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Changes Needed for Children in Out-of-home care

Major Changes Needed for Health of Children in Out-of-home Care: New Policy Released by New Zealand Paediatricians Today

AUCKLAND Aug. 8 /MediaNet International- AsiaNet/ --

Children in out-of-home care are likely to have poorer physical, mental and developmental health than their peers. A new policy by paediatricians released today says major changes are needed to the New Zealand health system to look after these children. The policy recommends routine ongoing health screening of all children on out-of-home care, improved access to health records of birth parents and improved support and training for foster carers.

Out-of-home care (also known as alternative care) arrangements include foster care, kinship placements and residential care. These placements can be instigated either by voluntary arrangement or via a court order.

At 30 June 2004, 5071 children were in care placements in New Zealand. Kinship placement is the preferred policy of the New Zealand Child protection services and 36% of children in care placements live with family or Whänau (Extended family). Average length of stay in care has been increasing and is currently almost three years.

“There are multiple reasons for vulnerability in these children including their high prevalence of abuse and neglect, their greater likelihood of disadvantaged backgrounds, and their increased biological weighting from parents,” Member of the working group, Dr John Clarkson said.

Children in foster care have a high level of psychological and mental health problems. It has been observed that foster parents and social workers tend to under-report psychological problems and therefore screening and careful assessment as well as effective intervention is needed.

“We recommend all children entering alternative care have a comprehensive health assessment within 30 days of placement. Then we would like every child to have a health coordinator and a follow-up health review within three months of assessment and subsequently at least on an annual basis.”

Regular health include physical examination, growth assessment, vision, hearing and dental screening and immunisation register check. It is also necessary to conduct developmental assessment and mental health screening on a regular basis.

“We propose strengthening support and training programs for foster parents. It is also important to ensure foster placements are not overcrowded or in other ways unable to meet the needs of the child,” Dr Clarkson said.

Communication between different groups such as health professionals, child welfare workers, foster carers, and biologic parents is often very poor. Medical information needs to be transferred to everyone involved in the care of children in out-of-home care. Listening and responding to foster children’s opinions and ideas as to how their health needs may be best met; and engaging birth parents in their child’s ongoing health planning where possible is important.

“Absence of information about birth families, birth history and early health issues is commonplace and problematic, and an important function of any health assessment is searching for and collation of what information is available,” Dr Clarkson said.

The RACP suggests the government investigate giving Community Services workers access to health records of birth parents in a fashion which is consistent with privacy legislation.

The RACP recommends a system be set up to manage health records of children in care, as change of placement in care often results in change of primary health practitioner and change in school and contributes to poor communication and difficulties of information transfer. Change of caseworker has a similar effect.

Recording information should include a patient hand-held record containing past history, relevant family history, health assessment information, treatments and interventions.

The RACP is responsible for training, educating and representing over 9,000 physicians in Australia and New Zealand. The RACP represents 25 medical sub-specialties including paediatrics, public health and occupational medicine. Physicians are often called medical specialists. They are doctors who have completed an extra eight years or more of training after their initial university medical training. Patients are generally referred to a physician by a general practitioner seeking expert medical advice.


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