Pot-pourri eBulletin 8 March 2019

President's Message

The Division Council will be meeting face-to-face next week at the College. Items for discussion include understanding the member journey, exploring how we can further engage with our South Pacific neighbours and strengthening advocacy amongst our profession.

The RACP has released its Pre Budget-submission and I am pleased to report that adolescent and child health features strongly. Some recommendations from the College include:

  • Commit funding to establish and maintain an Inequities in Child Health Alliance.
  • Immediately reinstate the Australian Health Ministers' Advisory Council (AHMAC) subcommittee on child and youth health.
  • Expand the eligibility of the Medicare Benefits Schedule (MBS) health assessment items 701, 703, 705 and 707 to include adolescents and young adults aged 10 – 24 years to facilitate early identification of risks and needs.
  • Invest in the development of specialised adolescent health services, which address the unique physical, mental and sexual health challenges of adolescence and build the capacity of adolescents to self-manage chronic disease.

We have been collaborating with both the National Aboriginal Community Control Health Organisation (NACCHO) and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to provide a statement in response to the Coroner’s report on the recent suicides in the Kimberly region. An urgent boost to Aboriginal community controlled health services is required to build on the existing range of effective initiatives that are being rolled out. We also call on the Government to expand evidence-based resilience and cultural connection programs and they be adapted and attuned to local needs. A long-term solution to Aboriginal and Torres Strait Islander self-determination requires commitment by the Government to the Uluru Statement from the Heart.

I strongly encourage you to attend this year’s RACP Congress in Auckland. There are many sessions paediatricians will find valuable including the Howard Williams Oration by Professor Lex Doyle and the First 1000 days – the window of opportunity for long term health with Professor Richie Poulton. We are also holding a joint session with Adult Medicine focusing on Transitions from Paediatric to Adult care with Dr Colette Muir, Dr Rachael Harry and Dr Fran Mouat. Research will feature prominently at this year’s Congress with the PCHD session Pathways to Hot Science: How I got here with Professor Jane Harding, Dr Stuart Dalziel and Dr Adrian Trenholme taking us through their diverse research journeys and lessons. There will also be the return of a free paper session showcasing recent research undertaken by members. Please register here.

I encourage you to complete the Member Satisfaction survey. You will have received an email from Woolcott Research with a link to the survey. The 2019 survey retains the core questions required to ensure the College can continue measuring changes in overall satisfaction, communication, policy & advocacy, online resources and representation and value for money. 

Professor Paul Colditz
President, Paediatrics & Child Health Division

Is ten years of age too young for a child to be held in custody?

Raising the Minimum Age of Criminal Responsibility by Dr Mick Creati

The fantastic advocacy by the RACP and its partners has seen the last child removed from offshore immigration detention in Nauru, and the number of children held in community detention in Australia dramatically decrease.

It's perhaps now timely to also consider the issue of children held in another form of detention in Australia, namely, detention (custody) within the Youth Justice system.

Scenario one:
When my friend was 12 years old, he was walking home from school, the battery in his walkman was flat, he went into a shop, took a battery, was caught and charged with shoplifting. He acknowledged his guilt, and did a diversion program. Last year, at the age of 30, he was pulled up by the police for a minor misdemeanour. The police officer checked his mobile tablet, and informed my friend that he had prior criminal charge.

Scenario two:
A 12 year old child impulsively jumps into a stolen car with his friends due to peer pressure.  As he is more than 10 years old he can be charged as an accessory to a crime. In cases where child protection cannot immediately arrange accommodation, the magistrate has the option of remanding this child in custody. 

Some key facts:

  • Under Law, in every State and Territory in Australia, children can be charged with a criminal offence and held in custody if they are 10 years or older. This minimum age, in legal terms is referred to as the “Minimum Age of Criminal Responsibility" (MACR)
  • On any single night in Australia, there are almost 1000 children held in detention (custody) within the Youth Justice System
  • Each year, around 600 children under the age of 14 years are held in custody
  • More than half (54 per cent) of children in custody on any one night are Indigenous
  • 60 per cent of children in custody are un-sentenced, and many of these are ultimately never found guilty of a crime

Ref: https://bit.ly/2PNIdKa 

The College argues that it is completely inappropriate to be able to charge a child with a crime at the age of 10 years, and then be able to hold that child in police cells, and then potentially in custody.  We are currently advocating that the MACR is raised to 14 years old. 

