2023.1 Cases 1A and 1B

cases involve conducting child health checks within an Aboriginal medical service environment, focusing on children in out-of-home care. Case 1A dealt with a kinship care scenario, while Case 1B focused on a foster care situation. Both cases required a trauma-informed and culturally sensitive approach, considering the unique medical, social, and cultural needs of the children and their carers.

Key Clinical Considerations:

1. Trauma-Informed Care

• Understanding Trauma: Children in out-of-home care, particularly those from Aboriginal backgrounds, may have experienced multiple layers of trauma, including exposure to violence, substance abuse, neglect, and loss of family connections. Trauma can affect development, behavior, and health outcomes.
• Minimizing Retraumatization: It is essential to create a safe, respectful, and supportive clinical environment. Clinicians should avoid practices that may be perceived as threatening or overwhelming, use appropriate communication styles, and ensure informed consent.
• Building Trust: Trust may take time to establish with children who have experienced trauma. Allowing sufficient time for appointments, being patient, listening actively, and demonstrating empathy are critical.
• Mental Health Assessment: Regular screening for mental health conditions such as PTSD, anxiety, depression, or attachment disorders may be necessary, with appropriate referrals for psychological support services.

2. Cultural Needs of Aboriginal Children

• Cultural Safety: Healthcare providers should strive to provide care that respects and incorporates the child’s cultural identity, customs, and values. This includes having Aboriginal health workers involved whenever possible.
• Connection to Culture: Encouraging activities and relationships that reinforce cultural heritage, such as involvement in community events, ceremonies, and language programs, can help strengthen the child’s identity and resilience.
• Historical Context: Awareness of historical injustices, including the Stolen Generation, is vital when addressing issues such as trust, engagement with services, and family connections.
• Culturally Relevant Health Education: Educating both children and carers on health-related topics should be framed in a culturally relevant manner, using culturally appropriate resources and language.

3. Holistic and Comprehensive Management

• Biopsychosocial Model: Medical assessments should be integrated with psychological and social assessments. This includes reviewing the child’s medical history, development, school performance, social behaviors, and home environment.
• Carer Support: Carers often need support to ensure the child’s well-being. Providing education on the child’s health needs, behavioral issues, and accessing support services can empower carers to offer better care.
• Community and Social Links: Facilitating connections with the broader community and cultural networks is beneficial for children’s social and emotional development.

4. Barriers to Care

• Geographical Barriers: Children in rural or remote areas may face limited access to specialized care. Telehealth options, mobile health clinics, and outreach services can be valuable in bridging these gaps.
• Cultural Competence of Providers: Ensuring that healthcare providers undergo cultural competence training to understand Aboriginal customs, beliefs, and communication styles.
• System Navigation: Helping carers navigate complex healthcare and social service systems by providing clear pathways to care and advocacy services.

5. Team-Based and Culturally Informed Approach

• Multidisciplinary Teams: Working collaboratively with a team of GPs, Aboriginal health workers, child psychologists, social workers, educators, and other allied health professionals ensures comprehensive care.
• Collaboration with Child Services: Regular communication and shared care planning between health professionals and child protection services ensure consistent support.
• Culturally Appropriate Programs: Incorporating culturally specific parenting and educational programs can enhance the capacity of carers to provide stable and nurturing environments.

6. Carer Involvement

• Carer Empowerment: Providing carers with practical tools, resources, and educational support to manage the child’s health and developmental needs effectively.
• Acknowledging Carers’ Role: Recognizing the critical role carers play in the child’s well-being. Providing respite care, counseling, and peer support groups can help address carer stress and burnout.
• Kinship vs. Foster Care Considerations: In kinship care settings, there may be greater cultural familiarity but also potential complexities with family dynamics. In foster care, building trust and fostering cultural connections may require more deliberate effort.

