Complexity and Culturally Competent Care for Aboriginal Children Seen in a Hospital Paediatric Outpatient Clinic—A Retrospective File Review

AIMS: To document the health status and clinical complexity of Aboriginal children attending the Wadja Health Clinic at The Royal Children's Hospital (RCH), Melbourne and to assess the delivery of culturally competent care. To use the findings to inform service delivery. METHODS: A retrospective review of 208 patient records (March 2018-March 2020) was conducted. Diagnoses and social-emotional difficulties were categorised into four domains: medical, developmental/behavioural, mental health and adverse childhood experiences (ACEs). Children with issues in ≥ 3 domains were classified as having complexity. Culturally competent care was assessed based on documentation or inference of cultural safety, relationship-based care, family-centred and strength-based care and a focus on social and emotional wellbeing. RESULTS: Sixty-eight percent of children met criteria for complexity. Thirty-six percent had experience with Out of Home Care (OOHC), and 80% had at least one ACE. Aboriginal Case Managers provided a median of 7 contacts per child over 2 years, while paediatricians saw children a median of 4 times. Referrals supported relationship-based care: 35% to Victorian Aboriginal Child Care Agency (VACCA) and 17.8% to an Aboriginal Community Controlled Health Organisation (ACCHO). Self-reported connection to culture and connection to cultural practices were poorly recorded. CONCLUSION: This Australian study documents high levels of clinical complexity in Aboriginal children attending an urban hospital clinic and demonstrates the value of embedding culturally competent care. The service response has been to strengthen an Aboriginal-led integrated multidisciplinary model of care at the hospital and could serve as a model for other hospital settings.