Infant risk assessment and response decision - advice

This advice provides additional information regarding working with children under the age of two years.

Document ID number 2401, version 3, 30 June 2018.

Introduction

See procedure Infant risk assessment and response decision for tasks that must be undertaken.

The fragility and developmental dependence of young infants significantly increases their vulnerability to potential harm. Where a child is less than two years and the severity and cumulative impact of risk is adversely affecting their safety and development, the case requires a specific response.

The infant response classification system identifies those infants in the child protection program most at risk and determines a service response. It focusses and maintains attention on infants who have been assessed as requiring a suite of specific responses by child protection that matches their risk level. The system includes two categories: infant intensive response and infant response.

See Infants and their families for additional guidance.

Infant response decisions 

The infant response decision can be one of two options: infant response required and infant intensive response required. The infant response decision should match the level of risk assessed for the infant and the service response required by child protection to address the protective concerns. An infant response decision can be made by a team manager or above.

The infant response decision tool has been designed to assist child protection practitioners and managers with their infant practice, including making the decision about whether an infant requires an infant intensive response or infant response. Please refer to the infant response decision tool. The tool is double sided and is a three step process:

  1. Use the considerations and prompts list on the tool under the four key areas of pattern and severity of harm, likelihood, vulnerability and strengths and protective factors. This is not an exhaustive list, but provides an infant-specific lens to assist information gathering.
  2. Use the information gathered about the infant and their family, along with your observations from visits to undertake a risk assessment using the Best interest case practice model Infant Analysis and Risk Assessment Snapshot.
  3. In consultation with a team manager, consider your risk assessment and think about the infant response decision key questions on the tool to assist you in determining which infant response decision is appropriate. This must occur at the point of substantiation, and can also occur at any other time in the Investigation, Protective Intervention and Protection Order phases.

Service provision

All children who are subject to protective intervention are considered to be at risk.  Infants are a particular vulnerable group; therefore, all infants in this situation receive an infant response.

An infant is assessed as requiring an infant intensive response when there are risk factors that have had, or are likely to have a significant impact on the infant and where there are insufficient safety factors evident, suggesting a more intensive service response from child protection is required. The service provision required for both infant responses are detailed in procedure Infant risk assessment and response decision.

Mandatory decision points

At substantiation, practitioners will be required in CRIS to record an infant response decision for each infant. The classification options are infant intensive response required or infant response required.

Mandatory review points

There are a number of points in the life of the case where review and update of the infant response decision is required. CRIS supports the policy by prompting review where:

  • a new Court Order is created in CRIS
  • a case plan has been submitted for endorsement (version 1.1 onwards only).
  • there is a New Familial Allegation recorded on CRIS
  • there is a phase movement to closure.

In addition, a review of this status should occur upon receipt of any new information or upon any change in the infant (or their family’s) circumstances, which may change the decision as to which infant response is required. As such, it is important that discussion about the infant response decision occurs frequently, to reflect the potential frequent changes in an infant’s circumstances. The infant response decision should match the current assessed level of risk. These discussions could be at any time, not excluding supervision, case consultation discussions and meetings.

Specific responses required for infant classifications

The following outlines all specific responses to infants under both classifications – infant intensive response and infant response. Please refer to the procedure aligned with the classification decided upon so that all mandatory tasks are completed.

Case allocation

Infant intensive response

The infant is to have an allocated child protection practitioner who will actively engage with the family or carers to promote visibility of the infant and to address the protective concerns. It is critical that practitioners new to the case take the time to read the client file, gain a clear understating of the history of trauma, abuse, family and social networks, current risk issues and case planning. Upon an infant being classified as requiring an infant intensive response the case is to be allocated that day or during the next business day.

Infant response - prioritise for allocation

The team manager should consider the risk issues and case planning direction for the infant and determine prioritisation for allocation. Considerations for allocation should consider best practice for the infant, the severity of the risk issues, the case plan for the infant and the need to conduct fortnightly visits. Allocation should be considered in the context of the case allocation advice.

