The Health Status of Children and Young People
Who Come into Care
Dr David RankinChild, Youth and Family
2 September, 2011
Royal New Zealand College of General Practitioners
Profile of ChildrenWho come to the Attention of CYF
Children Who Come Into Care(Aged: pre-birth to 17th birthday)
• 124,921 notifications to CYF– 13% increase on 08/09
– 8,326 from health practitioners
• 55,494 required further action– 21,025 findings of maltreatment
• 12,535 emotional abuse• 4,403 neglect• 2,886 physical abuse• 1,201 sexual abuse
• 3,178 individuals brought into custody
• CYF involved with 21,357 families• 5,446 individuals in custody of CE
2009-2010
• 53% of children are Maori
• < 53% have parents with AoD issues 1
– 67% for YP in a CYF residence 2
– 71% of mothers of children under 23
• 19% have parents with a MH history 1
– 54% for girls in a CYF residence– 43% of mothers of children under 23
• 25% of mothers have criminal convictions3
• 56% boys/ 26% girls hit >3 times last year2
• 50% have breakfast (Youth Health 07 = 90%4)– 54% of girls always have an evening meal
(99.6%)
• 76% have a family doctor– Only 56% see the same doctor each time
• 44% see a dentist each year (79%)
Profile of Children in Care
1 Results reported from the Needs Identification Prompt2 McKay & Bagshaw. Health needs of YP in CYF residential care, 2010 – Survey of 94 x 12 – 18 yo YP in YJ and C&P residences3 Research by CYF on 400 children under 2 in care. Completed in 2010 4 Youth Health Survey ‘07
Adverse life experiences(report on Children in High and Complex Needs Unit, 2010)
0% 20% 40% 60% 80% 100%
Abuse & Neglect
Parental Separation
Multiple Caregivers
Domestic Violence
Parental Mental Health
Multiple School Placements
Parental AoD
Other
Parental Offending
Family Transience
Accidental Injury
Gang Culture
ConsequencesOf Abuse and Neglect
Maternity, Disability & Chronic Disease
Maternity
(Conception)
Disability Support
Intellectual Disability
Asthma Diabetes
Non-CYF 13% 1% 1% 17% 1%
Notification 35% 2% 2% 25% 1%
Investigation 41% 3% 2% 25% 1%
Entry to Care 45% 6% 4% 23% 1%
YSS 51% 8% 5% 24% 1%
Residence 63% 10% 6% 28% 2%
Mental Health
Inpatient Events
Outpatient Events
Costs Life-time Incidence
Non-CYF 0.01 0.26 $108 13%
Notification 0.04 0.71 $437 31%
Investigation 0.02 0.99 $399 39%
Entry to Care 0.05 1.49 $718 42%
YSS 0.12 2.28 $1,325 58%
Residence 0.35 4.51 $2,062 84%
Outcomes Children Known to CYF
> 30% need education support> 29% end up with a corrections sentence 5
> Make up 67% of the adult justice population> 50% of completed youth suicides6
> 30% have been in care6
> Up to 67% are mothers within 18 months of leaving care7
> Extreme high risk behaviours (YP in residence)2
> 65% drive after drinking (Youth ’07 = 8%)> 7% more than 4 times in the last month
> 38% never or hardly ever used seatbelts
> 92% sexually experienced (36%)
> 35% boys and 18% girls >10 partners
> 80% of boys (68% girls) use cannabis (16%)
5 Recent work by CYF on Drivers of Crime6 Brown (2000), confirmed through TWB research7 Report from Victoria. NZ stats are unknown
Barriers to Accessing Health Services
> Children cannot advocate effectively for themselves> Parental capacity
> mental illness, AoD, finances, offending histories> Transience> Placement stability> Social worker skills and training in mental health> Language between professionals> Responsiveness from mental health services> Inter-sectoral relationships> Health service funding> Exclusions and interpretation> Lack of integration between services > Recognition of infant mental health issues> Lack of primary care based child service (particularly mental health)> Workforce constraints
Solutions
Government Investment
Budget 2011 announced the Government’s commitment to addressing the health & education needs of children who come to the attention of Child, Youth and Family
• Gateway Assessments– $3.8 million a year
• Primary mental health– Building to $2.5 million per year over 3 years
• Intensive Clinical Support Service– Building to $2.5 million per year over 4 years
Child Identified as likely to Benefit from a Gateway Assessment
Gateway Assessment Coordinator
• Collect existing health information• Family health history
• Determine appropriate assessment
Health Assessor
• Review history• Comprehensive health assessment• Write report and recommendations
Social Worker/FGC Coordinator• Prepare information for use at FGC
• Complete child or young person’s plan• Monitor agreed recommendations
Education
Health
ACC
Social Worker
Health (NZHIS)
Social Worker
Well Child Provider
Family
Teacher/Principal(School or Early Childhood Centre)
• Complete education profile• Identify issues affecting education
Health Referrals(with consent and consultation)
Gateway Assessment Flow Chart
Urgent health appointment if
required
Social Worker/FGC Coordinator• Gain consent
• Refer for health assessment• Refer for education profile
Gateway Assessment Coordinator • Collate information from CYF, family, Health and Education
• Drafts Interagency Child Development Agreement with social worker• Facilitate Interagency Case Conference (if required)
• Follow-up on implementation of recommendations at 3 months
Primary Care> Referrals from Gateway Assessments> Mild to Moderate mental health = emotional and behavioural
conditions> Provided in the community > Builds on current adult mental health initiatives> 1,600 children a year> “Packages of Care” valued at $1,550 per child> Includes services for the child and the parent> Implementation over 3 years
Mental Health Services
Focus on the Child
• Identify the issue– Recognise the consequences– Gain skills in detecting mental health of infants and children
• Recognise the environment– Family issues (mental health, AoD, disability, skills)– Barriers to engagement
• Every contact is an opportunity to make a difference– Identify intervention options– Bridge silos of specialisation– Ensure engagement (not service provision)
• Solution focus– Move beyond the diagnosis
Be a “concerned Kiwi”, not a technician
Discussion & Questions
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