led project aimed at ‘supporting the health needs of children and young people in out of home care (OOHC)’.
The overarching goal of the Framework is to improve responses to health needs of children and young people in OOHC and ultimately their health outcomes. Three objectives of the framework are:
- Improve the consistency of health care assessments and services for children and young people in OOHC provided by States and Territories.
- Provide advice about the role of clinicians and appropriate assessment tools.
- Guide jurisdictions to develop appropriate policies and to assist health professionals to make clinical decisions in order to detect problems early, when they are most amenable to interventions.
Additionally, another initiative arising from the National Framework is National Standards for OOHC which were agreed by the Community and Disability Services Ministers’ Conference (CDSMC) in December 2010.
The National Standards have been designed to deliver consistency and drive improvements in the quality of care provided to children and young people.
Standard No 5 states: “Children and young people have their physical, developmental, psychosocial and mental health needs assessed and attended to in a timely way.” 3
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Figure 1 - Relationship of the National Clinical Asessment Framework to implementaiton of the National Framework for Protecting Australia's Children 2009-2020.
The Framework has been developed in consultation with a range of government and non-government stakeholders with a focus on clinical, child protection and consumer issues.
What is out-of-home care?The Australian Institute of Health and Welfare (AIHW) has described OOHC as the provision of ‘alternate accommodation for children and young people who are unable to live with their parents. It is defined as out-of-home, overnight care for children and young people under 18 years of age where the state or territory offers a financial payment.4 A more comprehensive description of OOHC is included at Appendix A.
Children or young people may enter OOHC due to substantiated child protection concerns, because their parents are incapable of providing adequate care or because alternative accommodation is needed during times of family conflict. The placement of a child or young person in OOHC often follows a successful application to a relevant court to place the child or young person on a care and protection order, although in some cases agreement is reached with families to meet the protection and care needs of the child on a voluntary basis.5
A child or young person may enter OOHC on a temporary or long term basis, which can impact the type of health assessments undertaken and the level of health care provided.
Health status of children and young people in OOHCChildren and young people in OOHC often have high unrecognised and unmet complex health needs.6,7 They tend to have poor physical health, developmental delays and compromised mental health; they also have a lower rate of immunisation uptake compared to their peers.8 They tend to experience lack of easy access to health resources that are otherwise available to the rest of the community.9
Whilst it is true that a significant portion of children in OOHC have been the subject of abuse or neglect, multiple other reasons account for the vulnerability exhibited by these children including their greater likelihood to be socio-economically disadvantaged and their increased likelihood to have a parent with mental health or drug abuse problems. All of these factors also contribute to fragmented health care prior to placement in OOHC.10,11
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Furthermore, the large number of placements experienced by some children in OOHC often leads to reduced availability of information about past medical history, maintenance of accurate information about current health status and poor continuity of healthcare.12
Early identification, referral, intervention and coordination of care have been shown to improve health and wellbeing outcomes.
It is also essential that systems are put in place to ensure that when a child or young person in OOHC is moved to a different carer, all parties involved in that child’s medical, developmental and emotional care are notified and that the child’s personal health record is made available to the new carers. It is also essential that all medical records are made available to any new professionals who may become involved following the move.
The Framework aims to provide better consistency of healthcare assessments and services for all children and young people in OOHC. It will assist healthcare professionals to detect problems early when they are most amenable to interventions. The Framework will also support individual state-based initiatives aimed at improving health outcomes and contribute to other initiatives aiming to collect nationally consistent data on the health and wellbeing of children in OOHC.
1 Royal Australasian College of Physicians (2006) Health of Children in “Out-Of-Home” Care - Paediatric Policy
2The CHWS reports to the Australian Population Health Development Principal Committee (APHDPC) under the auspices of the Australian Health Ministers’ Advisory Council (AHMAC)
3 “An outline of National Standards for out-of-home care” – Department of Families, Housing, Community Services and Indigenous Affairs & National Framework Implementation Working Group, December 2010
4Australian Institute of Health and Welfare (2010) Child protection Australia 2008-09. Child Welfare Series Number 47. Cat. no. CWS 35. Canberra: AIHW p4
5Australian Institute of Health and Welfare (2010) Child protection Australia 2008-09. Child Welfare Series Number 47. Cat. no. CWS 35. Canberra: AIHW p3
6Tarren-Sweeney in Bromfield, L, Higgins, D, Osborn, A, Panozzo, S, and Richardson, N, 2005, Out of Home Care in Australia: Messages from Research p 34.
7Department for Community Development (WA), Placement Services.
8Nathanson, D and Tzioumi D, (2007) Health needs of Australian Children living in out-of-home care, Journal of Paediatric and Child Health, 43 pp 695-9.
9 Royal Australasian College of Physicians (2006) Health of Children in “Out-Of-Home” Care - Paediatric Policy
10 Royal Australasian College of Physicians (2006) Health of Children in “Out-Of-Home” Care - Paediatric Policy
11Department for Community Development (Western Australia) (2004) Parental Drug and Alcohol Use as a Contributing Factor in Care and Protection Applications 2003, p 3.
12 Payne H (2000) The health of children in public care. Current opinion in psychiatry 13: 381-388.