Chapter Chat – July 2019
Message from the Chair
Welcome to Chapter Chat.
2019 has been another busy year for the Committee in establishing priorities for the Chapter.
The Paediatric Policy and Advocacy Committee has agreed to support our Chapter and the Australasian Chapter of Addiction Medicine in developing a statement on the impact of parental addiction on the health of the family’s children. It is important that the message gets out that these children are at serious risk of adverse life outcomes in the areas of health, education and contact with the justice system. It is the responsibility of all doctors involved to consider if a notification to child protection services is warranted.
I would like to congratulate the winner of the 2019 Rue Wright Award – Dr Peter Vuillerman – with the presentation title 'Maternal gut microbiota during pregnancy and allergic disease in the offspring: a birth cohort study'.
The Satellite Day before Congress was a great event made ever the better by listening to two luminaries of our College, Sue Packer (Senior Australian of the Year) and Sir Ian Hassel (the first NZ Commissioner for Children), interviewed by Russell Wills.
Good news for our younger patients eligible for NDIS funding. There is now a fast track process for these children to ensure that their early intervention is truly early.
Similarly there has been an announcement about NDIS funding supports for our patients.
Chapter Chat has gone back to including photos from Chapter events so please enjoy and see who you recognise.
Dr Chris Pearson
Chair, Chapter of Community Child Health
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The burnout syndrome
Welcome to the first Chapter Chat for 2019. We have brought some interesting topics together that we hope you will enjoy and reflect upon.
Starting with reflection, in the last few months I've had a few occasions of self-reflection in various contexts. I guess self-reflection is a good thing as it promotes learning and self-education, when we try to use our fluid reasoning to analyse problems and identify patterns and relationships. It is particularly important in our specialty, where our clinical cases start from complicated category going to multiple layers of complexities when the social aspects are add-ons. The main topic stimulating my brain recently has been the parent-child relationship.
In a private setting, when you put the challenges aside, practising developmental-behavioural paediatrics has been very interesting. I have found myself working on parent-child relationship numerous times, in the context of ADHD, when parents often describe themselves as 'burnt out'. Extensive school letters describing the incidents, suspensions and detentions relating to the child’s behaviour often validate parental concern when their quality of life is disrupted significantly. The older the child, the bigger the problems, not mentioning the adolescents in the clinic and their relationship with their parents. I remember one of my senior colleagues mentioning the 'medicine breaks' during the weekends during my training years and how we didn’t prioritise the family relationship as a treatment outcome then. This only emphasises how important parental education is, and for some of the families, positive re-enforcement has worked wonders and children are happier overall, learning to improve their organisational skills while they have 'planned breaks' from the medication. So being happy doesn’t mean that the problems are over, but to know that one can deal with the 'acknowledged' problems.
As professionals working with complexities, all of us face unresolvable stress at times. In the long-term, we are at risk of being 'burnt out' just like the parents mentioned above and start dissociating with our 'child' (work). First described in the 1970s, Burn Out Syndrome (BOS) is a work-related constellation of symptoms that usually occurs in individuals without any prior history of psychological or psychiatric disorders. The three classic symptoms of BOS described include exhaustion (fatigue), depersonalisation (indifference) and reduced personal accomplishment (feeling inadequate). A common model outlining the four stages of burnout describes: first stage as excessive enthusiasm, second stage as stagnation (personal priorities being lost in work and business), third stage as frustration (feeling inadequate), and the final stage as apathy.
Evidence-based interventions to treat and prevent BOS are currently not available. It is important to ask if you are feeling at risk of burning out, what interventions can help and how does one build resilience. Resilience has been recognised as a mechanism to reduce symptoms of Post-Traumatic Stress Disorder and may prevent BOS. While resilience is an innate quality, there are qualities of resilience that can be learnt (positive thinking, mindfulness, supportive social/professional network and looking after yourself). I was particularly looking into this recently while building up our private practice. Interviewing administration staff was a learning experience as to what our employees expect from us so that they can remain productive. Effective communication came up as number one priority.
The American Thoracic Society has released a public health information series which is worth reading in this context. Some action steps to prevent BOS include:1
- Understanding that there are ways you can manage your work-related stressors that put you at risk of BOS.
- Engaging the support of management, co-workers and friends that may help you cope with stress at work.
- Taking breaks from work. Go outside for a walk or fresh air.
- Understanding what you enjoy about work and focusing on your interests and passions.
- Practising techniques (e.g. reframing and optimism) when dealing with stressful work experiences.