Demonstrated Competencies:

1. Specific and Individualized Care: Competent candidates demonstrated the ability to address the specific medical and social needs of the child within the cultural context, avoiding generic or rote responses. They engaged deeply with the child’s social history and understood the complexities of their care environment.
2. Meaningful Engagement with Social Context: Candidates recognized the importance of the child’s social background, including the implications of being in out-of-home care, and addressed the broader impact on the child’s health and development.
3. Carer and Child Needs: A balanced approach that considered the needs of both the child and their carer, offering support and resources to the carer to help them provide a nurturing environment.
4. Awareness of Barriers: Understanding the barriers to accessing culturally informed care and exploring ways to overcome these challenges demonstrated an awareness of the complexities faced by the family unit.
5. Beyond the Aboriginal Health Worker: Competent candidates demonstrated an understanding of culturally informed care beyond merely involving an Aboriginal health worker. They appreciated the broader scope of culturally safe practices and integrated this into the child’s management.
6. Team-Based Approach: Practical examples of a collaborative approach were highlighted, including engaging with allied health, child services, and culturally appropriate parenting programs, illustrating the importance of a multidisciplinary strategy.
7. Biopsychosocial Framework: A comprehensive management plan that considered medical, psychological, social, and cultural aspects of care, tailoring the approach to meet the specific needs of the child and their carer.
8. Self-Reflection and Seeking Help: Candidates demonstrated self-awareness, acknowledged their knowledge limitations, and sought assistance or advice to improve their cultural understanding and care delivery.

Common Pitfalls in Management:

1. Over-Reliance on Aboriginal Health Workers: Some candidates viewed engaging an Aboriginal health worker as a catch-all solution for cultural aspects, without understanding the specific role and scope of these workers within the healthcare team.
2. Ignoring Historical and Cultural Context: Failing to recognize the impact of historical trauma, such as the Stolen Generation, and the potential trauma associated with being in out-of-home care led to a lack of depth in understanding the child’s needs.
3. Medical Focus Without Cultural Context: Treating the case solely through a medical lens without integrating cultural considerations or adopting a trauma-informed approach limited the effectiveness of the care provided.
4. Failure to Recognize the Setting: Not framing responses within the context of an Aboriginal medical service environment led to missed opportunities for culturally specific care and resources.
5. Omitting Key Components of the Health Check: Important aspects of the Aboriginal Health Check, such as hearing assessments and aural examinations, were often overlooked, compromising the comprehensiveness of the health assessment.
6. Misunderstanding Cultural Concepts: Some candidates confused cultural aspects with social or health equity measures, such as citing chronic disease prevalence or Closing the Gap initiatives as cultural factors, reflecting a lack of understanding of true cultural needs.
7. Stereotyping and Generalizations: Approaching the case with stereotypes or assumptions about Aboriginal health rather than engaging with humility and curiosity about the individual child’s circumstances hindered culturally appropriate care.

Recommendations for Best Practice:

• Adopt a Trauma-Informed Approach: Recognize the impact of trauma on children in out-of-home care and integrate trauma-informed principles into the care plan to ensure a sensitive and supportive approach.
• Culturally Safe Care: Engage deeply with the cultural context of Aboriginal children, understanding the importance of connection to community, culture, and identity. Address historical trauma respectfully and provide culturally appropriate support.
• Holistic and Individualized Management: Use a biopsychosocial framework that considers medical, psychological, social, and cultural aspects, tailored to the specific needs of the child and carer.
• Support for Carers: Recognize the crucial role of carers in the child’s well-being, offering resources, support, and education to help them provide the best care possible.
• Collaborative Team Approach: Engage with a multidisciplinary team, including allied health, child services, and culturally specific programs, to provide comprehensive care that addresses the full spectrum of the child’s needs.
• Avoid Assumptions and Stereotypes: Approach each case without preconceived notions, demonstrating curiosity, humility, and a willingness to learn from the patient, their family, and cultural experts.
• Access to Resources and Supports: Utilize available resources within the Aboriginal medical service and community, ensuring the child and carer have access to appropriate supports.
• Reflect and Seek Help: Continuously reflect on personal biases and knowledge gaps, seeking further training and guidance to improve cultural competence and provide the highest standard of care.

