Staying connected in the face of COVID-19

We are facing unprecedented times as the reality of COVID-19 begins to change the way we live our lives.

In our office, we are thinking carefully about the implications for the children and young people we work for, and the way we can carry out our work.

The need to limit contact with others and, in some cases, self-isolate is now becoming clear.

But while the concept of ‘social distancing’ may sound simple, we know that it will pose real risks for many vulnerable people in our community, not least children and young people in care and those who are in youth detention. Connection and belonging, human touch and social relationships are crucial for all people to thrive.

For hundreds of children and young people living in residential and commercial care and the youth detention centre, there is the risk that ‘social distancing’ will have mental health impacts. Many already experience a lack of connection to family and community, and there is a possibility that the intense period we are currently experiencing will only magnify this. It is important that we all stay connected and look out for these vulnerable young people as much as possible. That may mean an extra phone call to see how they are doing or looking to provide more positive experiences within the facility.

Our office is in the process of consulting with DCP and Youth Justice about the arrangements they are making, guided by the advice of the Health Department, to manage the health needs and wellbeing of residents. We don’t underestimate the difficulties involved in responding to requirements for quarantine, isolation and social distancing – and understand that these will all be difficult to achieve and maintain, given the close proximity in which the residents live and the nature of rostered staffing. More than ever, DCP staff and those in the Adelaide Youth Training Centre will be called on to carry out work that is essential for protecting and supporting the children and young people in their care. We are grateful for their service at a time of such challenge.

What is our office doing?

At a time like this, when big systems have to swing into action, it is even more important that the needs and interests of the smallest players are not swept aside. Our main priority is to ensure we maintain contact with children and young people who need our support and advocacy.

We know that face-to-face contact is important, if it can be done safely, and visiting children and young people can be a vital way to safeguard their interests and hear from them directly. We will be guided by health advice but will work hard to maintain this contact while it is possible.

We are also actively developing alternatives such as video conferencing and video calls so we can ensure a presence and connection for the children we work for.

Many of our staff will be working from home until further notice but we will still be contactable by phone on 8226 8570, 1800 275 664 (freecall for children and young people only) or email. If you or a young person want to meet with us in our office please call ahead to see if we can accommodate this.

Talking to children and young people about COVID-19

These are stressful times for everyone, particularly for children and young people who may not understand the magnitude of the virus and the need to distance themselves from others. They may experience disruption or changes they don’t understand, feel scared that they will get sick or worry about others they care about.

There are many resources available that we can use to start the conversation with children and young people about how they are feeling.

What we can all do to reduce the spread of infection

We can help to reduce the spread of infection by practising good hygiene and avoiding non-essential contact with others. This is particularly important if we are visiting a residential care facility or the detention centre where self-isolation is harder to maintain.

We must remember to:

  • wash our hands regularly
  • keep a 1.5 metre distance from others
  • avoid large gatherings
  • stay home if we are sick or if we have been in contact with someone who is
  • notify a child’s case worker if a child or young person in our care requires testing of COVID-19. If a child or young person who lives in residential care or youth detention tests positive they will be admitted to hospital for isolation.

Get the latest updates on COVID-19

For the latest updates on COVID-19 go to www.health.gov.au.

Some gaps closed but many remain for Aboriginal and Torres Strait Islander peoples

More than a decade on from the original report, the 2019 Closing the Gap report shows only two of the seven original targets are on track to be met.

Important targets around education, health and employment have expired before they were met, while other targets to halve the gap in life expectancy remain off track.

These shortfalls perpetuate Aboriginal disadvantage and contribute directly and indirectly to the high proportion of Aboriginal children and young people coming into state care and coming into contact with the youth justice system.

What’s been achieved?

The target to see 95 per cent of all Indigenous four year olds enrolled in early education by 2025 is on track to be met. In 2017, South Australia had education enrolments about the 95 per cent benchmark with universal enrolments.

Halving the gap in Year 12 attainment, or equivalent, by 2020 is on track to be met. Nationally, the gap has decreased from 36 percentage points in 2006 to 24 percentage points in 2016.

