JCPSLP Voll 15 No 3 Nov 2013

Child protection in Australia In recent years there has been a significant change in child protection policy. In 2009, the Wood Inquiry announced a detailed package of reforms to the child protection system in NSW that were applicable to government and non- government organisations (NGOs) (NSW Department of Premier and Cabinet, 2009). The Keep Them Safe Report (2009) identified that child protection was everyone’s collective responsibility; that government agencies should expand their role in supporting children who have been maltreated while government would increase investment in prevention and early intervention. The Keep Them Safe Report (2009) recommended that children in OOHC receive adequate health treatment and that services, such as speech pathology, should prioritise these children. There has been little research into speech pathology and children in OOHC in Australia. An Australian study by Golding and colleagues (2011) considered the importance of education of foster carers regarding identification of speech/language disorders in children. Their study showed that foster carers had a sound understanding of the benefits of speech pathology and were aware of the impact of environment and biological factors on speech and language development. Foster carers included in the study wanted the children to receive a comprehensive medical/ developmental/psychological assessment upon entering foster care and requested further information on speech, language and disability. This paper aims to highlight the challenges associated with working with children in OOHC in a community-based speech pathology service setting. It aims to add value to clinical services by providing an increased awareness of this vulnerable population, while also identifying practical strategies that have been implemented successfully in one setting when working with children who have been maltreated and their carers. Referral to the Kaleidoscope speech pathology service The Kaleidoscope community-based speech pathology service is a community-centre-based service within the Hunter New England Local Health District (HNELHD) (New South Wales, Australia), which has seven sites across three local government areas (Newcastle, Lake Macquarie and Port Stephens). This is a public health service for children aged 0–18 years with approximately 12 staff receiving 1,200 referrals per year. Referrals, which can be made by carers or professionals (with carer’s consent), are received through a central intake and are allocated to the closest of the seven community health centres. Clients need to meet eligibility criteria for this service and there are limits to the numbers of sessions provided. All client information, appointments and medical record documentation occur through the centralised electronic medical notes system. Demographic data pertaining to clients for this paper, including living arrangements (i.e., OOHC) and Aboriginality, were also gathered retrospectively from this system. In 2010, 31 children (3% of total referrals) referred to the speech pathology service were in OOHC. In the 12-month period from December 2011 to November 2012 (Table 1), 70 children (6% of total referrals) referred to speech pathology were in OOHC (note these numbers do not include children who entered OOHC while already in speech pathology services or on the waiting list). Thus, the referral rate has doubled in less than two years. The

speech pathology service identified that children in OOHC appeared to be a growing group of clients and that there were specific challenges associated with this group. The increase in referrals to the speech pathology service is likely to have been influenced by a number of factors, including an increase in the number of children entering OOHC (AIHW, 2012). In addition, implementation of Keep Them Safe recommendations (NSW Department of Premier and Cabinet, 2009), which requires children entering OOHC to receive a primary and/or comprehensive health screen, would facilitate the identification of speech and language problems, and thus referrals to speech pathology services. Further, the service has increased reliability in identifying and documenting that children are in OOHC as part of the referral intake process. The increase in referral numbers may also be partly attributed to education of foster carers, NGOs and caseworkers regarding appropriate referrals, referral processes and normal speech and language development. It should be noted that the referral figures reported in this paper may be an underrepresentation of the actual figures, as they do not include children in the care of their grandparents/other family members, but not under the direction of the courts, nor do they include children who enter OOHC after the referral to speech pathology has been made. Additionally, Sedlak (2001) reports there is a large number of children who are recognised as maltreated by professionals but are not investigated by child protection services, thus indicating that the reports that have been substantiated may be the “tip of the iceberg”. Table 1. Demographics of children in out of home care referred to Kaleidoscope community-based speech pathology service (December 2011 to November 2012). Gender Male 50 (71%) Female 20 (29%) Age at referral 0–4 years 35 (50%) 5–8 years 24 (34%) 9+ years 11 (16%) Average 5.7 years Range 1–15 years Aboriginality Aboriginal 14 (20%) Non-Aboriginal 56 (80%) For the entire service, approximately 67% of referrals are children aged 4 years and under, while 27% are children aged between 5 and 8 years; with less than 6% of referrals for children aged over 9 years. Whereas for children in OOHC, only 50% were referred aged 4 years and under and 16% were referred over 9 years, suggesting children in OOHC were more likely to be referred later to the service than children not in OOHC. Nine percent of referrals for children who were not in OOHC were Aboriginal, compared to 20% for children in OOHC (the authors consider this statistic may indicate under identification of Aboriginality). These results suggest children in OOHC were referred later and were more likely to be Aboriginal. Furthermore, 9% of children in OOHC had been referred to the same service at some stage previously. In line with the COAG National Framework which mandates that child protection is not solely the realm of statutory agencies and with local health district directions, the service committed to improving links with key stakeholders to support families, coordinate planning

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JCPSLP Volume 15, Number 3 2013

Journal of Clinical Practice in Speech-Language Pathology