Dr Manina Pathak
1. What is Burnout Syndrome (BOS)? American Thoracic Society
The Annual Chapter Satellite Day was held one day prior to RACP Congress 2019 on 5 May, with a focus on trauma. The meeting was attended by approximately 73 members, with an overwhelming number providing positive feedback and rating the sessions as ‘excellent and good’.
The day began with an insightful plenary from Dr Patrick Kelly on head trauma prevention, looking at various techniques that have been used to reduce trauma, and what we can do next. This was followed by Professor Graham Vimpani speaking on the importance of trauma informed care and the adverse childhood experiences study.
Ms Sally Kedge, a speech-language therapist and court-appointed communication assistant highlighted the need for respect and trust with patients and for simplifying the language used in the court room. Dr Pat Tuohy showcased the New Zealand Gateway program that aims to enhance the child or young person’s physical, mental, educational and social wellbeing through the identification of unmet needs.
Ms Robyn Shearer and Ms Sonya Russell from the NZ Ministry of Health spoke to us about the NZ Mental Health Enquiry and how they were responding to the recent tragedy in Christchurch. As we know, such events are traumatising for all involved, and may also trigger traumatic memories for others.
To end the day, we were fortunate to have Dr Sue Packer and Sir Ian Hassall speak to the audience on their experiences and lessons learnt in their careers. We thank all speakers for taking the time and effort to present on the day. Their presentations are available to read.
Joint Dinner with the Neurodevelopmental and Behavioural Paediatric Society of Australasia (NBPSA)
On 4 May, we held a joint dinner with the NBPSA at the Glass Goose, Auckland. This is a wonderful opportunity for colleagues to get together and we encourage you all to come along to this event in 2020. Details will be published closer to the date.
As many as one in three children in Australia are living with adversity such as family violence, parent mental health problems, family breakdown, bullying or housing problems, just to name a few. Adults who have experienced adversity as children are six to 10 times more likely to go on to develop mental health disorders later in life. Whilst there are good, evidence-based services to address early childhood emotional and behavioural problems that turn into later mental health disorders, many Australian children miss out on these services.
Despite more services and funding available for adults and young people with mental health problems, the number of Australians with common mental health problems like anxiety and depression is not falling. Distressingly, our suicide rate in Australia is not declining despite the increased number of programs and services aimed at lower suicide rates.
Why is this? Well, part of the answer may be the need for a greater focus on early intervention. For at-risk individuals the focus may need to come earlier in life, before mental health problems really take hold. We may need to begin when a mother becomes pregnant, and then continue our support to families through a child’s preschool and primary school years. To get the best ‘bang for our buck’ we may need to direct support to children and families living with adversities.
In this Centre of Research Excellence (CRE), funded by Beyond Blue and the National Health and Medical Research Council, we aim to engage and work with children and families in adversity to design community hubs where parents can get help for their child’s behaviour or emotional difficulties. We also support parents with their parenting, their own mental health, gambling, legal problems, housing problems etc. We will bring the expertise of psychologists, paediatricians and psychiatrists out from the hospitals and into these community hubs. These clinicians will work with frontline clinicians along with lawyers and social workers to better support families and the clinicians working with them.
With this CRE, we will synthesise the evidence for what works best to help children, then deliver this evidence through services and supports for the range of adversities that families face. We will do this with an eye on creating an approach which is sustainable, scalable and accessible to families facing adversity. In doing so we hope that we can improve the mental health and wellbeing of very young children and ultimately the young people and adults they become. We will work in Wyndham, Victoria and Marrickville, NSW and with research partners across the Murdoch Children’s Research Institute, the Universities of Melbourne, Monash and NSW, the Parenting Research Centre, Sydney Local Health District and Children’s Health Queensland.
More information about the Centre.
Professor Harriet Hiscock
Group Leader, Health Services, Centre for Community Child Health, Murdoch Children's Research Institute
Director, Health Services Research Unit, The Royal Children's Hospital
Principal Fellow, Department of Paediatrics, The University of Melbourne
Ep46: The First 1,000 Days
This episode was recorded at RACP Congress 2019 in Auckland. The three speakers dealt with the profound influence that the early years of life have on lifelong health, wellbeing, behaviour and socioeconomic outcomes.
Professor Richie Poulton CNZM FRSNZ outlined the influential Dunedin Multidisciplinary Health and Development Study, which has followed over 1,037 participants since 1972. All sorts of measures have been taken throughout the participants’ lives, but Professor Poulton showed the incredible predictive power of one behavioural trait in particular: self-control.