Reasons underpinning this argument are:

  • Human Rights: Australian law is out of line with the United Nations High Commissioner for Refugees  (UNHCR) argument that the MACR should be 14 or 16 years old 
  • International Comparisons: The average age MACR in the European Union is 14 years
  • Doli Incapax: is a legal argument that a child under 14 years of age does not have the capacity to know if their conduct is criminally wrong unless it can be proven otherwise. (This of course often cannot be tested until after a child is remanded in custody).

What we can add to the debate as Paediatricians:

As Paediatricians we are able to bring an understanding of health and development to the debate.

Many behaviours labelled as 'criminal' are impulsive acts

Neuro-imaging shows that the pre-frontal cortex, responsible for impulse control, does not fully develop till the age of 25 years.  Even as adults we do not have full control of our impulses, otherwise chocolates would not end up in our basket at the supermarket.

Incarceration is damaging

Adolescence is a critical time between childhood and adulthood. The most important influences in the development of a positive adult identity are connection to community, family, school and positive peer relationships.  Placing a child in custody, and removing them from these positive influences, sends them on a worse developmental trajectory. 

The younger a child goes into custody, the higher the recidivism rate.

We need to be politically smart and offer alternatives so as not to be seen as being 'soft on crime'.

Behavioural Paediatricians are skilled at working with families to help them develop and implement appropriate consequences for inappropriate childhood behaviour. We try to teach children to be responsible for their own actions from a young age (for example, if a three year old throws their Lego across the room, they help clean it up and the Lego goes away for a while).

Having a criminal history and /or incarceration are not appropriate consequences for problematic behaviour in 10 to 14 year olds. We do want children to take responsibility for their actions. A restorative justice approach where there is facilitated dialogue or meetings between the parties involved, including the victim and the offender, has been shown to be effective in reducing recidivism and more effective than incarceration.

We need to offer children the mental health support they need, retain them in the education system, support parents struggling with addiction or mental health issues, and work with Indigenous communities to identify solutions and implement them.

The law needs to change

The RACP and its partners have been successful in raising the profile of this issue at important meetings including a Roundtable in Canberra hosted by Senators Patrick Dodson, Mark Dreyfus and Lisa Singh.  The agenda is now on the table for consideration of the COAG Council of  Attorneys-General who have the power to change the law.

Coroner's report on the death of a baby from complications of herpes simplex virus type 1 infection 

On 15 June 2018, the Victorian state coroner reported the death of a baby from complications of herpes simplex virus (HSV) type 1 infection. The coroner determined that the Paediatrics & Child Health Division of The Royal Australasian College of Physicians consider educational opportunities arising from the death particularly 'in relation to the presentation of neonates with HSV’. It would be worthwhile for anyone who may look after babies to read the coroner's report.

Read more…

Paediatrics stream at RACP Congress 2019

RACP Congress 2019 sees a reinvigorated Paediatrics stream which should have great appeal to anyone with an interest in children’s health and welfare. Preceding the opening of Congress is the Chapter of Community Child Health’s annual Chapter Satellite Day, to be held at the Aotea Centre on Sunday 5 May. Registrations are rapidly filling for this event which promises an exciting program featuring highly-respected community child health experts including Senior Australian of the Year Dr Sue Packer AM, New Zealand’s first Children’s Commissioner Sir Ian Hassall KNZM, and Dr Patrick Kelly ONZM who will give the plenary – 'Head Trauma Prevention'. See the Satellite Day webpage for full program details and to register for this event.

RACP Congress 2019 opens on Monday, 6 May 2019 at the Aotea Centre. Following the President’s Welcome and Opening Keynote, Professor Lex Doyle will present this year’s Howard Williams Medal Oration entitled 'A Career in Neonatal Research – Really?'    

