Issue 1 • 2021

Fellows on the ground – social determinants, children, and health equity

Dr Jacqueline Small Alongside her work as President-elect of the College, Dr Jacqueline Small has been one of the key national leaders in improving access to, and quality of, healthcare for children and adults living with a developmental or intellectual disability.
Dr Small is a developmental paediatrician with over 32 years of clinical practice experience. She has extensive experience in driving policy outcomes in Australia through various organisations and College Committees and is the current Chair of the RACP College Policy and Advocacy Committee.
Last year Dr Small gave evidence to the Disability Royal Commission, firstly in her position as President of the Australian Association of Developmental Disability Medicine, and then on behalf of the College in her role as RACP President-elect.
Dr Small also gave evidence at the Senate Inquiry into Autism to help inform a national autism strategy in Australia. Dr Small spoke specifically about our national diagnostic guidelines and the importance of multidisciplinary care for children with autism spectrum disorder. Dr Small told the Senate Committee:
“Parents need to be able to access early intervention early... I'm not sure that we've got it low enough at the moment for very young children.
“We need to improve how our systems connect with each other so that they work much more smoothly together so that, if a child is looking like they're reaching a diagnosis for which they would then be eligible for other services, there is not a gap in service provision.”
Dr Small also emphasised the importance of integrated care, which she describes as a “mechanism for bringing together health providers from different sectors to try and break down some of the silos.
“Our college is a strong supporter of integration of care, which does not happen without deliberate effort, even within the health sector. But of course, the needs of children with autism extend beyond health, to education and the disability sectors.”
Dr Small has also recently been involved in the establishment of a new multidisciplinary team in the Sydney Local Health District to provide support to people with intellectual disability right across the lifespan. This team is one of six across New South Wales. The teams are called Specialist Teams for Intellectual Disability and are part of a state-wide approach to improving care and outcomes for people with intellectual disabilities.
The Management and Operational Plan for COVID-19 for People with Disability
In 2020, experts from across the health and disability sectors came together to provide advice to the Department of Health to ensure the needs of people with disability were specifically addressed in national strategic COVID-19 pandemic plans.
It was clear from early in the pandemic that COVID-19 would present a significant challenge for many people with disability and their carers. Many people with disability are at greater risk of contracting COVID-19 and becoming extremely unwell or suffering long-term impacts due to pre-existing co-morbidities and health inequities, which is why it was so critical to have a rapid plan of action to address this.
Dr Small was involved in the consultation process, and says “It was really important that the government prioritise development of a plan to address these unprecedented challenges that people with a disability, their families and their carers faced.
“There were multiple iterations of the national plan, reflecting the evolving situation and the need to continuously adapt it depending on the feedback the Government was receiving.
“Ensuring that people with disabilities are protected from the spread of COVID-19 remains an ongoing concern, and this national plan acts as a tool for us to continue to navigate these challenges as the pandemic continues,” said Dr Small.
ASSOCIATE PROFESSOR SUE WOOLFENDEN New research underway to address child health inequities through Social Prescribing
It has long been known that social determinants of health must be addressed to eliminate child health inequities. While current interventions exist, they do not provide the ongoing care needed to ensure that children can positively access the healthcare system.
With over 90 peer reviewed publications in her field and over 20 years of experience as a community and developmental paediatrician, and a National Health and Medical Research Council (NHMRC) fellowship, Associate Professor Woolfenden is part of a major push to improve developmental and health outcomes of children in priority populations.
Associate Professor Woolfenden’s current major project (funded by the RACP – The Sir Roy McCaughey Research Establishment Fellowship 2020) in collaboration with people from the University of New South Wales, The George Institute for Global Health, Sydney Children’s Hospitals Network, University of Wollongong, Western Sydney University, South West and South East Sydney Local Health Districts and non-government agencies, ‘Social prescribing for housing to address child health inequities: developing equity focussed pathways for clinicians to improve child health’ focuses on the child health inequities that are tied to access to stable, safe, good quality housing. With this team, she is developing Social Prescribing pathways for clinicians – specifically considering their patients’ housing needs.
Social Prescribing describes the process of referring patients to support services to address unmet psychosocial needs. It’s an approach recommended by the National Academies of Sciences, Engineering, and Medicine, and our College. “We see many housing issues impacting on the families we serve, particularly Aboriginal families. These include unsafe housing, lack of safe play areas, issues with ventilation and mould and insufficient space for families. This has severe impacts on children’s respiratory health, their physical development and mental health,” says Professor Woolfenden.
Robust, randomised, controlled trials indicate that Social Prescribing interventions are feasible in their practice, acceptable to families, and result in families being up to 44 times more likely to receive specific psychosocial support within four months of their unmet psychosocial needs being identified. Parents also report significant improvements in their child’s health.
Associate Professor Woolfenden – who is also an advocacy representative on the RACP Paediatric Policy and Advocacy Committee (PPAC) and was the co-chair of an RACP working group for the Inequities in Child Health Position Statement – shared that, to date, there is no evidence of Social Prescribing for any groups of children in Australia. But thanks to ground-breaking new research, that’s about to change.
“We don't have any standardised pathway yet. That is what we are designing. At present, physicians write letters for families when requested, but lack a systematic approach to pro-actively identify housing issues that may impact on child health in daily practice and how to best respond.”
Other social prescribing programs are already on the table. Associate Professor Woolfenden is leading the NSW arm of The Healthier Wealthier Families project in collaboration with the Murdoch Children’s Research Institute, where families living in financial hardship are identified by clinicians and linked with financial counsellors. She will also lead the Equitable Pathways for Children with Cerebral Palsy (EPIC-CP) project funded by the Cerebral Palsy Alliance.
© 2021 The Royal Australasian College of Physicians