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my notes for this case:

conducting child health check ATSI

• children in out-of-home care
• cases
  • kinship care scenario
  • on a foster care situation
• a trauma-informed and culturally sensitive approach
• considering the unique
  • medical
  • social
  • cultural needs

Key Clinical Considerations

1. Trauma-Informed Care

• Past Trauma: Children may have experienced trauma, loss, and separation impacting their well-being.
• Trauma-Informed Approach: Tailor care to minimize retraumatization and use open-ended, non-intrusive questions.
  • Example Questions:
    • “Have there been any significant events in your life that you feel still affect your health or well-being today?”
    • “Would you like to share anything about your past experiences?”
• Validation: Acknowledge their courage in sharing and validate their feelings.
  • Example: “Thank you for sharing that with me. It’s understandable that those experiences may still be affecting you.”
• Empathy: Show empathy without trying to immediately fix the problem.
  • Example: “It’s completely understandable that you feel this way given what you’ve experienced.”
• Avoid Probing: Respect the patient’s boundaries and avoid pushing for more details.
  • Example: “We don’t have to talk about this further unless you feel ready.”

2. Cultural Needs of Aboriginal Children

• Cultural Connections: Explore the child’s connection to their language, traditions, and community.
  • Example Questions:
    • “Do you speak or understand any traditional languages at home or with your family?”
    • “Are there any special cultural or family traditions that are important to you?”
• Impact of Historical Factors: Acknowledge the history of colonization and the Stolen Generation.
  • Example Questions:
    • “Do you or your family talk about the Stolen Generation? How does that affect you?”
    • “How do you think the past experiences of your parents or grandparents, like being part of the Stolen Generation, impact child’s sense of identity or emotional well-being?”
• Identity and Belonging: Explore how the child balances their cultural identity with other aspects of life.
  • Example Questions:
    • “What do you like most about being part of your culture?”
    • “Are there any cultural activities or traditions that are important for them?”
• Emotional Well-being and Support: Understand how cultural practices impact emotional well-being.
  • Example Questions:
    • “Is there something from your culture that helps you feel better when stressed?”
    • “Are there any traditional practices, stories, or ceremonies that help child’s feel safe or calm when they are upset”
• Family Dynamics: Recognize the role of family and community in care.
  • Example Questions:
    • “Who are the people who care for you the most?”
    • “Who are the key people in child’s life that provide support, both inside and outside of the family?”
    • Is there someone in the community, like an Elder or family member, who plays a special role in child’s life or well-being

3. Holistic and Comprehensive Management

• Biopsychosocial Approach: Address the biological, psychological, social, and cultural dimensions of care.
  • Biological Dimension:
    • Manage chronic conditions while respecting cultural healing practices.
    • Example: Incorporating traditional healing rituals into a child’s treatment plan.
  • Psychological Dimension:
    • Provide trauma-informed mental health support.
    • Example: Therapy for anxiety that incorporates cultural understanding.
  • Social Dimension:
    • Assess living conditions
    • family dynamics
    • community connections
    • Example: Facilitating participation in cultural festivals to enhance social support.
  • Cultural Dimension:
    • Recognize and incorporate the child’s cultural background into care plans.
    • Example: Working with an elder to integrate traditional healing with therapy.

4. Engaging with Carers

• Involvement in Care:
  • Involve family, extended kin, and community in the care process.
  • Example: Family counseling sessions involving caregivers.
• Providing Culturally Appropriate Support Services:
  • Ensure resources and services are culturally sensitive.
  • Example: Referring a child to an Aboriginal health service.

5. Barriers to Care

• Limited Access to Culturally Sensitive Healthcare:
  • Lack of culturally safe services can lead to distrust in healthcare.
  • Example: A family may avoid seeking care if cultural beliefs are not respected.
• Logistical Challenges in Rural Areas:
  • Geographical isolation and transportation issues hinder access to care.
  • Example: A child may miss appointments due to long distances to healthcare services.
• Navigating Complex Social Service Systems:
  • Difficulty in understanding healthcare and social service systems.
  • Example: Families may struggle to coordinate care across multiple services.
• Trust and Historical Trauma:
  • Historical trauma and fear of discrimination lead to mistrust in institutions.
  • Example: Families may avoid seeking care due to fear of racial discrimination.
• Socioeconomic Disadvantages:
  • Poverty and housing instability affect healthcare access.
  • Example: A carer may delay seeking care due to financial constraints.
• Lack of Awareness and Education:
  • Health literacy challenges hinder families from following care plans.
  • Example: A carer may struggle with understanding medical prescriptions.