Early Monday afternoon will see six presentations for the Rue Wright Memorial Award. This annual presentation event seeks to award “a Fellow or trainee who demonstrates excellence in hypothesis, scientific merit and relevance to community child health”, and always generates a lively question and answer dialogue with the audience. All members interested in community child care and paediatrics are encouraged to attend.

A shared session on Monday afternoon – 'The first 1000 days – the window of opportunity for long term health' – has a strong paediatric focus but should also be of interest to all RACP members. This session features two speakers – Professor Richie Poulton and Dr Matire Harwood – and is chaired by PCHD Fellow  Dr Patrick Tuohy, Chief Advisor Child and Youth Health, Ministry of Health NZ.

The Congress Gala Dinner on the Monday evening represents the perfect chance for colleagues and friends old and new to catch up, as well as taking the opportunity to acknowledge worthy award and prize winners from the Congress and throughout the year.

On Tuesday, 7 May, the Divisions of Paediatrics & Child Health and Adult Medicine team up to present on 'Transition from paediatric care into adult medicine'. Experts from both areas of specialty will come together to seek solutions on how to create a smooth transition process for patients, their carers and their medical teams. Post-lunch there will be a free paper session, 'New Paediatric Research', and members are encouraged to attend and lend their support to these presentations.

The final session on Tuesday, 7 May features a line-up of esteemed researchers presenting on 'Pathways to hot science: how I got here'. This session will promote the new Paediatric Academic Pathways career guide to paediatric research, and attendees with an interest in research will have the chance to engage in a question and answer session with speakers Professor Jane Harding, Dr Stuart Dalziel, and Dr Adrian Trenholme.

Poster presentations will take place throughout Congress, and attendees are urged to take time to engage with the presenters and their work. See the Congress 2019 program for venues and times for these presentations.

Further information regarding speakers and sessions is still coming in, so members are encouraged to be on the lookout for email updates and to regularly check the Congress 2019 website. Be sure to register to ensure your place at Congress 2019, encourage your colleagues to attend, and don’t hesitate to refer any questions to Paed@racp.edu.au  We look forward to seeing many of you in Auckland in May.

Chapter of Community Child Health Satellite Day 2019

The annual Chapter of Community Child Health Satellite Day is a forum that promotes an understanding of contemporary matters of community child health. This year the Satellite Day is being held in New Zealand, Sunday, 5 May 2019 at the Aotea Centre, Auckland.

The day will begin with a plenary from Dr Patrick Kelly ONZM, Service Clinical Director of the Starship Children’s Hospital Child Protection Team, on the topic of Head Trauma Prevention.

PCHD Fellows Professor Graham Vimpani and Dr Pat Tuohy will present thought-provoking sessions on Trauma Informed Care and the New Zealand Gateway Program respectively.

Speech-language therapist and court-communication assistant Ms Sally Kedge is the Director of the social enterprise, Talking Trouble Aotearoa New Zealand. She will be presenting a session on building awareness of, and capacity to respond to, the speech, language and communication needs of children, adolescents and adults involved with care and protection, justice, mental health or behaviour services.

The afternoon will feature a panel discussion with two exceptional child health advocates:  Dr Suzanne Packer AM and Sir Ian Hassall. This panel discussion on the topic of “Ka mua, ka muri (looking forward, looking back)” is an opportunity not to be missed. The Q&A format of this session will give delegates the chance to ask questions of these two highly respected community child health leaders.

The Chapter Satellite Day traditionally ends with the viewing of a film, but this year takes a more modern and energetic angle by featuring a TedTalk by Dr Nadine Burke Harris on How childhood trauma affects health across a lifetime. For those Satellite Day attendees staying in Auckland for the RACP Congress (6 to 8 May), the discussion stirred by this TedTalk should segue neatly into the wider Congress theme of Impacting health along the life course.

