Demographics (Table 1)
The mean age of students was 12.7 years (range 2.8 -16.2). The younger range of students represent siblings who were seen at the clinic as a preventative approach, given that siblings were at a similar risk of developmental and behavioural issues. Males represented 63.3% of the sample and females 35.4%. The majority of students identified as being of Australian Caucasian descent (48.1%). Indigenous Australians formed 35.4% of the population, compared with 2.8% in the Australian population(32). English was the predominantly spoken language and no interpreters were required.
Table 1: Demographic information
|
Number
|
Percentage
|
Age
|
Mean
|
12.7
|
|
Range
|
13.4
|
|
Minimum
|
2.8
|
|
Maximum
|
16.2
|
|
Gender
|
Female
|
28
|
35.4
|
Male
|
50
|
63.3
|
Cultural Background
|
African
|
1
|
1.3
|
Australian Caucasian
|
38
|
48.1
|
Indigenous Australian
|
28
|
35.4
|
Korean
|
1
|
1.3
|
Lebanese
|
2
|
2.5
|
New Zealand Maori
|
2
|
2.5
|
not recorded
|
7
|
8.9
|
Preferred Language
|
English
|
78
|
98.70%
|
Involvement of Other Services
Prior to the assessment other services were involved with the students and their families. In this cohort, 22.8% of students had a paediatrician but about a third (33.3%) were not engaged with the paediatrician. Mental health services were involved in 27.8% of cases but about 18.2% were not engaged with this service. DCJ were involved with 43% of students in the past and 32.9% of students had a current open case with DCJ. This acts as marker of increased safety risk and highlights the vulnerability of students seen at the school.
Attendance
Attendance at the clinic was high with a 7.6% failure to attend (FTA) rate and 8.9% cancellation rate. The reasons for FTA were varied. For cancellations in about a third (28.6%) of cases there were behavioural issues with the child which prevented the family from attending. Other reasons for cancellations included the parent being unable to attend (28.6%) or clinic variables (28.6%). This showed a promising high level of initial engagement.
Clinical Activity
Most of the students were assessed by a paediatrician (97.5%), a youth health nurse (67.1%), a school counsellor (60.8%) and a social worker (49.4%). There was a period of between 12 to 18 months were a social worker was not available, which may account for why this figure was lower than the others. The majority of students received a medical history review (97.5%), physical examination (88.6%), hearing screening (59.5%), vision screening (63.3%) and dental screening (63.3%).
Diagnostic Information (Table 2)
The referrals were made by the school and primarily reflect issues pertinent to a child’s engagement with the education process. The main reasons for referral were behavioural concerns (84.8%). Other reasons included learning difficulties (24.2%), absenteeism (12.7%), emotional wellbeing concerns (12.7%) and social concerns (12.7%).
Diagnoses recorded prior to the assessment included behavioural concerns (63.3%) and absenteeism (24.1%). A DSM 5 diagnosis was present for many. These included ADHD (39.2%), ASD (3.8%), CD (12.7%) and ODD (21.5%). About 20.3% were each recorded for learning difficulties, a medical diagnosis, and a mental health diagnosis. Importantly, 6.3% had concerns around deliberate self harm (DSH)/suicidality. Social vulnerability was previously ascertained with a trauma background identified in 27.8% and domestic violence in 26.6%. Around 12.7% had been in out-of-home care (OOHC).
At the assessment the following was added to the above known diagnoses. ADHD was diagnosed in 3.8%, ASD in 1.3%, CD in 1.3% and ODD in 1.3%. More notable increases in diagnoses included learning difficulties (12.7%), medical diagnoses (10.1%), emotional concerns (16.5%), domestic violence (12.7%), OOHC (7.6%) and a trauma background (27.8%). There were no formal mental health diagnoses made, primarily because this was outside the scope of practice of the assessors. Where concerns existed a referral to mental health services were made (3.8%). A further 3.6% students were identified as experiencing DSH/suicidality.