What’s remains to be done?

A number of the original targets expired last year, on the tenth anniversary of Closing the Gap. These included a target to halve the gap in child mortality. While the rate has declined by 10 per cent since 2008, the gap has widened because the non-Indigenous rate has declined faster.

The national school attendance rate was around 82 per cent for Indigenous students in 2018. There has been no improvement in school attendance rates for indigenous students in South Australia in the last four years. While there has been improvement, targets to close the gap in literacy and numeracy have also not been met.

Large gaps remain between the life expectancy of Indigenous and non-Indigenous Australians. The target to close the gap within a generation, by 2031, is also not on track to be met.

Targets to halve the gap in employment outcomes between Indigenous and non-Indigenous Australians within a decade have not been met. The gap has not only not narrowed, but it has widened.

After 11 years of Closing the Gap significant gaps remain. Ambitious targets were set but many observers have noted that the failure to work closely with the Aboriginal and Torres Strait Islander community and to make the necessary structural, systemic changes have led to a largely disappointing result.

What’s next?

The latest Closing the Gap report promises a new collaborative approach.

Last year, the council of Australian Governments (COAG) developed Closing the Gap Refresh. It commits the Commonwealth Government to creating a partnership with Aboriginal and Torres Strait Islander representatives to ensure the next phase is driven by principles of empowerment and self-determination.

Indigenous advocates have pushed for new targets to address the over-representation of Aboriginal and Torres Strait Islander young people in out-of-home care.

Nationally, Aboriginal and Torres Strait Islander young people are ten times more likely to enter out-of-home care than their non-Indigenous counterparts. It’s predicted the number of Aboriginal and Torres Strait Islander children in out-of-home care will more than triple over the next 20 years without intervention.

In South Australia, Aboriginal and Torres Strait Islander children and young people are seven times more likely to be in care than the same age group in the general population and Draft Closing the Gap Refresh Targets mandate targets that will see significant and sustained program to eliminate the over-representation of Aboriginal children in out-of-home care.

Aboriginal and Torres Strait Islander young people are still over-represented in the justice system, making up more than 50 per cent of young Australians in detention. Another state led target is to reduce the rate of young people in detention by 11 to 19 per cent by 2028.

Under the new framework, different levels of government are held accountable and responsible for different priorities. State and territory governments will also be required to make annual reports on its Closing the Gap strategies and progress.

The Productivity Commission’s Indigenous Commissioner will also independently review progress every three years.

There is still much of the new strategy that is uncertain as federal, state and territory governments finalise the draft targets and develop appropriate responses. For example, South Australian government released its Aboriginal education strategy late last year to increase outcomes for Aboriginal students but it remains to be seen how it will work to meet these targets to close the gap of young people in out-of-home care and youth justice.

Young people and the non-hospital based services review

Commissioned in August 2012, the Review of Non-Hospital Based Services led by Warren McCann looked at the performance and outcomes of 235 individual non-hospital based services across South Australia’s metropolitan Local Health Networks. The Guardian’s response to the review of non-hospital based services in January 2013 considers the impact on child and youth primary health care services for young South Australians and implications for child protection in the future.

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Meeting the mental health needs of young people in care

graphic of six hand-drawn children's facesLast year our Office audited 60 case files from five Families SA offices to determine the unmet need for mental health services for children and young people in care.  A 2010 consultation with mental health professionals had suggested that the mental health needs of young people in care were not always being met. The audit did not examine the quality or outcomes of the intervention, only how needs had been identified and services provided to meet those needs.

The audit showed that the majority of children and young people whose files were viewed had received a service.  There was evidence of flexibility in service provision and, in half the cases, of therapists being prepared to stay with the client over a period of time.

Where needs were not being met it was for three main reasons.

Fifty four of the 60 children and young people had at least one mental health assessment completed but most of the assessments were made to inform court order applications and judicial decisions.  These addressed issues relevant at that stage of entry into care but did not comprehensively address the child’s social and emotional wellbeing or identify psychological conditions needing attention, set therapy goals and highlight risks.

