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