This year’s Chapter Satellite Day will align with the Neurodevelopmental & Behavioural Paediatric Society of Australasia (NBPSA) Rational Prescribing Workshop on Saturday, 4 May. A joint dinner of CCH and NBPSA delegates will be held on the Saturday evening – remember to book a seat when you register for the Chapter Satellite Day.

You can find speaker biographies here on the RACP Congress website.

We welcome your attendance.

Dr Chris Pearson
Chair, Chapter of Community Child Health

Education Development (Study) Grant Applications

Applications are now open for the 2019 Eric Burnard Fellowship worth up to $10,000. This grant aims to support and encourage advancement of knowledge in the field of neonatology and improve health outcomes of infants.

Applications close on Tuesday, 2 April 2019. Information about this award including eligibility criteria and the link to the online application form is available on the RACP Foundation webpage.

Dr Atul Malhotra was awarded the Eric Burnard Fellowship in 2018 for the project ‘Teaching life saving childbirth skills to medical and nursing students in a low – middle income country’ and has now published the paper ‘Mobile obstetric and neonatal simulation based skills training in India’ as part of his research. 

Expression of Interest: RACP representation to a New Zealand Ministry of Health discussion of tongue-tie

RACP members are invited to participate in a discussion to be held at the Ministry of Health on 1 April 2019 in Wellington, New Zealand. According to two international surveys of health professionals, opinion is divided about tongue-tie and the most common form of treatment for the condition (frenotomy). It appears that this is also the case in New Zealand where there are ongoing exchanges between and within different health professional groups about tongue-tie, as well as between health professionals and women, between women and the government, and between government agencies.

In 2016 a petition was presented to the House asking the Ministry of Health to revisit how tongue and lip ties are treated in New Zealand. Here is a link to the Ministry’s response to that petition.

Since that time the Ministry has received a request from a group of health professionals to gather a group of relevant parties to discuss the burgeoning numbers of frenotomies being performed, and the ‘industry’ of tongue-tie. Additionally, in late 2018 the NZ Health & Disability Commissioner recommended that the Ministry of Health consider developing guidelines for the diagnosis and treatment of tongue-tie. This recommendation is the result of a recent decision.

This is your opportunity to take part in the discussion about New Zealand’s approach to the assessment, diagnosis and surgical treatment of tongue-tie in breastfeeding babies.

Please note that only two representatives may attend on behalf of the RACP. Expressions of interest will be considered by the PCHD Council and applicants advised of the outcome soon after. The confirmed representatives will be provided with an agenda and information pack prior to the meeting.

To express interest, download the EOI form from the RACP website, attach a current curriculum vitae, and return to Paed@racp.edu.au by no later than COB Friday, 15 March 2019.

Podcast: Cervical Screening – Less Is More

Cervical cancer is one of the most common cancers in women worldwide, but it’s almost entirely preventable.

In December 2017 Australia was the second country in the world to adopt HPV testing as the primary tool in cervical screening. This kind of test has many benefits, such as, the increased five year interval between screens (rather than two) and the requirement for women to start being tested at age 25 instead of 18.

Some, however, are concerned about the costs and risks involved in the triage pathway. This episode of Pomegranate Health will answer some questions that women and health professionals might have about the HPV-based National Cervical Screening Program. 

RACP Submission into the Royal Commission into Aged Care 

The College is preparing a submission to the Royal Commission into Aged Care Quality and Safety.

Members may contribute to this submission by sending any input relevant to the Terms of Reference to Racpconsult@racp.edu.au.

Please provide your input by COB Tuesday, 30 April and be as specific as you can.

For further information please contact Dr Kathryn Powell, Senior Policy & Advocacy Officer, on +61 02 9256 5497.

RACP Member Satisfaction Survey

We want to hear your thoughts on RACP membership via our Member Satisfaction Survey (MSS). On Monday, 25 February 2019 all RACP members (including trainees) should have received an email containing the survey link from WoolcottResearch@woolcott.com.au with the subject line 'RACP Member Satisfaction Survey – Have your say'.  

Please complete and have your say so we can understand your overall satisfaction with the College and identify areas for improvement. The survey closes on Tuesday, 19 March. If you have not received the survey email, please contact memberservices@racp.edu.au.