There were long delays between assessment recommendations and the first service appointment, with a median delay of five months.  A small number were not referred at all while about a quarter had to wait for over three months for their worker to make the referral.  Adding to the delay, waiting times for first appointments were sometimes lengthy, with 38 per cent waiting between four and eleven months for a first appointment.

There was limited consideration of the child’s mental health that was documented in case planning (58 per cent made reference to mental health recommendations) or in annual reviews (24 per cent considered mental health recommendations).

The audit also uncovered examples of effective cooperation. Qualitative data collected during the audit showed strong collaboration between case managers and mental health services in approximately one third of cases, although this was not documented in case plans.

While carer participation was frequently not evident and some carers actively blocked therapy, there were examples of carers engaging in therapy and, on occasions, sourcing therapy for children or themselves following agreement with case managers.

Since the Report was published, Families SA has developed a framework for the provision of therapy services to children and young people in care.  It promises to address waitlists and reduce the time between the identification of mental health concerns and service provision, enhance clinical assessment and match the child or young person to an appropriate service provider.  Under the framework new Families SA mechanisms will monitor the provision of therapy to children, advocate for them and cooperate with service providers in case planning.

Read the other findings and recommendations in the summary report on our website.

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The release of the Office’s reports are always notified first on Twitter.

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Rapid Response is five

An across-government policy initiative, Rapid Response was developed to ensure that children and young people under the guardianship of the Minister received the health, education, welfare, housing and disability services to which they were entitled.

An evaluation report released in June 2010 reports that the five-year persistence with Rapid Response has paid off with greatly increased awareness of the circumstances and needs of children and young people under guardianship. Focus group participants reported increased inter-agency collaboration and recognition that agencies adopt different practices to meet their needs.

Matt Kay, Social Worker at the Marion Families SA Office describes how well cooperation can work for young people in care.

When her carers noticed that a client had dental issues that were affecting her health, the young woman was dismissive, saying that health services don’t listen, don’t understand and don’t do what you need.

The nurse I contacted at the public dental clinic was very understanding and promised to be flexible with the appointment timing, to explain carefully what needed to be done and to allow time to do as much work as possible at the one appointment to minimise return visits. The young woman got what she needed and was pleased.

Not all services respond quite this flexibly but we don’t always have to bring up Rapid Response – some services just get it.

The Report notes that prioritising of children and young people under guardianship for services had been most effective where additional resources had been provided, such as special funding to CAMHS. Where the resources were not topped up, they were sometimes in competition with other young people and families with high needs or children at risk. These are the very early interventions that might prevent young people coming into care. Flagging that children and young people were under guardianship did not automatically create the necessary capacity to respond where the level of demand was already high or where clinical assessment was a prerequisite for service.

Elissa-Jane Dix, Supervisor of the Connected Care Team at Port Pirie Families SA Office reports that their office has good relationships with its local agencies.

We can just make a call so it isn’t often necessary to invoke Rapid Response formally. The awareness of guardianship children is already there in most agencies but this may have been an effect of Rapid Response.

Colleague, and Supervisor of the Family Support and Child Safety Team Christy Brown adds,

Many of our local agencies are proactive, like our dental service that actually contacts us to make sure their lists are up to date.

Getting services for children who are placed in Adelaide can be a bit slower but this is probably due to the high demand on services.

The report concludes that Rapid Response has had considerable success and that there is value in continued investment in training, information, resources and the ongoing support of senior management.

Wellbeing of children and young people in care 2008-09

The Guardian for Children and Young People monitors the circumstances of children under the guardianship, or in the custody, of the Minister for Families and Communities. The feedback and findings of monitoring activities are reported directly to the agencies involved and to the Minister.

The Report on the wellbeing of children and young people in care in South Australia – 2008-09 summarises the information in one place and makes the general conclusions available to a wider audience.  We will publish a written response from Families SA in the near future.