6. Team-Based and Culturally Informed Approach

• Collaboration Across Disciplines: Involve GPs, Aboriginal health workers, child services, and allied health professionals.
  • Example: A GP collaborates with an Aboriginal health worker to ensure culturally appropriate asthma management.
• Allied Health Professionals: Provide specialized services tailored to the child’s needs.
  • Example: A speech therapist incorporates traditional language practices into therapy.
• Culturally Appropriate Educational and Parenting Programs: Support carers in maintaining cultural connections.
  • Example: A foster carer attends a culturally informed parenting program.

7. Carer Involvement

• Support for Carers: Provide emotional, practical, and financial support to carers.
  • Example: Offering respite care or peer support groups for carers.
• Kinship or Foster Care Settings: Support kinship and foster carers in navigating cultural and caregiving challenges.
  • Example: Offering legal advice and cultural training for carers.

8. Pitfalls Correction

• Specific and Individualized Care: Tailor care to the child’s unique history and cultural needs.
• Meaningful Engagement with Social Context: Acknowledge the child’s care history and its impact.
• Carer and Child Needs: Balance the needs of the child and their carer.
• Awareness of Barriers: Identify and address barriers to accessing culturally appropriate care.
• Team-Based Approach: Involve the healthcare team in a coordinated care plan.
• Biopsychosocial Framework: Consider the child’s physical, psychological, social, and cultural needs.
• Self-Reflection and Seeking Help: Acknowledge any knowledge gaps and seek guidance on culturally appropriate care.

Case Example:

A 9-year-old Aboriginal child has been placed in kinship care after experiencing family instability. history of domestic violence and grand parents were part of the stolen generation who used to live with the child. currently kinship care is very supportive. but the child has developed behavioural issues, is struggling with school, and has a history of asthma.

1. Trauma-Informed Care

Key Considerations:

• The child may have experienced trauma, loss, and separation.
• Focus on providing care that minimizes retraumatization and acknowledges past experiences.

Questions to Ask in the Appointment:

• “How is [child’s name] coping with the changes in their living situation?”
• “Have there been any triggers or events that seem to upset [child’s name]?”
• “What kind of behaviors or emotional responses have you noticed?”
• “How does [child’s name] express their emotions or frustrations, and what seems to help them calm down?”
• “Do they have any memories or fears related to their previous home situation that we should be aware of?”

Management Strategies:

• Sensitivity: Approach every conversation with empathy, acknowledging the child’s traumatic experiences without forcing them to relive details unless necessary.
• Minimize retraumatization: Avoid asking invasive or repetitive questions about the trauma. Instead, create a safe environment by focusing on strengths and the child’s current well-being.
• Tailoring care: Consider therapy, such as trauma-informed cognitive behavioral therapy (CBT) or art/play therapy, to help the child process trauma in a way that is age-appropriate.

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2. Cultural Needs of Aboriginal Children

Key Considerations:

• Importance of maintaining cultural identity through language, traditions, and community links.
• The child’s grandparents, who were part of the Stolen Generation, may have passed down feelings of disconnection or trauma.

Questions to Ask in the Appointment:

• “Are there any cultural activities or traditions that [child’s name] enjoys or misses?”
• “Is [child’s name] involved with the local Aboriginal community or any programs that help them connect with their culture?”
• “Would you like support in connecting [child’s name] with community Elders or other Aboriginal cultural programs?”
• “Does [child’s name] speak or understand any traditional languages? Is this something important for them?”

Management Strategies:

• Cultural Connections: Help the child stay connected to their cultural roots. This may include involving the child in community activities, traditional ceremonies, or events led by Elders.
• Community Links: Ensure that the child has access to their Aboriginal community and its support structures, such as cultural mentoring programs or Aboriginal youth groups.
• Understanding Historical Impact: Acknowledge the intergenerational trauma of the Stolen Generation and ensure care is respectful of the family’s past experiences. Offer support for the carer in addressing these concerns, such as providing counseling services that understand this historical context.

