Health and wellbeing of child protection clients - advice
This advice focuses on the child protection practitioner's responsibility to consider the child's broader ongoing health and wellbeing needs whilst maintaining a focus on risk.
Document ID number 2422, version 4 5 May 2020.
See procedure Consent for medical examination and treatment for tasks that must be undertaken when medical examinations or treatment is required.
In situations where the child is placed in care, s. 597 of the CYFA states that the Secretary may at any time order that a child be examined to determine his or her medical, physical, intellectual or mental condition when the child is subject to:
- an interim accommodation order
- a family reunification order
- a care by Secretary order
- a long-term care order
- therapeutic treatment (placement) order; or
- has been taken into emergency care as a result of a protection application or breach of a protection order.
The department's role with a child subject to any level of intervention is broader than only addressing the presenting or immediate risk issues. Practitioners need to maintain a holistic approach when working with children and a focus on the child's health needs is one important aspect of this.
Addressing child health needs
Contemporary research informs us that to assist children to develop and grow into well-functioning adults, a holistic approach to addressing their needs must be taken. Therefore, practitioners must consider and respond to a child's needs, in addition to immediate safety.
Many children coming to the attention of the department or in care may have unmet health needs or develop health issues during the course of child protection involvement. Unmet health needs or poor health may have a negative impact on other aspects of a child's life. For example, poor eyesight may have an impact on the child's education or participation in sport.
The health and welfare dimensions incorporated in the Client Relationship Information System (CRIS) are derived from the looking after children (LAC) practice framework and are relevant to all clients of child protection not only children in care. in CRIS they can be found in the case practice component and LAC In developing a comprehensive assessment, practitioners should consider the child's broader ongoing needs, including health requirements, whilst maintaining a focus on risk.
For all children and young people subject to child protection intervention, practitioners should arrange for children or young person to be seen by a general practitioner to assess:
- general physical health
- chronic health conditions such as asthma, diabetes, allergy and developmental delay
- mental wellbeing
- adolescent specific issues such as sexual health and substance misuse.
Children should also be assessed by public dental services for their dental health noting that for school aged children and young people the Smile Squad dental vans visit schools regularly.
General practitioners may also refer children and young people to more specialist medical services for a range of physical, chronic disease, developmental and mental health conditions.
Practitioners share the responsibility with parents, other care providers and involved professionals to identify health and developmental issues and seek early and regular assessment with health providers to ensure that children do not have unmet health needs. Where medical practitioners recommend specific medical treatment, practitioners should facilitate access to recommended medical treatment services at the earliest opportunity.
Whilst child protection practitioners are not trained health professionals, information on the child’s health needs should be obtained from the parents during the course of an investigation and intervention with a family. Families should be involved in discussions with health providers about their child’s health where it is appropriate for this to occur.,
The community expects that children in care will be cared for in the way that any good parent would care for their own child. For children in care, child protection should arrange a general practitioner appointment as all children in care must have a medical assessment completed within 30 days of entering care (National Health Standards).
For children living at home, practitioners should work in partnership with parents to assist them to fulfil the parenting role to the best of their ability. To ensure that the child's best interests are met, practitioners should discuss the child’s identified health needs with the child and parents and actively refer the child to relevant health services. If there is any doubt to the information provided about a child’s health, or any concerns exist, at a minimum, practitioners should encourage and support a parent to take the child to a general practitioner (GP) for a health check.
Identifying the child's health needs
During the course of child protection involvement, the practitioner needs to obtain information on the child's physical, mental, intellectual or medical needs via:
- discussion with the child
- discussion with the parent
- discussion with the carer (when a child is in care)
- direct observation
- discussion or liaison with other health care providers and professionals relevant to the child's age and stage of development. This includes: maternal and child health (MCH) nurse; specialist children's service: speech therapist: kindergarten: school: paediatrician: general practitioner: occupational therapist. It is crucial to obtain information from health experts to fully inform a practitioners assessment.
Identified health needs for a child may include developmental delays, poor gross and fine motor skills, speech delay, language or learning difficulties, all medical conditions including chronic health conditions, immunisation, emotional and mental wellbeing. This information should be contained in the child’s case plan where relevant and recorded in the health screens in CRIS.
However, some health needs are not obvious, and therefore may go unnoticed for significant periods of time. If a child is in care they must be taken for a health assessment within 30 days, and if a child is living at home encourage the parent to take the child to the general practitioner.
In Victoria all referrals for specialist medical services must be made through the general practitioner, therefore it is essential that every child has a GP.