Importantly, the clinical assessment added a more holistic understanding of the social factors and trauma background of children. These included the death or loss of a close relative or friend, which was identified in 8.9% (previously identified in 1.3%), parental separation 31.6% (from 5.1%) and substance use 19% (from 7.6%). New medical diagnoses were also made. These included obesity 13.9% (previously 5.1%), sexual health concerns 2.5% (previously 0%) and sleep difficulties 8.9% (previously 3.8%). This reflects the high needs of this group, who otherwise have limited access to health services.
Table 2: Summary of referral reasons, previous diagnoses and new diagnoses
Referral Reason
|
Previous Diagnosis
|
New Diagnosis
|
|
N
|
%
|
N
|
%
|
N
|
%
|
Absenteeism
|
10
|
12.7
|
19
|
24.1
|
1
|
1.3
|
ADHD
|
13
|
16.5
|
31
|
39.2
|
3
|
3.8
|
ASD
|
1
|
1.3
|
3
|
3.8
|
1
|
1.3
|
Behavioural concerns
|
67
|
84.8
|
50
|
63.3
|
3
|
3.8
|
Conduct Disorder
|
2
|
2.5
|
10
|
12.7
|
1
|
1.3
|
Death or Loss of Close Relative or Friend
|
0
|
0
|
1
|
1.3
|
7
|
8.9
|
Deliberate Self Harm/Suicidality
|
0
|
0
|
5
|
6.3
|
3
|
3.8
|
Dental concerns
|
0
|
0
|
4
|
5.1
|
6
|
7.6
|
Domestic Violence
|
0
|
0
|
18
|
22.8
|
10
|
12.7
|
Emotional concerns
|
10
|
12.7
|
21
|
26.6
|
13
|
16.5
|
Hearing concerns
|
0
|
0
|
1
|
1.3
|
0
|
0
|
Injury
|
0
|
0
|
3
|
3.8
|
2
|
2.5
|
Learning difficulties
|
19
|
24.1
|
16
|
20.3
|
10
|
12.7
|
Medical Diagnosis
|
2
|
2.5
|
16
|
20.3
|
8
|
10.1
|
Mental Health Diagnosis
|
6
|
7.6
|
16
|
20.3
|
0
|
0
|
Obesity
|
0
|
0
|
4
|
5.1
|
11
|
13.9
|
Oppositional Defiant Disorder
|
5
|
6.3
|
17
|
21.5
|
1
|
1.3
|
Out-of-home Care
|
0
|
0
|
10
|
12.7
|
6
|
7.6
|
Parental Separation
|
0
|
0
|
4
|
5.1
|
25
|
31.6
|
School Refusal
|
3
|
3.8
|
0
|
0
|
0
|
0
|
Sexual Health Concerns
|
0
|
0
|
0
|
0
|
2
|
2.5
|
Sleep Difficulties
|
0
|
0
|
3
|
3.8
|
7
|
8.9
|
Social Concerns
|
10
|
12.7
|
10
|
12.7
|
11
|
13.9
|
Substance Use
|
3
|
3.8
|
6
|
7.6
|
15
|
19
|
Trauma Background
|
0
|
0
|
22
|
27.8
|
17
|
21.5
|
Vision Concerns
|
0
|
0
|
6
|
7.6
|
4
|
5.1
|
Recommendations (Table 3)
In terms of health, the following were most commonly recommended: dental review (36.7%), drug and alcohol services (16.5%), medication (13%), NDIS referral (5.1%), nutrition support (17.7%), ongoing review by a paediatrician (20.5%) and referral to a youth health service (43%). In terms of mental health the following were recommended: counselling (82.3%), art/music/play therapy (44.3%). These forms of therapy were often accessed via the school either through the skills of the school counsellor or teachers/therapists. Other therapy uniquely available through NS included trauma-informed occupational therapy (73.4%) and trauma-informed speech therapy (69.6%). Education also resourced other recommendations including extracurricular activities (49.4%), learning support (6.5%), and a strengths-based approach to learning (36.7%).
On the social wellbeing side, a high proportion were referred to a case management service (24.1%), while others were referred to domestic violence services (11.4%), DCJ (3.8%), or a parenting course (20.3%). Provision of housing support was made in 21.5%.
