Children and young people in out-of-home care: are GPs ready and willing to provide comprehensive health assessments for this vulnerable group?Susan M. Webster A B and Meredith Temple-Smith A
A General Practice and Primary Health Care Academic Centre, Melbourne Medical School, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
B Corresponding author. Email: email@example.com
Australian Journal of Primary Health 16(4) 296-303 http://dx.doi.org/10.1071/PY10019
Submitted: 26 May 2010 Accepted: 27 September 2010 Published: 3 December 2010
Children living in out-of-home care because of abuse or neglect are among the most vulnerable in Australia. In 2005 the Royal Australasian College of Physicians highlighted the need for increased attention to the health of such children and recommended regular health assessment. This qualitative study explored the views of a purposive sample of 20 GPs about what would influence GP willingness and readiness to undertake comprehensive health assessments for children entering out-of-home care. Ethical concerns, training, professional development needs, medico-legal issues, workforce and financial pressures and communication problems with the child protection sector were among key factors identified. Professional values about continuity of health care for children emerged as a new issue with important policy implications. This is the first in-depth study in Australia of GP perspectives about systematic health assessments for children in child protection and sheds new light on the low GP uptake of such assessments for at-risk population groups.
ReferencesBannon MJ, Carter YH, Barwell F, Hicks C (1999a) Perceptions held by general practitioners in England regarding their training needs in child abuse and neglect. Child Abuse Review 8, 276–283.
| Perceptions held by general practitioners in England regarding their training needs in child abuse and neglect.CrossRef |
Bannon MJ, Carter YH, Ross L (1999b) Perceived barriers to full participation by general practitioners in the child protection process: preliminary conclusions from focus group discussions in West Midlands, UK. Journal of Interprofessional Care 13, 239–248.
| Perceived barriers to full participation by general practitioners in the child protection process: preliminary conclusions from focus group discussions in West Midlands, UK.CrossRef |
Booth B, Portelli R, Snowdon T (2005) ‘A quality framework for Australian general practice.’ (Royal Australian College of General Practitioners: Melbourne) Available at http://www.racgp.org.au/Content/NavigationMenu/Advocacy/AqualityframeworkforAustralianGeneralPractice/20060210qualityframe_companionguide.pdf. [Verified 30 August 2010].
Britt H, Miller GC, Charles J, Bayram C, Pan Y, Henderson J, Valenti L, et al. (2008) ‘General practice activity in Australian 2006–07.’ General practice series 21 Cat no GEP 21. (Australian Institute of Health and Welfare: Canberra) Available at http://www.aihw.gov.au/publications/index.cfm/title/10574 [Verified 30 August 2010]
Bromfield L, Higgins D, Osborn A, Panozzo S, Richardson N (2005) ‘Out-of-home care in Australia: messages from research. A report to the Community Services Ministers Advisory Council commission by the Australian government, Department of Families, Community Services and Indigenous Affairs.’ Australian Institute of Family Studies, Melbourne.
Clyman RB, Harden BJ, Little C (2002) Assessment, intervention and research with infants in out-of-home placement. Infant Mental Health Journal 23, 435–453.
| Assessment, intervention and research with infants in out-of-home placement.CrossRef |
Corby B (2006) ‘Child abuse, towards a knowledge base.’ 3rd edn. (Open University Press: New York)
Department for Children, Families and Schools (2009) ‘Statutory guidance on promoting the health and well-being of looked-after children.’ Available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108592.pdf [Verified 30 August 2010]
Dicker S, Gordon E, Knitzer J (2002) ‘Improving the odds for the healthy development of young children in foster care.’ (National Centre for Children in Poverty, Columbia University: New York) Available at http://www.nccp.org/publications/show.php?id=370 [Verified 30 August 2010]
Felitti V, Anda R, Nordenburg D, Williamson D, Spitz A, Edwards V, Koss M, Marks J (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine 14, 245–258.
| Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study.CrossRef | 1:STN:280:DyaK1c3pvVyjug%3D%3D&md5=49c6ef46d9bd84103ed2b55baa94996bCAS | 9635069PubMed |
Leslie LK, Hurlburt MS, Landsverk J, Rolls JA, Wood PA, Kelleher KJ (2003) Comprehensive assessments for children entering foster care: a national perspective. Pediatrics 112, 134–142.
| Comprehensive assessments for children entering foster care: a national perspective.CrossRef | 12837879PubMed |
Liamputtong P, Ezzy D (2006) ‘Qualitative research methods.’ (Oxford University Press: Melbourne)
Lupton C, North N, Khan P (2000) What role for the general practitioner in child protection? British Journal of General Practice 50, 977–981.