Health, wellbeing, examinations and treatment for children
No court order or in parental care on a protection order where there is no change of parental responsibility
If health needs for a child are identified as discussed above, then the practitioner needs to discuss the issue(s) with the parent. The practitioner should clearly outline the child's health needs and what is necessary to address those needs as informed by medical advice. The practitioner should encourage and support the parent to engage with services to ensure that the child's health needs are met. This may involve the practitioner explaining to the parent the likely consequences for the child's development if the identified health needs are not met. For example, if the child has language delays and does not receive speech therapy at an early age, this will impact on the child's ability to learn and progress at school, peer relationships and social interaction.
As part of the process to address the child's health needs, the practitioner may request the general practitioner make a referral for a general paediatric assessment or cognitive assessment, to clearly identify the exact nature of the child's health needs. Additionally, it is the practitioner's responsibility to follow up with the GP to ensure the child has been referred, as requested, to relevant health professionals for the child to receive any necessary treatment. Depending on the order the child is subject to and therefore who has parental responsibility, this referral may require the parent's consent, for example, if the child is subject to a family preservation order. Otherwise this decision can be made by the child’s case planner, as ordered by the Court or under s. 597 of the CYFA.
Consent and parental refusal
See procedure Consent for medical examination and treatment for actions that must be taken.
Parental consent is required for any type of health assessment of a child where:
- there is no court order, or
- the child is residing in the care of the parent subject to a court order.
In these circumstances, the child protection practitioner has no legal authority to insist or require a parent to take the child for a health assessment or treatment, or take the child themselves.
When assessing a parent's level of protectiveness and possible risk of harm to the child, it is important for the practitioner to consider the following areas regarding the parent's refusal:
- Does the parent have an intellectual disability, mental health issue or any other additional need that may prevent them from understanding the health needs of the child or from providing informed consent?
- Does the parent deny or not acknowledge the health needs of the child?
- Is the parent not motivated to follow through with recommended treatment for the child? If this is the situation, the practitioner may need to explore with the parent the reason for this and attempt to encourage and support the parent to do so, including the possibility of the practitioner transporting the parent and child to the appointment.
- Does the parent understand and acknowledge the health needs of the child, however refuses to follow through with recommended assessment and treatment?
When seeking a medical examination, assessment or treatment, practitioners must be cognisant of the issues of consent given the legal status of the child.
Initiating legal intervention
Where the parent refuses to allow the child to undergo a medical examination or treatment for health needs, the practitioner needs to assess the level of risk to the child and consider the possibility of initiating legal intervention. The practitioner, in consultation with the team manager, needs to consider the following when determining whether legal intervention is required:
- the immediacy of the child's medical or health need
- whether there is risk of cumulative harm to the child
- how the unmet health need may impact the child
- what are the consequences for the child if they are not assessed or able to receive treatment that is recommended by health professionals
- how to meet the child's best interests.
If the case is in the investigation phase, or child protection is working with the family by agreement in the protective intervention phase, a protection application under s. 162(f) of the CYFA, may need to be issued. This relates to where:
- the child's physical development or health has been, or is likely to be, significantly harmed and the child's parents have not provided, arranged or allowed the provision of, or are unlikely to provide, arrange or allow the provision of, basic care or effective medical, surgical or other remedial care.
Note that under s.162(2) the harm may be constituted by a single act, omission or circumstance or accumulate through a series of continuing acts, omissions or circumstances.
If the child is living in the care of parents under a family preservation order, the practitioner may consider:
- issuing a notice of direction
- applying to vary the conditions on the family preservation order to include a condition related to the child’s specific health need
- breaching the family preservation order.
Medical examinations and treatment for children on temporary assessment orders
Section 232 of the CYFA, stipulates that a temporary assessment order (TAO) may:
- authorise the medical examination of the child by a medical practitioner or psychologist
- direct the parent of the child or any person with whom the child is living to permit the child protection practitioner to take the child for that medical examination.
Despite a TAO, the medical practitioner or psychologist must not examine the young person if they are of the opinion that the young person has sufficient understanding and maturity to give or refuse consent to the examination and the young person refuses to consent. It is the role of the medical practitioner to assess the maturity of the young person to provide informed consent and they will consider any intellectual disability or mental health issue that may impact on the young person’s understanding.
Medical examinations and treatment for children on interim accommodation orders
After initiating legal intervention, an interim accommodation order (IAO) may be issued placing the child in the care of a hospital or parent and baby unit. This may be required in situations where the medical staff recommend that the child remains in hospital for further assessment or treatment or when a residential parenting assessment is required of the parent.