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3. Holistic and Comprehensive Management

Biopsychosocial Framework:

• Biological: Address asthma and any other medical conditions.
• Psychological: Address emotional and behavioral issues stemming from trauma.
• Social: Consider the child’s living situation, school difficulties, and social interactions.
• Cultural: Ensure cultural safety and connections are maintained.

Questions to Ask in the Appointment:

• Physical Health: “How is [child’s name] doing with their asthma management? Are there any issues with medications or symptoms?”
• Behavioral and Emotional Well-being: “What specific behavioral concerns have come up at school or home?”
• Social Well-being: “How is [child’s name] adjusting to the kinship care arrangement?”
• Cultural Engagement: “Are there any cultural or community programs that [child’s name] enjoys participating in?”

Management Strategies:

• Biological: Ensure proper asthma management, including regular check-ups, medication adherence, and an asthma action plan.
• Psychological: Arrange for a mental health assessment and consider trauma-informed counseling or therapy (CBT, play therapy, etc.). Include cultural elements in therapy when possible.
• Social: Work with the school to develop a learning plan that accommodates the child’s behavioral and emotional needs. Consider whether the child needs an educational support worker or additional school resources.
• Cultural: Refer to Aboriginal health services or cultural programs to support the child’s connection to their heritage.

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4. Identifying Barriers to Care

Key Considerations:

• The family may face barriers such as limited access to culturally sensitive healthcare, logistical challenges, and difficulties navigating social services.

Questions to Ask in the Appointment:

• “Have you had any difficulties accessing healthcare or other services for [child’s name]?”
• “Are there any logistical challenges, such as transportation, that make it hard to attend appointments or access services?”
• “Is there anything that would make it easier for you to get the support [child’s name] needs?”

Management Strategies:

• Access to Culturally Sensitive Care: Refer the child and carer to Aboriginal-controlled health services where they can receive culturally appropriate care.
• Logistical Support: If transportation is an issue, explore telehealth options or arrange for transport assistance.
• Social Services Navigation: Connect the family with a social worker who can help them navigate complex systems and access support for schooling, healthcare, and financial aid.

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5. Team-Based and Culturally Informed Approach

Multidisciplinary Team Involvement:

• General Practitioner (GP): Oversees asthma management and general physical health.
• Aboriginal Health Worker: Provides cultural support, health education, and acts as a liaison between the family and healthcare providers.
• Child Services: Monitors the well-being of the child in kinship care and ensures appropriate support for the carer.
• Allied Health Professionals: Psychologists, speech therapists, or occupational therapists may address specific behavioral or developmental concerns.
• Culturally Appropriate Parenting Programs: Programs that help kinship carers support the child’s needs while maintaining cultural connections.

Questions to Ask in the Appointment:

• “Would it be helpful for us to involve an Aboriginal health worker to support [child’s name]’s care?”
• “Has [child’s name] been connected with any mental health professionals or school support staff?”
• “Would you like information about any culturally appropriate parenting programs or support services available in your area?”

Management Strategies:

• Engaging the Team: Ensure coordination between GPs, mental health professionals, and Aboriginal health workers. Establish regular communication between these professionals to share updates on the child’s progress.
• Involvement of Carers: Provide kinship carers with access to parenting programs that teach trauma-informed care and strategies to support behavioral issues.
• Allied Health: Refer to a psychologist or behavioral specialist for an assessment of the child’s emotional and behavioral issues. Consider a speech therapist or occupational therapist if school struggles are related to developmental delays or communication issues.

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Summary of Management Plan:

• Trauma-Informed Care: Acknowledge the child’s past trauma and provide trauma-sensitive therapy. Focus on emotional safety and stability.
• Cultural Connections: Maintain and strengthen cultural identity through community programs and connection with Elders.
• Holistic Approach: Address physical, emotional, social, and cultural dimensions through a biopsychosocial model.
• Barrier Identification: Recognize and address any challenges in accessing culturally sensitive healthcare and navigating social services.
• Team-Based Care: Collaborate with a multidisciplinary team that includes GPs, Aboriginal health workers, child services, and allied health professionals to provide comprehensive care.