Milburn N, Lynch M, Jackson J (2008) Early identification of mental health needs of children in care. A therapeutic assessment program for statutory clients of child protection. Clinical Child Psychology and Psychiatry 13, 31–47.
| Early identification of mental health needs of children in care. A therapeutic assessment program for statutory clients of child protection.CrossRef | 18411864PubMed |
Mooney A, Statham J, Monck E, Chambers H (2009) ‘Promoting the health of looked after children – a study to inform revision of the 2002 guidance.’ (Institute of Education, University of London: London) Available at http://www.dcsf.gov.uk/research/data/uploadfiles/DCSF-RR125.pdf. [Verified 30 August 2010]
Nathanson D, Tzioumi D (2007) Health needs of Australian children living in out-of-home care. Journal of Paediatrics and Child Health 43, 695–699.
| Health needs of Australian children living in out-of-home care.CrossRef | 17854456PubMed |
Ombudsman Victoria (2010) ‘Own motion investigation into child protection – out-of-home care’. Available at http://www.ombudsman.vic.gov.au/resources/documents/own_motion_investigation_into_child_protection_-_out_of_home_care_may_2010.pdf [Verified 30 August 2010]
Power P (2009) Children’s Court of Victoria. Research Materials. ‘5. Family Division – Child Protection.’ Available at http://www.childrenscourt.vic.gov.au/CA256902000FE154/Lookup/Research_Materials_Chapters/$file/Research_Materials_5_FD_Child_Protection.pdf [Verified 30 August 2010]
Productivity Commission (2003) ‘General practice administrative and compliance costs. Research report.’ Available at http://www.pc.gov.au/projects/study/gpcompliance/docs/finalreport [Verified 30 August 2010]
Richardson N (2005) ‘Social costs: the effects of child maltreatment. Resource sheet no. 9.’ (National Child Protection Clearinghouse, Australian Institute of Family Studies: Canberra) Available at http://www.aifs.gov.au/nch/pubs/sheets/rs9/rs9.html [Verified 30 August 2010]
Rogers W, Braunack-Mayer A (2004) ‘Practical ethics for general practice.’ (Oxford University Press: New York)
Royal Australasian College of Physicians (2008) ‘Health of children in “out-of-home care”. Paediatric policy.’ (Royal Australasian College of Physicians: Sydney) Available at http://www.racp.edu.au/index.cfm?objectid=D7FAA370-0B87-808A-90C36BD48C54B2D8 [Verified 30 August 2010]
Sawyer M, Carbone JA, Searle AK, Robinson P (2007) The mental health and well-being of children and adolescents in home-based foster care. The Medical Journal of Australia 186, 181–184.
Schattner P, Coman G (1998) The stress of metropolitan general practice. The Medical Journal of Australia 169, 133–137.
Simms MD, Dubowitz H, Szilagyi MA (2000) Health care needs of children in the foster care system. Pediatrics 106, 909–918.
Smith A (2008) Child protection and child health: a shared future. Journal of Paediatrics and Child Health 44, 85–86.
| Child protection and child health: a shared future.CrossRef | 18307416PubMed |
Stokes T, Tarrant C, Mainous AG, Schers H, Freeman G, Baker R (2005) Continuity of care: is the personal doctor still important? A survey of general practitioners and family physicians in England and Wales, the United States and the Netherlands. Annals of Family Medicine 3, 353–359.
| Continuity of care: is the personal doctor still important? A survey of general practitioners and family physicians in England and Wales, the United States and the Netherlands.CrossRef | 16046569PubMed |
Tarren-Sweeney M, Hazell P (2006) Mental health needs of children in foster and kinship care in NSW. Journal of Paediatrics and Child Health 42, 89–97.
| Mental health needs of children in foster and kinship care in NSW.CrossRef | 16509906PubMed |
Underwood P, Clare M, Gillieatt S, Clare B, Paley G (1999) Understanding and improving the provision of general practice services to children in state care: final report. General Practice Evaluation Program, GPEP Project 705. Primary Health Care Research and Information Service, Adelaide.
US Congress (2008) ‘Fostering connections to success and increasing adoptions act of 2008.’ Available at http://www.govtrack.us/congress/bill.xpd?bill=h110-6893 [Verified 30 August 2010]
Victorian Department of Human Services (2009) ‘Child protection practice manual.’ Available at http://www.dhs.vic.gov.au/office-for-children/cpmanual/ [Verified 30 August 2010]
Victorian Department of Human Services (2010) ‘Child protection orders: custody to secretary order – information for parents.’ Available at http://www.cyf.vic.gov.au/__data/assets/pdf_file/0004/15970/custody-to-secretary-order-info-parents.pdf [Verified 30 August 2010]
Victorian Law Reform Commission (2010) Protection applications in the Children’s Court. Final report. Available at http://www.lawreform.vic.gov.au/wps/wcm/connect/justlib/law+reform/home/current+projects/child+protection/lawreform+-+protection+applications+in+the+childrens+court+final+report [Verified 27 October 2010]
Watts I, Foley E, Hutchinson R, Pascoe T, Whitecross L, Snowdon T (2004) ‘General practice nursing in Australia.’ (Royal Australian College of General Practitioners: Melbourne) Available at http://www.racgp.org.au/Content/NavigationMenu/Advocacy/IssuesinGeneralPractice/GeneralPracticeNurses/gpna_mainreport.pdf [Verified 30 August 2010]
Woolverton M (2002) ‘Meeting the health care needs of children in the foster care system: strategies for implementation.’ (Child Development Centre, Georgetown University: Washington DC) Available at http://gucchd.georgetown.edu/products/FCStrategies.pdf [Verified 30 August 2010]
Wulczyn F, Barth RP, Yuan YYT, Harden BJ, Landsverk J (2005) ‘Beyond common sense. Child welfare, child well-being and the evidence for policy reform.’ (Aldine Transaction: New Jersey)