Early childhood health checks do not effectively identify OM
WA Health currently offer 5 child health checks from birth until the school entry check. These Universal checks are usually delivered by nurses in a clinic and are currently the main service offered that could pick up ear health problems. In the 2017-18 financial year there were 102,890 checks performed in WA, with 4,497 checks of Aboriginal children
While the Universal checks are designed to assess a child’s overall health and development rather than specifically identifying OM, they are the best opportunity for early detection and intervention. The checks do not include a physical ear check which is the best method of detecting OM and instead rely on parental observations of development. This means WA Health is unlikely to detect OM early and OM is only likely to be identified if the child’s development has already been affected.
Our review of Universal check files in Halls Creek, Kalgoorlie and Armadale found the rate at which Aboriginal children were identified with ear or hearing problems was much lower than would be expected based on published research. This demonstrates problems with the effectiveness of the testing regime in identifying potential hearing problems in Aboriginal children. We reviewed 140 files of children (63 Aboriginal and 77 Non-Aboriginal) who had received at least one Universal check. We found only 1 case where an ear or hearing problem was found in an Aboriginal child, but 9 in non-Aboriginal children (Figure 5).
This would suggest that the major problem was in the non-Aboriginal population, but this does not match the research data, WA Health and NGO data and experience, or what people told us of their lived experiences. Such a significant discrepancy with the research and data would suggest that WA Health needs to review the effectiveness of the checks in identifying OM.
The Universal child health checks are achieving limited coverage among Aboriginal children. Our analysis showed that only 4% of Universal checks in 2017-18 involved Aboriginal children, even though the ABS national census data indicates that they make up 7% of all children in WA. We note that there is no simple agreed way to identify the number of Aboriginal people, and that this can affect data analysis.
Our review of CAHS Universal checks data for the period 2013-2018 found that Aboriginal children were almost 3 times as likely to not attend an appointment as non-Aboriginal children. The data showed a ‘did not attend’ (DNA) rate of 28% for Aboriginal children against 11% for Non-Aboriginal. When families do not attend an appointment this is a missed opportunity to detect problems.
Aboriginal specific services that should identify ear problems are not offered to all Aboriginal children
WA Health offers the EACHS program which are culturally appropriate health checks that are dedicated and designed to improve the level of engagement with Aboriginal families. Our analysis of metropolitan EACHS data showed a much lower rate of non-attendance for appointments than the universal checks, at 10% compared to 28%.
The EACHS is a more intensive version of the Universal checks and are better at identifying OM. They are usually delivered by Aboriginal health nurses and include physical ear screening rather than relying on parent’s observations. Our file review found EACHS identifies more potential ear issues (11 of 43 checks we reviewed) than the Universal checks (1 of 63 checks of Aboriginal children we reviewed), although we concede the EACHS cohort is more likely to have a higher rate due to their more complex needs.
EACHS is only offered to children that a nurse assesses at risk, even though Aboriginality in itself is a risk factor for ear disease. In some areas, such as in Kalgoorlie, nurses have chosen not to offer EACHS at all.
The EACHS checks program is being revised by WACHS and by CAHS, but in different ways. WACHS plans to keep the schedule but remove the focus on Aboriginal children, so it is for all at risk children and rename it the Enhanced Child Health Schedule. This could impact how much service Aboriginal families can access if resourcing does not change. CAHS has replaced EACHS with a system of tiered Universal checks based on assessed individual and family need. Families using Aboriginal Health Team services will be offered an extended service that includes physical ear checks. However, these changes will not increase the availability of the targeted services to Aboriginal children and without the focus on Aboriginality may result in fewer Aboriginal children receiving ear screening.
In Perth, the CAHS Aboriginal Health Team also run two ear clinics for Aboriginal children – one north of the river, one south. The clinics improve access to timely treatment by cutting down the waiting time to see ear health specialists. For example, an Aboriginal family who attends the ear clinic can see an ENT specialist within a month or two, while the median wait time is 105 days (in 2017, all children) to see one at Perth Children’s Hospital’s outpatient clinics.
The ear health clinics however have a limited reach. Clinics only have a small number of appointments available, for instance 14 per month at Armadale, and funding is partially external and subject to budget fluctuations. As a result, there is unmet demand for these services.