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Complexity and Culturally Competent Care for Aboriginal Children Seen in a Hospital Paediatric Outpatient Clinic-A
Renata Kukuruzovic1,2, Selena White1, Sharon Mongta1
1Wadja Aboriginal Family Place, Royal Children's Hospital, Melbourne, Australia.
Insights
High clinical complexity is prevalent in Aboriginal children in urban hospital settings. Culturally competent care is vital and can be enhanced through integrated, Aboriginal-led multidisciplinary models.
Area of Science:
- Indigenous Health
- Paediatric Healthcare
- Clinical Complexity Assessment
Background:
- Aboriginal children face unique health challenges.
- Assessing clinical complexity and culturally competent care is crucial for effective service delivery.
Purpose of the Study:
- To document the health status and clinical complexity of Aboriginal children at a specific clinic.
- To evaluate the delivery of culturally competent care for these children.
- To inform future service delivery strategies.
Main Methods:
- Retrospective review of 208 Aboriginal children's medical records (March 2018-March 2020).
- Categorization of diagnoses and social-emotional difficulties into medical, developmental/behavioural, mental health, and adverse childhood experiences (ACEs) domains.
- Classification of clinical complexity based on issues across ≥3 domains; assessment of culturally competent care through documented practices.
Main Results:
- 68% of children met criteria for clinical complexity.
- 36% experienced Out of Home Care (OOHC), and 80% reported at least one ACE.
- Culturally sensitive referrals were made (e.g., to VACCA, ACCHO), but cultural connection documentation was poor.
Conclusions:
- High clinical complexity exists among Aboriginal children in urban hospital settings.
- Embedding culturally competent care is valuable and demonstrates positive impact.
- An Aboriginal-led integrated multidisciplinary model of care can be a successful service delivery approach.
Aims:
To document the health status and clinical complexity of Aboriginal children attending the Wadja Health Clinic at The Royal Children's Hospital (RCH), Melbourne and to assess the delivery of culturally competent care. To use the findings to inform service delivery.
Methods:
A retrospective review of 208 patient records (March 2018-March 2020) was conducted. Diagnoses and social-emotional difficulties were categorised into four domains: medical, developmental/behavioural, mental health and adverse childhood experiences (ACEs). Children with issues in ≥ 3 domains were classified as having complexity. Culturally competent care was assessed based on documentation or inference of cultural safety, relationship-based care, family-centred and strength-based care and a focus on social and emotional wellbeing.
Results:
Sixty-eight percent of children met criteria for complexity. Thirty-six percent had experience with Out of Home Care (OOHC), and 80% had at least one ACE. Aboriginal Case Managers provided a median of 7 contacts per child over 2 years, while paediatricians saw children a median of 4 times. Referrals supported relationship-based care: 35% to Victorian Aboriginal Child Care Agency (VACCA) and 17.8% to an Aboriginal Community Controlled Health Organisation (ACCHO). Self-reported connection to culture and connection to cultural practices were poorly recorded.
Conclusion:
This Australian study documents high levels of clinical complexity in Aboriginal children attending an urban hospital clinic and demonstrates the value of embedding culturally competent care. The service response has been to strengthen an Aboriginal-led integrated multidisciplinary model of care at the hospital and could serve as a model for other hospital settings.
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