NBPSA Administration
Email: admin@nbpsa.org
Web: www.nbpsa.org\
ABN: 30 828 719 189
Our Ref:221024 JL to WASC
24 October 2022
The Honourable Dr Sally Talbot MLC Chair, Select Committee into Child Development Services Western Australian Parliament C/- sccds@parliament.wa.gov.au
Dear Dr Talbot
Role of Developmental Paediatricians
The Neurodevelopmental and Behavioural Paediatric Society of Australasia (NBPSA) is a membership organisation for doctors, primarily paediatricians, as well as child psychiatrists. NPBSA members share a specialist interest in the field of developmental paediatrics. Established in 2012, the NBPSA has grown from an initial membership of about 50 members, to now have over 750 members.
Developmental paediatrics is an emerging area of medical expertise encompassing the journey of children and their families from birth to the age of 18 years.
Paediatricians working in developmental paediatrics provide specialised support including assessment of a child during vulnerable periods of childhood development, as well as assessment and management of children who experience functional impairment in their daily life activities, or problems with physical and mental health. Importantly these paediatricians also fill an essential role in facilitating support needs required by children and families to help the child reach their personal potential to become a happy and contributing member of society.
Working from a medical model as well as encompassing a biopsychosocial approach, paediatricians consider developmental disorders as the expression of fundamentally biology- driven problems. This means that understanding a child’s problems at a medical level is essential to providing the best care. As an example, if a child is to gain the greatest benefit from targeted interventions, it is important that any medical issues are recognised early and well managed (e.g. problems of sleep, attention control, anxiety, aggression, bowel control).
Children can receive important domain-specific care from allied health clinicians and time-limited care from therapists and teachers. However, paediatricians also provide longitudinal care, partnering with children and their families over many years to optimise a child’s developmental outcomes. This partnership enables paediatricians to advocate for the support needs of the child without bias, as they are not reliant on funding from programs such as the National Disability Insurance Scheme.
The NBPSA encourages the development of child-focussed services, with improved coordination of these services across the health, disability and education sectors. In addition, as a professional member organisation, the NBPSA aims to support ongoing improvements in the quality and consistency of developmental paediatric practice and in the advice available to
governments and others responsible for planning, organising and delivering services for children with developmental concerns. As an example we have recently developed a set of Practice Statements to help guide professional development for our members. The statements cover topics such as diagnostic assessment (case formulation), planning and undertaking the care of children, and optimised long-term outcomes through the care of children over time. Should the Inquiry be interested the Society could make these statements available on a confidential basis.
With regard to the Inquiry Terms of Reference we would urge emphasis on the importance of equitable access for all children and families to developmental paediatric care. This is particularly important for First Nations children as well as those from ethnoculturally and linguistically diverse backgrounds and from families who are socio-economically disadvantaged or have mental health concerns.
We note increasing rates of referral for developmental paediatrician care.
In addition to the rise in children experiencing developmental concerns across Australia, we believe paediatricians are increasingly and necessarily managing the care of children with mental health issues. These children may previously have received care from child and adolescent psychiatrists, but we understand that the continuing workforce shortage of this group has been exacerbated by a worldwide trend of increasing mental health difficulties in light of the COVID-19 pandemic.
Members report that many private paediatricians are no longer taking on new patients with paediatrician shortages across Australia resulting in pressure on child development services. This is supported by the 2022 National Skills Priority List where for the first time paediatricians are listed as in shortage for every Australian state and territory.[1] Workforce matters with regard to Australian graduates in medicine are determined by universities and their funding agencies, with paediatric training overseen by the Royal Australasian College of Physicians. Training positions are determined largely by state governments who have responsibility for funding health in their jurisdictions. The NBPSA seeks to provide support to its member doctors, including a focus on the wellbeing of early career consultants.
We understand there are waitlist pressures across Australia, including in Western Australia.
Our understanding is that paediatrician workforce shortages and increasing levels of childhood morbidity have all impacted on waiting times for children to access necessary medical assessments and care.
Key to addressing waitlist demands is investment in prevention. Early childhood development is a window of opportunity to improve health and equity. Research now shows that many challenges in adult society - mental health problems, obesity/stunting, heart disease, criminality, competence in literacy and numeracy -have their roots in early childhood. Investing in the First Thousand Days is considered economically wise and the greatest investment a government can make, with returns over the life course many times the amount of the original investment.[2]
[1] Skills Priority List | National Skills Commission [2] The first 1,000 days | Pregnancy Birth and Baby (pregnancybirthbaby.org.au)
Government investment provides the opportunity to redress any siloing of agencies or non- government organisations to support child and family centred care. Ensuring a child focussed and seamless approach to assessment and care requires strong collaboration across government agencies (e.g. health, education and justice) and non-government organisations, including Aboriginal Community Controlled Health Organisations (ACCHOs). To be effective these collaborations require public investment in time and people. Current Medicare arrangements would not appear to support optimal levels of this type of engagement. While it is understood that similar to public health services ACCHOs are struggling to meet demand, there may be opportunities to reduce demand on health-funded child development services by improving the scope and reach of organisations that deliver parent support services.
I hope that the above information is of benefit to the Inquiry’s considerations. A selection of references that may be useful to the Inquiry is attached. Should the Committee be interested the NBPSA would be pleased to provide a representative to discuss these matters further.
For questions or further information please do not hesitate to contact John Fenwick, Interim Chief Executive Officer, NBPSA at admin@nbpsa.org
Yours sincerely
Dr Jane Lesslie NPBSA President
(encl)
NBPSA selected references on childhood development
- Australia’s children, The health of Australia’s children - Australian Institute of Health and Welfare (aihw.gov.au)
- Baby development milestones | Raising Children Network
- Developmental milestones in babies and children | healthdirect
- Early Learning Strategy (education.sa.gov.au)
- Early Years Last Forever - Brainwave Trust
- First 1000 Days Australia
- First 1000 days: conception to two years | Raising Children Network
- Gregory, T., Harman-Smith, Y., Sincovich, A., Wilson, A., & Brinkman, S. (2016). It takes a village to raise a child: The influence and impact of playgroups across Australia. Telethon Kids Institute, South Australia. ISBN 978-0-9876002-4-0. It-takes-a-village-to-raise-a-child-PDF.pdf (playgroupaustralia.org.au)
- Growing Up in Australia
- Skills Priority List | National Skills Commission
- The first 1,000 days | Pregnancy Birth and Baby (pregnancybirthbaby.org.au)
- The First 1000 Days | Department of Social Services, Australian Government (dss.gov.au)
- The Nest in action - Australian Research Alliance for Children and Youth (ARACY)
- The Royal Children’s Hospital : RCH National Child Health Poll
- Thrive By Five | The Minderoo Foundation