The Impact of Health on the Educational Performance of Children in Care

Paediatrician Dr Karen McLean provides frontline insight into health related factors that are contributing to the poor educational outcomes of children and young people in out-of-home care:

As a paediatrician, I have seen significant challenges with the intersection between the health sector and the welfare/child protection sector, and have long suspected there are similar difficulties between the education and welfare sectors.

There is, of course, enormous overlap between health issues and educational outcomes for all children. However this is especially so for children in out-of-home care, who have far higher rates of physical, mental and developmental health problems than the general population. Take the following basic stats for example:

  • 20 per cent have abnormal vision screening
  • 28 per cent have abnormal hearing tests
  • 30 per cent have dental problems
  • Almost half of children under 5 years of age have speech / language delays.

The higher the health needs, the poorer the educational outcomes of these children will be. Yet all too often their health concerns are not identified or managed.

Here at the Royal Children’s Hospital Pathway to Good Health clinic we have seen well over 100 children who are in out-of-home care. One of the most common things that we record on their health records is “school issues”. While this is a broad term, it does come as a surprise to child protection workers that even as health practitioners, our focus includes the educational experiences of this cohort. There are many factors that contribute to their difficulties in the classroom.

Firstly, the circumstances (abuse, neglect) that have led to children being removed from their parents set them up poorly for general development. A number of these children have been exposed to substances in utero, or have been exposed to experiences after birth that will affect their cognitive development (and often remain undiagnosed in early years).

A child’s family history (when we hear it) often includes learning difficulties for parents, and dropping out from school in early high school. Both genetic factors and environmental factors will, in many cases, contribute to the challenges for the children we see.

There are high rates of challenging externalising behaviour in this group of children and young people. This often comes from what they have observed and learned, or is a way that children ‘act out’ their distress. For many, this type of behaviour is a protective defensive mechanism that unfortunately is not conducive to spending appropriate time in the classroom and learning.  At our clinic we have seen a group of children who, prior to removal from their parents, have had a diagnosis of ADHD or Autism which is actually very likely to be symptoms of post-traumatic stress disorder. Psychological concerns can also present as physical symptoms, in children especially, which may add further to school absences due to ‘ill health’. Sore tummies or headaches due to anxiety are not uncommon.

Here in Victoria, enormous system challenges exist around health information being passed on. I suspect this is also the case in NSW. Not infrequently, when we have checked our clinic patients with the RCH medical records, we have found significant health details that their current carers and caseworkers have been unaware of, such as heart conditions, asthma and congenital infections. There is no central health record to track health history from before to after removal.  This can then lead to delays in appropriate management, which of course will make children potentially sicker and less able to attend school.

Bureaucracy also seems to be so slow.  On so many occasions I have seen children who might have been in care for already 6 – or even 12 – months, and all workers involved say they know the child needs speech therapy (for example), or mental health support, but the paperwork has not been achieved yet. It is heartbreaking that we cannot be more efficient in meeting these identified needs in a timely way (particularly when we are not good at identifying them in the first place). Frequent placement changes and case manager turnover also makes consistency of health care a challenge.

Delays in identifying and managing health needs only make it harder and harder to positively effect change, including improved educational outcomes, for this incredibly vulnerable group in our community.

Dr Karen McLean is a paediatrician working in the Pathway to Good Health multidisciplinary assessment clinic within the Royal Children’s Hospital in Melbourne. Dr McLean provides comprehensive health assessments to children 12-years and under who have entered out-of-home care. She is also undertaking her PhD studies with the Murdoch Children’s Research Institute Department of Paediatrics, University of Melbourne on how the health needs of children in OOHC are assessed.

ACWA has embarked upon the ‘Let Them Learn’ advocacy initiative aimed at bringing about system wide change to ensure that children and young people in care have access to appropriate education that will prepare them for life.