Visits - weekly or fortnightly depending on classification

Visits are to include face-to-face contact with the parent and the infant. Where a decision has been made that the infant requires an infant intensive response, weekly visits are to occur at a minimum. Depending on the level of risk, visits may be required more frequently than once a week. Following a decision that an infant response is required, the infant is to be visited at least fortnightly.

All visits are to be discussed between the practitioner and their supervisor to develop an active plan for each visit. The visits are to include contact with the infant for the purpose of assessing risk, observing interaction between parent and infant, viewing the infant’s sleeping environment, discussing SIDS risk factors and case planning with the parents.

A case conference or care team approach

A case conference should include the child protection practitioner, supervisor and any service providers that are currently involved with the family, or able to provide information about the case. Consideration could be given to inviting the practice leader or principal practitioner if there is a valid purpose for their attendance.

Depending on the level of risk, case conferences may need to occur on a fortnightly or monthly basis, to ensure active discussions of the risk issues, action plans and review of the intensive infant response status. See Case planning – advice for further information.

The purpose of the case conference is to:

  • assist with developing goals and tasks relevant to case planning and once a case plan has been endorsed, support its implementation and review
  • promote a shared understanding of roles and responsibilities within the group of professionals regarding supporting the infant’s safety and wellbeing
  • consider the immediate and future risks to the child's safety and development
  • identify the causes of harm or risk
  • identify the strategies, support agencies and other resources to address the risks to meet the child's safety and developmental needs and provide for their care and wellbeing
  • establish information sharing arrangements, appropriate monitoring and review mechanisms, and support systems relevant to the permanency objective and goals
  • identify the roles and responsibilities of the case manager and other professionals and agree on timelines for tasks to be completed
  • establish contact and monitoring arrangements with the child and the family.

Practice leader or principal practitioner involvement

A discussion with a practice leader or principal practitioner can provide a broader understanding of case dynamics and assist with planning and decision making. The intent is that our most ‘at risk’ infants have a higher level of oversight by multiple sources.

An interactive approach to the discussion by all participants will provide an opportunity for information to be shared and advice given in addition to standard line management. Any infant with an infant intensive response status must be subject to practice leader and/or principal practitioner involvement and oversight.

Practice leader or principal practitioner involvement should not be a one-off event. Further discussions with the practice leader or principal practitioner need to occur at various points in the life of the case. If a practitioner is in doubt about risk issues, action plans or case direction a discussion with the team manager should occur, who will involve the practice leader or principal practitioner if required. This is inclusive of when an infant has not been assessed as requiring an infant intensive response.

A decision to re-classify an infant from infant intensive response to infant response must have the endorsement of a practice leader or above (for example, a deputy area operations manager or a principal practitioner).

Regular case review

  • The review of an infant’s classification should include a discussion on a regular basis that considers all information relating to current risk issues, action plan and case plan direction. This review could be undertaken as part of the infant intensive meeting or through a practice leader and/or principal practitioner consultation, or alternative meeting could be scheduled.
  • Further to this, practitioners and supervisors must undertake case reviews that examine part or all of the history of an individual case to evaluate practice effectiveness and outcomes, and identify opportunities for improvement. The practitioner must ensure that CRIS is accurately updated and all key decisions are entered.
  • The decision regarding which infant response is required is to be subject to regular and ongoing case discussion. The receipt of any new information should prompt a review as to whether the infant response decision should be changed.

Infant intensive response meeting

The infant intensive response meeting provides a framework and mechanism to support the management of those infants who are highly vulnerable and at highest risk. The purpose of the infant intensive meeting is to:

  • consider which cases should be discussed at the infant intensive response panel
  • consider current case status and whether there is a requirement for the infant intensive response status to remain in place at that time
  • identify cases that require attention to promote targeted implementation of case plans.

Any client who has been classified as requiring an infant intensive response should be discussed in the area’s monthly infant intensive response meeting.

The meeting composition is determined at an area level, but is to be chaired by a CPP 6 or above and attended by either the principal practitioner or practice leader or both.