Paediatrician Dr Johan Morreau FRACP revealed how associations between childhood deprivation and behavioural outcomes might be explained by developmental neuroscience, and finally, public health physician Professor Susan Morton FAFPHM showed evidence from the Growing Up in New Zealand Study which reveals the importance of social factors in protecting against poor outcomes.
Together, these speakers demonstrated that the consequences of childhood disadvantage are borne not just by individuals and families but by all of society. The lectures were framed by the launch of the RACP early childhood position statement titled “The Importance of the Early Years” and another released last year on “Inequities in Child Health”.
Ep47: Complex Adolescent Transitions
Everyone knows that adolescence is a turbulent time. Teens are faced not just with changes to their bodies, but to their moods and thought patterns as well. They might also be saying goodbye to familiar carers in the paediatric department, and in Episode 11 we heard how important it is to ensure a smooth transition to adult services, which tend to be more anonymous.
This is especially true for young people with special needs such as diabetes, transplant management or intellectual disability, though they are the least likely to receive dedicated transition support. The three speakers in this podcast explain that improving this transition process doesn’t require going way above and beyond regular practice, it just needs a little more coordination.
Recorded at RACP Congress 2019. First, Dr Fran Mouat outlined Starship’s transition program for young patients with diabetes, and some of the data showing its impact on glycaemic control after they’ve left paediatric care.
Dr Rachael Harry leads a transition program for adolescents who’ve undergone transplants early in life. With a moving case study, she described how all the medical care in the world needs to fit in with the lifestyle that every young adult aspires to.
Finally, Dr Colette Muir, described what this period is like for adolescents with developmental disabilities. Intellectual disability is associated with a lower quality of care throughout the lifespan, often because of 'diagnostic overshadowing' – the phenomenon by which the complaints of such patients get attributed to the disability itself, rather than being investigated thoroughly in their own right.
The RACP is a signatory to an international consensus statement called Equally Well, and has also published a position paper about transition of young people with chronic disability needs.
Date: 5pm Wednesday, 25 September 2019 to 6pm Saturday, 28 September 2019
Location: American University of Beirut, Beirut, Lebanon
Host: International Society for Social Pediatrics and Child Health
The conference is a forum for child health professionals and child advocates to meet and define how the rights, health and wellbeing of children in armed conflict and their families can be advanced.
The conference will launch a concerted and sustained global movement to respond in collaboration with global organisations on the front line of this work. Just being there as a child health professional will make a statement to professional societies, national governments, global organisations and most importantly to children and families.
See the International Society for Social Pediatrics and Child Health for more information.
ISSOP 2019 registration
The Committee is keen to receive your input so we can understand how the Chapter is currently viewed. We want to know how you want us to engage with you and more importantly be relevant to your needs. Some questions might include:
- Are you aware who to approach to promote activities within the Chapter?
- What are your thoughts on attending the Chapter Satellite Day? What would encourage or discourage you from registering your attendance?
- Are you aware of the Community Child Health Special Interest Groups and what they represent?
- What does the term community child health paediatrician mean to you? What would encourage or discourage you to obtain membership of the Chapter?
- Do you feel that there is adequate and regular communication from the Chapter and its Committee in relation to their ongoing activity? Do you feel sufficiently engaged?
We welcome your thoughts on how we can build upon a sense of identity and purpose within the Chapter, as well as identifying guiding key priorities for the membership. Send any thoughts or suggestions to Paed@racp.edu.au.
Dr Chris Pearson
Chair, Chapter of Community Child Health
The Chapter has a close collaboration with the NBPSA. Dr Alicia Montgomery is the NBPSA representative on the Chapter Committee. Membership of the NBPSA is open to doctors working in the area of Neurodevelopmental Paediatrics, including Developmental-Behavioural and Developmental Disability Paediatrics.
For more information on how to join the society, and the benefits of membership please visit the NBPSA website.
The Chapter is the authoritative source of advice within the College for anything relating to Community Child Health. Links to useful information are below:
To raise matters with the Committee, please contact us.
Through the RACP, the Chapter is a member of:
Through the RACP, the Division is a member of:
It is always great to have new members of the Chapter and we are pleased to welcome the following:
- Dr Hema Kumar Ahuja
- Dr Apak Dede
- Dr Keita Hada
- Dr Kate Harley
- Dr Sathiyapriya Karthigeyan
- Dr Rona Kelly
- Dr Vikrant Khanna
- Dr Gaurav Kulkarni
- Dr Jonathan Tang
- Dr Lin Tiong
- Dr Amelia Wong
Take part in College activity or be an RACP representative to an external group. You can now go to the Expression of Interest page at any time, to find out if there are any opportunities that are of benefit to you.