Australian Primary Health Networks could pioneer local health service reform for children and young people living in out-of-home care. Significant maltreatment, the leading cause of placement of 0-17-year-olds under the protective canopy of foster, kinship and residential care (described collectively as out-of-home care) left more than 50000 children vulnerable to poor health outcomes in 2013-14. Opportunistic health care is inadequate to meet the chronic and complex health needs of maltreated children. This article reviews some critical lessons from English commissioning and US healthcare marketplace reforms in an attempt to better meet the needs of children and young people in out-of-home care. It identifies key questions that Australian Primary Health Networks would need to resolve if they were to follow overseas trends and adopt health service commissioning as a means to provide more effective and efficient health care for this at-risk population.
This formative study aimed to identify health professionals’ perspectives on vaccination issues among children in statutory out-of-home care in Victoria. Eight health professionals, drawn from a purposive Victorian sample known to be proactive in addressing the vaccination needs of children in out-of-home care, took part in semi-structured interviews. Questions addressed participants’ views about roles and responsibilities, barriers and enabling factors affecting vaccination, and ideas about systems improvements. Interview transcripts were analysed thematically. The main themes that emerged were health professionals’ observations about vaccine hesitancy among significant adults in the out-of-home care sector, the paucity of child medical history information available and diffuse responsibility for the provision of legal consent to vaccination. More accurate immunisation status monitoring appears warranted for children in out-of-home care. Unless the collection and maintenance of child medical records improves and vaccination consent processes are streamlined, health professionals will be limited in their capacity to provide efficient vaccination services to these children. Research on vaccine hesitancy among staff and carers in the statutory care sector may be of value. This study supports other Australian research that indicates these children may require more targeted, inter-sectoral immunisation approaches.
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