The chair of the meeting is to arrange for minutes of the meeting to be taken. Outcomes for each individual infant should be provided to the allocated practitioner in the outcomes section of the infant intensive response meeting template.

Referral to the infant intensive response panel

Of those infants discussed at the infant intensive response meeting a smaller number of cases may be referred to the infant intensive response panel (the panel). The decision to refer an infant to the panel is made by the chair of the infant intensive meeting (CPP6 or above).

The primary role of the panel is to support rigorous multi-disciplinary case review, planning and decision making, service integration and collaborative problem solving. It should provide support and direction to case managers and other direct service staff in respect of infants who have been identified as requiring an infant intensive response and presentation to the panel. In particular, infants identified with cumulative concerns, lack of progress, or needing a collaborative approach to assist with the progress of addressing concerns can be taken to the panel. Cases should be prioritised for the panel where they:

  • have an infant intensive response status; and
  • require panel members’ input and specialist advice (relevant to their role and expertise); and
  • require panel members to be proactive in providing (or arranging within their sector) direct service provision to the family in order to progress the case plan and increase safety for the infant.

Panels are convened at an area level and chaired by a CPP6 level or above and meet at least monthly. Panels are expected to include representatives at an appropriately authorised level of seniority.

The composition of panels is determined at an area level as relevant to the client group and local service arrangements. Factors for consideration include service delivery catchments, including case management service providers, and practical issues such as limiting the number of meetings members may be expected to attend.

The membership of the panels should include a core group and others that attend as required depending on the cases to be presented. Membership could include:

  • child protection practitioner and supervisor or team manager responsible for the client being considered
  • out-of-home care and case management services
  • disability services
  • mental health services
  • drug and alcohol treatment services
  • therapeutic treatment services (for example Take Two)
  • Department of Education and Training
  • Maternal Child Health Nurse
  • PASDS
  • Maternity hospitals
  • Queen Elizabeth Centre (QEC)
  • the area’s divisional principal practitioner.

Where a service has a relationship with a specific client or family, it may be appropriate for them to attend a care team meeting or other case planning forum.

An infant can be presented to the panel:

  • as a singular occurrence
  • at subsequent panel meetings where the previous panel meeting has not achieved its desired outcome
  • periodically, as required, based on changes in circumstances that result in the case plan not adequately progressing, where it is assessed that the expert input of panel members is again required.

Consideration should be given to providing the panel with a succinct progress update of any infant presented at the previous month’s panel.

The chair of the panel is to arrange for minutes of the panel to be taken. Outcomes for each individual infant should be provided to the allocated practitioner in the outcomes section of the infant intensive response panel template.

Service responses

Initiatives to improve the quality of services delivered to infants at risk of significant harm from maltreatment include:

  • Parenting Assessment and Skill Development Services (PASDS) for families who are caring for infants known to child protection. These services are divisionally based and consist of:
    • a parenting capacity assessment service — the assessment informs child protection decision-making and, in many cases, allows the mother and infant to reside together, with intensive supports, while the assessment of parenting capacity is undertaken; and
    • a parenting skill development and education and support service — the results of the assessment process inform a tailored skill development program to assist the family to acquire the skills to care for the infant in a safe and nurturing manner.
  • The Cradle to Kinder intensive ante and postnatal support service to provide longer term, intensive family and early parenting support for a group of vulnerable young mothers and their children.
  • Healthy Mothers Healthy Babies Program to address maternal risk behaviours and provide women with support during their pregnancy until about four to six weeks after birth. The program targets pregnant women who are unable to access antenatal care services or who need extra support because they are at risk of poorer health outcomes.
  • The Enhanced Maternal and Child Health Service to provide an intensive level of support for vulnerable families experiencing early parenting difficulties and children identified as being at risk of harm. The aim of the service is to improve the health and wellbeing.
  • The Right @ Home model, a structured program of sustained nurse home visiting for families at risk of poorer maternal and child health and development outcomes. Families are offered the program from the antenatal period up to when children turn two years of age. 
  • The health assessment initiative for children entering out-of-home care.​

Reducing risk of sudden infant death

See advice SIDS and safe sleeping.

 

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