Table 3: Recommendations
Recommendations
|
Number
|
Percentage
|
Audiology
|
9
|
11.4
|
Art/Music/Play Therapy
|
35
|
44.3
|
Case Management Agency
|
19
|
24.1
|
Cognitive/Developmental/Behavioural Assessment
|
34
|
43.0
|
Continue with Current Mental Health Service
|
10
|
12.7
|
Counselling
|
65
|
82.3
|
Dental Services
|
29
|
36.7
|
Department of Communities and Justice
|
3
|
3.8
|
Domestic Violence Services
|
9
|
11.4
|
Drug and Alcohol Services
|
13
|
16.5
|
Extracurricular Activities
|
39
|
49.4
|
Housing Support
|
17
|
21.5
|
Immunisations
|
2
|
2.5
|
Investigations
|
4
|
5.1
|
Learning Support
|
52
|
65.8
|
Medication
|
9
|
13.0
|
National Disability Insurance Scheme
|
4
|
5.1
|
Nutrition Support
|
14
|
17.7
|
Occupational Therapy
|
58
|
73.4
|
Optometrist
|
14
|
17.7
|
Paediatrician Review
|
22
|
27.8
|
Parenting Course
|
16
|
20.3
|
Referral to a Mental Health Service
|
3
|
3.8
|
Referral to a Medical Service
|
6
|
7.6
|
School/Work Transition Programme
|
19
|
24.1
|
Sexual Health Management
|
7
|
8.9
|
Sibling Review
|
4
|
5.063291139
|
Smoking Cessation advice/programme
|
4
|
5.1
|
Speech Therapy
|
55
|
69.6
|
Stable Environment
|
16
|
20.3
|
Strengths -Based Approach to Learning
|
29
|
36.7
|
Youth Health Service
|
36
|
43
|
Strengths and Difficulties Questionnaire (SDQ) (Table 4)
SDQ teacher reports before and after attending NS (n = 33) showed a statistically significant decrease in total difficulties scores (M = 6.2, SD = 6.165, p < 0.05, eta squared = 1.013 (large effect)). This was seen in all the subsets of the SDQ including behavioural/conduct difficulties (M = 1.8, SD = 2.4, p <0.05, eta squared = 0.741 (medium effect)) and hyperactivity and concentration difficulties (M = 2.8, SD = 2.4, p <0.05, eta squared 1.15 (large effect)). There was also a significant decrease in impact scores (M = 1.636, SD = 1.8, P <0.05, eta squared = 0.909 (large effect)).
There were no significant differences in the parent (n = 12) and self-reported SDQ (n = 12).
Table 4: SDQ pre and post Teacher 11-17 years (n=33)
Paired Samples Test
|
|
SDQ Teacher 11-17 years old
|
Paired Differences
|
t
|
df
|
Sig. (2-tailed)
|
|
Mean
|
Std. Deviation
|
Std. Error Mean
|
95% Confidence Interval of the Difference
|
|
Lower
|
Upper
|
Eta squared statistic (Cohen)
|
Total Difficulties
|
6.242
|
6.165
|
1.073
|
4.057
|
8.428
|
5.817
|
32
|
0.000002
|
1.013 (large effect)
|
Emotional Distress
|
0.970
|
2.365
|
0.412
|
0.131
|
1.808
|
2.355
|
32
|
0.025
|
0.450 (small effect)
|
Behavioural/Conduct Difficulties
|
1.758
|
2.372
|
0.413
|
0.916
|
2.599
|
4.256
|
32
|
0.0002
|
0.741 (medium effect)
|
Hyperactivity and Concentration Difficulties
|
2.758
|
2.398
|
0.417
|
1.907
|
3.608
|
6.605
|
32
|
0.0000002
|
1.15 (large effect)
|
Difficulties getting along with others (Peers)
|
0.758
|
1.985
|
0.346
|
0.054
|
1.461
|
2.193
|
32
|
0.036
|
0.382 (small effect)
|
Kind and helpful behaviour (Prosocial)
|
-0.697
|
1.630
|
0.284
|
-1.275
|
-0.119
|
-2.457
|
32
|
0.200
|
0.428 (small effect)
|
IMPACT
|
1.636
|
1.800
|
0.313
|
0.998
|
2.274
|
5.223
|
32
|
0.00001
|
0.909 (large effect)
|