To understand how the health care needs of children and young people in out-of-home care may be addressed it is necessary to consider the broader processes of the overall child protection system. In this context there have been increasing concerns in recent years about the efficacy and impacts of a child protection system that is fundamentally based on statutory investigation and mandatory reporting, such as those used in Australia, the United States and Canada.74 In summary, too many reports are being made to child protection authorities that do not warrant the exercise of statutory powers. As a result, much effort and cost is expended in managing reports/notifications and the children/young people who are the subject of these reports receive little in the way of support or assistance.75
As a consequence, there is an increasing international trend toward a public health model of child protection. This model of child protection is similar to that used in some Western European countries in that it is focussed on a model of prevention rather than a legalistic emphasis. The model employs a range of public health strategies that target whole populations or sub-groups within populations, and strategies are generally divided into primary, secondary and tertiary interventions.
The National Framework for Protecting Australia’s Children 2009-202076 notes that leading researchers and practitioners – both in Australia and overseas – have suggested77, 78, 79 that applying a public health model to care and protection will deliver better outcomes for our children and young people and their families.
“Under a public health model, priority is placed on having universal supports available for all families (for example, health and education). More intensive (secondary) prevention interventions are provided to those families that need additional assistance with a focus on early intervention. Tertiary child protection services are a last resort, and the least desirable option for families and governments.”
Brief wellbeing assessments at intake can identify children at risk of significant behavioural problems and in need of support during the early phases of placement from those with a lowered risk. 80, 81 Early therapeutic intervention with these children may enhance their wellbeing, provide them with greater opportunity for stability while in care and increase the likelihood of better long-term outcomes.
Studies show that when professionals use reliable and valid screening instruments, they are able to identify 70% to 80% of children with developmental delays.82
The Submission to the Special Commission of Inquiry into Child Protection Services in NSW (March 2008) provides extensive further detail on how the public health model could be applied to overall child protection and in addressing health care needs of children in out-of-home care.83
74 Submission to the Special Commission of Inquiry into Child Protection Services in NSW (2008) NSW Commission for Children and Young People
75 Report of the Special Commission of Inquiry into Child Protection Services in NSW (2008) The Hon James Wood AO QC
76 Protecting Children is Everyone’s Business National Framework for Protecting Australia’s Children 2009-2020, Commonwealth of Australia (2009)
77 Holzer, P. J. (2007). Defining the public health model for the child welfare services context. Resource Sheet no. 11. Retrieved from www.aifs.gov.au/nch/pubs/sheets/rs11/rs11.html
78 O’Donnell, M., Scott, D., & Stanley, F. (2008). Child abuse and neglect - is it time for a public health approach? Australian and New Zealand Journal of Public Health, 32(4), 325-330.
79 Scott, D. (2006). Towards a public health model of child protection in Australia. Communities, Children and Families Australia, 1(1), 9-16.
80 Barber, J. G., & Delfabbro, P. H. (2003b). The first four months in a new foster placement: Psychological adjustment, parental contact, and placement disruption. Journal of Sociology and Social Welfare, 30(2), 69–85.
81 Barber, J. G., Delfabbro, P. H., & Cooper, L. (2001). The predictors of unsuccessful transition to foster care. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 42(6), 785–790.
82 Squires, J. Nickel, R. E., Eisert, D. (1996). Early detection of developmental problems: Strategies for monitoring young children in the practice setting. Journal of Developmental & Behavioral Pediatrics, 17, 420–427.
83 Submission to the Special Commission of Inquiry into Child Protection Services in NSW (2008) NSW Commission for Children and Young People