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2008-09 Audit of Annual Reviews

It is required by law in South Australia that there will be a review at least once in each year of the circumstances of each child under the guardianship of the Minister until the child attains 18 years of age (Children’s Protection Act 1993, Section 52 [1]).  The review panel, which is convened by Families SA, must consider whether the existing arrangements for the care and protection of the child are still in the best interests of the child.

The Office of the Guardian attends and audits annual reviews to:

  • provide further external accountability on review panels
  • provide some external scrutiny of case management practice and interagency collaboration
  • advocate for quality outcomes for children and young people.

We aim to attend ten per cent of reviews.  In 2008-09 we attended 93 reviews in total, conducted in 13 District Centres.  This represents 5.7 per cent of the reviews that should have been conducted in the year.

You can download a PDF file of the Audit of Annual Reviews 08-09 summary.

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CAMHS model of care

[link to CAMHS model of care]

This submission, made in August 2009, has been edited from the original to remove references to specific sections of the mental health consultation paper and clauses that may have identified individuals.

Paying attention to mental health

 

pam

Pam Simmons Guardian

Most children and young people who come into care need assistance in achieving or sustaining mental health. This is hardly surprising given the high likelihood of early childhood trauma. The level of need and assistance required will vary but the key to successful intervention is timeliness and appropriateness to need.

 

We have become so used to rationing health resources that this sounds like a big ask. However, I have learnt from my conversations with experts that most of the healing work is done by the adults who spend the most time with children, such as carers, teachers and family. Regardless of who delivers the assistance, sound professional advice and timely intervention is needed.

In South Australia, we have good cooperation between Child and Adolescent Mental Health Services (CAMHS), Child Protection Services, the Youth Sexual Assault/Abuse Counselling Service and Families SA Psychological Services in providing therapeutic services for children in care. Since 2005 there have been improvements in timeliness and appropriateness as a result of the extra services under the Keeping Them Safe reform program and the Rapid Response commitment by government agencies. Assessments are now conducted within two to three weeks of a referral.

Late last year, the Royal Australian and New Zealand College of Psychiatrists adopted a position statement on the mental health care needs of children in out-of-home care. Among other things, the statement commits them to work collaboratively with state health departments and child welfare agencies to ensure all children in care are assessed.

It seems to me though that assessment is the easier bit to fix. The persistent gaps are with the follow-up services. Here, too, there have been steps forward and health services in general have been terrific in giving priority to children in care. However, I am hearing that children are waiting too long and that good alternative care arrangements are sometimes threatened by delays in getting professional advice and help. So in an attempt to understand better I asked what the most significant gaps are.

A delay of three or four months for a child who has been assessed as in high need of therapeutic assistance has an immediate adverse impact on their stability in placement and in school, and a longer term impact on their emotional and social development. Less often identified but equally important is the delay in working with traumatised infants and their primary carers. A child or adolescent’s distress and associated destructive behaviour often triggers the referral to therapeutic services. Much of this could be avoided if early work is done with infants and carers.

Other priorities for action were the development of more appropriate models for working with Aboriginal children and families, prompt professional assistance to carers when acute problems arise, specialist assistance to children and young people with very high need, and services for young people once they reach 18 years but are not accepted for adult mental health services. The good news is that those I spoke to were not short of ideas for tackling these problems.

The first gap that came to light did not, however, concern only children in care. Instead it was the torment of removing children from parents with mental illness. In 2007 a coalition of mental health and child advocates estimated that between 78,000 and 85,000 young South Australians live with a parent with a mental illness. Most continue to live as a family and the impact on children depends on the severity of the illness and access to support. The statutory child protection system cuts in only at the most serious end of disruption and isolation of children. Forty per cent of children taken into state care have mental illness of one or both parents as a major contributing factor. In 2007-08 this would have been about 180 children. South Australia needs to catch up with the other states and territories in implementing a strategy to assist children of parents with mental illness.

If we are serious about providing good care and education for children and young people, prevention of illness, good early childhood development, crime prevention, and strong families we will pay more attention now to the mental health care needs of children.