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JCPSLP
Volume 15, Number 3 2013
Journal of Clinical Practice in Speech-Language Pathology
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”.
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
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