More than 10,000 Victorian children and young people live with a foster or kinship (relative) carer. They enter such care because of court orders aiming to protect them from abuse or neglect.
These children have more physical, developmental and mental health needs than others, which is why they are meant to have a number of health checks when they enter care.
But when we checked the records of more than 6,000 children who were in foster or kinship care for the first time, we found just 41 of them had attended all of the recommended health appointments.
The health needs of children in out-of-home care are high across all areas of health. Around half will have behavioural, mental health and developmental problems. Most have some physical health concern, such as asthma, constipation or hearing difficulties.
These high rates are not surprising, given their experiences of abuse, neglect or trauma and increased likelihood of living in adverse socioeconomic circumstances. This is why there are National Standards for out-of-home care which specifically state that health needs need to be assessed and addressed in a timely manner.
There is also a national framework, adopted by Victoria, that spells out the details: an initial health check by 30 days and a thorough check within three months, led by a paediatrician and including hearing, vision and dental checks.
Nine years ago, specialised health care clinics with paediatricians, psychologists and speech pathologists were established in some areas of Melbourne for vulnerable children to provide a comprehensive assessment and develop health management plans. Such clinics are now in Gippsland too, but they have not been rolled out to the rest of the state.
In the handbook for foster carers, Victorians are told to take a child to a GP, dentist, optometrist and for a hearing test within a month. The comprehensive health check is not mentioned.
We were concerned many children were missing out on these important health visits that could identify health issues and make a plan to address them. So we applied for federal and state de-identified administrative health data for Victorian children in care. This showed us health visits through Medicare (say, for GPs and optometrists) and at Victorian community, mental, dental and hospital outpatient health services.
Too little, too late
We looked at health visits for all children who entered care and stayed at least three months – long enough to see a doctor. We analysed visits within the first year of care to all the recommended health professionals: GPs, paediatricians, dentists, optometrists and audiologists.
We found only one in every 130 children attended all the services within 12 months (far fewer attended all services within three months). It was good to see nine out of ten children saw a GP – but only 37% saw one within the recommended 30 days.
Using Medicare data meant we couldn’t see why a child had gone to the GP – it’s likely some visits were not for a check-up, but were for a specific issue or illness. About one-third of children made it to a paediatrician within a year, but less than 20% saw an optometrist, audiologist or community dentist. Very few attended these services within three months.
Because we looked at data over more than five years, we could see that in areas where a dedicated specialised health clinic was started up to provide health assessments, more children attended paediatricians, audiologists and optometrists. Even before the strains the COVID pandemic has placed on our health system, foster and kinship carers said there were not enough health services and very long waiting lists at those that did exist.
To make sure access to health care does not depend upon a child’s postcode, we need statewide paediatric health services that can provide health assessments and ongoing care.
Those children in foster care had higher odds of attending all health services than those in kinship care. We think this is because kinship carers do not receive as much training, support or financial compensation as foster carers. While it is good Victoria has world-leading rates of kinship care – children in kinship care tend to have better outcomes for behavioural and mental health than children in foster care – it is important all children in care get access to health assessments and the services they need.
Listen to those inside the system
To improve these rates, and to get in early to meet children’s health needs, we need to address what carers have told us present barriers to health care. They report limited paediatric and mental health services and difficulty navigating the systems.
Bureaucratic delays in providing Medicare numbers to carers and getting consent for health care need to be reduced. We could, as in the United Kingdom, make health assessments a legal requirement of care.
More data is also important. Our research only looked at Victorian children – each state and territory has its own approach to health care for children in care. But there are no publicly available data anywhere in Australia, and therefore no public accountability for some of the children who need it the most.
Because it takes years to get permission, analyse data and publish, we do not yet know the impact of COVID upon this group of children. With reports of worsened mental health and longer wait times for services, it is unlikely things have improved.
If we have a system that removes children from families when we believe they are being harmed or their needs neglected, then we need to make sure we don’t overlook them any further.