The survey should only take approximately ten minutes. Woolcott Research provides aggregated results back to the RACP and any individual comments are not identified as being by a specific member.

2019 Palliative Medicine Communication Skills Workshop

Registrations are now open for the 2019 Palliative Medicine Communication Skills Workshop.

The workshop is a three day experiential learning opportunity run by experienced facilitators in teaching communication skills with the aid of simulated patients. This will enable you to develop and enhance your communication with patients, their families and with other health workers.

Previous participants have rated the workshop highly.

The workshop will take place in Sydney at the RACP office on Wednesday, 3 to Friday, 5 July inclusive. It is suitable for all advanced trainees in palliative medicine, as well as Fellows and those training in other specialties who have an interest in further developing their communication skills.

The format will be learner-centred involving a mixture of lectures, demonstrations, role play and feedback in carefully facilitated groups in an environment of mutual respect and a willingness to share ideas and experiences.

Places are limited and priority will be given to currently enrolled trainees in Palliative Medicine and Fellows of the Australasian Chapter of Palliative Medicine.

The course fee is $2624 (AU) for trainees and $3280 (AU) for Fellows. This includes materials, morning tea, lunch and afternoon tea.

Registration are now open via an application form on the RACP Events webpage.

Please contact PalliativeMedTraining@racp.edu.au if you have any questions.

Register now for the 2019 Combined Special Interest Group meeting

The 2019 Combined Special Interest Group meeting will be held on 26 to 28 July in Sydney.

Convened by the Leadership and Management special interest group, the theme Developing leaders with 20:20 vision will explore topics of relevance to current and emerging leaders, such as: 

  • Inclusion and diversity
  • Building healthy workplaces
  • Having difficult conversations
  • Medical regulation
  • Digital technology

For more information, visit the event website.

Strengthened tenancy laws for victims of domestic violence

New tenancy laws that improve and strengthen protections for victims of domestic violence in NSW started on 28 February 2019.

Under the new laws, a tenant will be able to end their tenancy immediately and without penalty if they or their dependent child are in circumstances of domestic violence. They will not be liable to pay any compensation or additional money for the early termination.

The tenant will need to give their landlord or agent a domestic violence termination notice and attach one of the acceptable forms of evidence. Evidence includes a declaration made by a medical practitioner, such as a GP.

The documents used to end a tenancy due to domestic violence cannot be used or disclosed for any other purpose (unless compelled by law). For example, a property manager cannot use these documents as part of a reference check. The documents must be stored and disposed of securely.

Landlords and agents will also be prohibited from listing a tenant on a tenancy database if they ended a tenancy in circumstances of domestic violence.

More information on the domestic violence reforms is available on the NSW Fair Trading website

The RCPA advocates for a collaborative approach for the successful introduction of pharmacogenetics in healthcare in Australia

The Royal College of Pathologists of Australasia (RCPA) have released a new position statement on the significance of genetic testing to predict a patient’s response to drugs, also known as pharmacogenetics. The RCPA is advocating for a collaborative approach with medical colleges and the wider medical profession, the Australian Government, educators, and researchers, with the aim of creating national guidelines that will facilitate the safe and appropriate introduction of pharmacogenetics in Australia. By using pharmacogenetic testing, a clinician can align a prescription with the patient’s potential for a beneficial or adverse response to a drug.

For further information on the RCPA, visit www.rcpa.edu.au.

Tri-Nation Alliance annual International Medical Symposium (IMS 2019)

Register now for the Tri-Nation Alliance annual International Medical Symposium (IMS 2019), in Auckland, New Zealand on Friday, 22 March 2019.

The theme for the 2019 symposium is Visioning the impact of advanced technology on medical education with a program featuring diverse sessions such as the debate.

Topic: Machines make better doctors?

Four healthcare professionals debate issues of the future. What areas of medicine can machines takeover? What areas will remain with human doctors? What upskilling will human doctors need to make best use of machines?