On occasions, a child who is subject to an IAO and is residing in care may require medical treatment. Section 597(4), CYFA, stipulates that the Secretary may authorise or consent to medical treatment, surgery or admission to hospital of a child in situations where:
- a child has been placed in care, a declared hospital or parent and baby unit, or with a suitable person, having been taken into emergency care or under an IAO, and
- a registered medical practitioner has advised that the medical treatment or operation or admission to hospital is necessary to avoid a serious threat to the health of the child, and
- the child's parent either refuses to give consent or cannot be found within a time which is reasonable in the circumstances.
Infants and preschool children
As part of a comprehensive assessment, the practitioner needs to liaise with the hospital where the child was born, the maternal and child health (MCH) nurse and general practitioner when identifying and assessing the health needs of an infant or pre-school child. The purpose of this is to obtain detailed information regarding:
- pre-natal and post-natal care
- possible complications with the pregnancy and the birth which may impact on the infant's development
- stage of development in relation to speech, motor skills, social skills, growth
- childhood illnesses or medical conditions which may require ongoing monitoring.
This will assist practitioners in identifying the possible health needs of infants and pre-school children and in consultation with health professionals, ensure that appropriate support services are engaged with the child and family so that the child's needs and best interests are met.
All pre-school children will benefit from regular contact with the MCH service.
The scientific evidence is clear that immunisations are safe and save lives. Immunisations are part of the health schedule for the Department of Health and Human Services and are considered routine medical care. Child protection practitioners should encourage parents, where the child is living at home, to immunise their child.
If a child is in care, child protection practitioners should seek to establish if a child is up to date with their immunisations as part of the health assessment completed within the first 30 days of a child entering care and record this information on CRIS. If a child is behind with their immunisations arrange for these to be completed. Also note that adolescents have immunisation requirements.
If any concerns are raised by the parent about the intention to have their child immunised, encourage them to seek medical advice about immunisations from their general practitioner. If parents continue to object, the practitioner should advise them to seek legal advice. Further information on immunisations can be located on the Better Health Channel and the immunisation advice.
Chronic Health Conditions
If the child or young person has asthma, it is important for the practitioner to clarify whether an asthma plan has been developed by health professionals or whether this is included in a general health management plan if the young person has a number of health conditions requiring ongoing treatment.
A separate health plan to cover issues related to ‘Thunderstorm asthma’ is not required, as an existing asthma plan is sufficient to cover what action should be taken. Further information on Thunderstorm asthma can be found at the Better Health Channel.
It is important to be aware that many children also suffer from allergies which require a health management plan by health professionals and this should be managed carefully and recorded accurately in the health screens in CRIS.
If the child has diabetes, it is important for the practitioner to clarify whether a health management plan has been developed by health professionals or if this has been included in a general health management plan.
Diabetes is a chronic medical condition and occurs when there is a problem with the insulin hormone and how it works in the body. Diabetes requires treatment and must be managed carefully or there can be severe consequences such as kidney damage, eye damage, heart disease and death.
Further information on diabetes can be found on the Better Health Channel.
There are a range of other chronic health conditions that a child or young person may experience and child protection practitioners must seek advice from health professionals and record this accurately in the health screens in CRIS including;
- the client’s diagnoses or existing condition
- the medication required and the medication regime
- the ongoing testing and monitoring required, including reviews by health professionals
- essential equipment required
Young people may also have infectious diseases, such as HIV or Hepatitis C. If a child is in care, it is very important this information is shared with the child’s carer to ensure their health needs are met and those caring for the child can take appropriate safety precautions
Young children under 5 years and children and young people with special health conditions can also be susceptible to influenza. Influenza immunisations can be provided for these groups and should be discussed with the child’s GP.
Recording of information
All information relating to a child’s health must be recorded in the health screens in CRIS and not only in case notes. The health screens can be found in the case practice component of CRIS.
It is critical health information is recorded in the health screens. This information must be accessible in order to highlight the health information and needs of a child or young person so that they are provided with the health care they require in a timely way.
Children or young people placed in court-ordered care are required to have an initial health assessment completed by a GP within 30 days of entering care, as per the National Clinical Standards applicable to all children in care. Information following this assessment should be documented on CRIS, including the name of the general practitioner and practice, the outcome of the assessment and any follow up appointments required, or health management plans that are to be followed and who is responsible for this.
It is important to obtain Medicare information for the child from the parent, or to secure a Medicare card for the child in the absence of this information. See Medicare (pdf, 2.88 MB) protocol for further information and Applying for a Medicare number for a child in care. