Event Reflection – Assessment of health needs of children entering out-of-home care: a mixed methods study
Dr. Karen McLean
Date: 18 February 2020 Location: Royal Children’s Hospital, Melbourne
Please Note: OPEN are currently in the process of organising for Dr. McLean to deliver her findings to the child and family services sector – keep an eye on the OPEN News and the OPEN Portal for details!
Dr. Karen McLean is a paediatrician who has previously worked to implement the Pathway to Good Health Clinic at the Royal Children’s Hospital. Pathway to Good Health clinics are DHHS funded specialist clinics led by a paediatrician (and involving a multidisciplinary assessment team) that provide comprehensive health assessments for children entering out-of-home care.
Dr. McLean undertook her PhD with the Murdoch Children’s Research Institute and the University of Melbourne Department of Paediatrics from 2017 to 2020. Her research was supported by OPEN and CFECFW through a Learning System Grant in 2017-18. The Learning System grant helped to fund the data linkage study that made up the third part of her research.
There are a number of reasons that ensuring high quality healthcare for children in out-of-home care is so important and challenging. Children are not only more likely to be diagnosed with health issues than the average population, but they are also less likely to receive consistent medical care as they move between placements and homes. This inconsistency effects their development and wellbeing not just in childhood, but into their adult years as well.
In response to this issue, the Australian Government developed the National Clinical Assessment Framework for Children and Young People in Out-of-Home Care (2011).
Dr McLean wanted to assess how well the standards outlined by this framework were being met for Victorian children, focusing on two research questions:
- To what extent are children (aged 0-12 years) who enter out-of-home care in Victoria having their physical, developmental, psychosocial and mental health needs assessed and attended to in a timely way?
- What are the barriers and enablers to timely health assessment?
Studies and Findings
To answer these questions Dr. McLean used a mixed methods approach, undertaking three different studies:
- An audit of the Royal Children’s Hospital’s Pathway to Good Health Clinic records
- A carer voices study – incorporating the perspectives of both kinship and foster carers
- A data-linkage study using a number of Victorian health databases and the Medicare Billing Schedule database
Across the three studies Dr. McLean identified that there are currently a number of barriers to these children receiving timely healthcare. Many of these were related to delays, inflexibility, and a lack of coordinated support in either child protection systems or healthcare systems.
She also found, however, that there are a number of factors that can enable children in care to receive timely medical treatment. More timely medical treatment occurs when carers received support in navigating difficult systems, and where flexible and accessible medical services were available. Carers themselves were also an enabling factor in their determination to ensure that children received the medical care they needed.
Where to from here?
Dr. McLean’s findings reveal a clear need to develop programs and policies that can improve outcomes for these children.
We need to ask:
- How can we reduce the barriers to routine and timely healthcare for these children?
- How can we make the most of the enabling supports that assist these children to receive timely healthcare?
There is also more evidence that needs to be gathered to better understand this topic (especially with adolescents) and what are effective and feasible interventions or system changes.
Resources for Review
- Read more about the National Clinical Assessment Framework for Children and Young People in Out-of-Home Care (2011).
- Read more about the Pathway To Good Health Program and other health initiatives for Victoria’s vulnerable children.