For the affirmative

  • Physician, Associate Professor Rebecca Grainger
  • Psychiatrist, Dr David Codyre

For the negative

  • Surgeon, Mr Andrew Connolly
  • Anaesthetist, Dr Lara Hople

Register now to hear the debate that will be followed by questions from the floor.

Other not to be missed sessions taking place at IMS 2019:

  • Professor Enrico Coiera - Trust and AI
  • Professor Jenny Weller - Using simulation training to learn about non-technical skills management
  • Associate Professor Rebecca Grainger - Current research on apps to monitor patient self
  • Mr Andrew Connolly - Informed by AI: the systemic challenges before us
  • Professor Jim Warren - Consumer health information revolution
  • Mr Greg Cross - Using avatars for teaching
  • Dr Jaron Chong - Training radiology residents when machines read imaging
  • Professor Tim Shaw - AI in trainee assessment

 View the program and register for IMS 2019.

Refinancing made simple: your ten step guide

As a RACP member, receive a discounted rate for the life of your Macquarie Home Loan.

Your home loan is probably your biggest household expense – and with interest rates at an all-time low, there’s never been a better time to switch. Follow these simple steps to switch your home loan lender.

Request a call with one of Macquarie's banking specialists today and discuss the life of loan discounts that you have available through your benefits program with Member Advantage.

Find out more about our home loans here or call Member Advantage at 1300 853 352.

Macquarie Bank Australian Credit Licence 237502. Lending criteria, fees and T&Cs apply.

Health and Well-being of Children and Youth on the Move survey

Since 2017, more than 30 professional organisations, including The RACP, have endorsed the ISSOP's Budapest Declaration-on the Rights, Health and Well-being of Children and Youth on the Move.  A survey has been created to capture the similarities and differences in the approach to refugee, immigrant and International Development Program (IDP) children from paediatricians' home countries. 

RACP members are invited to complete the survey, in order to capture the insights and experiences of a large sample of physicians from Australia and New Zealand. The ultimate goal is to collect create the largest database from the paediatric perspective on this crucial issue.

The survey contains 16 questions covering demographics, borders, health conditions, and health systems. The survey take approximately 15 minutes.

Genomic medicine here to stay? Have your say.

Researchers from the Australian Genomics Health Alliance would like to hear from non-genetic medical specialists who work clinically in Australia.

They want to know about past, present and future aspects of genetics and health, including genomics in healthcare. It doesn't matter if you do or don’t know much about these areas, or don’t incorporate them into your practice at the moment.

By participating you will help shape future workforce practices and continuing education and training programs.

If you’re interested,  please complete this anonymous survey by 31 May 2019.

If you have any queries, please contact Dr Amy Nisselle, Specialist Project Officer, Australian Genomics Health Alliance at amy.nisselle@mcri.edu.au or +61 3 9936 6340.

This survey is an activity of the Workforce Development Program of the NH&MRC-funded Australian Genomics Health Alliance.

This survey has HREC approval, The University of Melbourne (1646785.8).

Autism Training for WA Health Sector

The Autism Association of Western Australia is partnering with the WA Health Sector to develop training packages and resources to increase Autism awareness within the health sector. The ultimate aim of this initiative is to improve access to health care and the health outcomes for individuals with Autism.

This survey is for WA Health Professionals. It will take a maximum of five minutes to complete.

The aim of this survey is to understand your perception of your ability to provide health care to people with Autism and the type of training and resources you need to feel confident when interacting with people with Autism and improve their health outcomes. 

For more information, please contact Aristea Kazantzidou on +61 08 9489 8900 or aristea.k@autism.org.au

Pot-Pourri submissions welcome

To submit an article for publishing in Pot-pourri, please email paed@racp.edu.au. The article should be no more than 350 words. If you would like to submit an image with your article, it would be assumed that you have received appropriate permission to use the photo and it needs to be of high resolution, above 300 dpi. Please note that articles may need to be edited by the RACP Communications Team.

Update your details with the College

Did you know that you can now update your address details online? Simply Login to MyRACP and go to “Edit my details”.

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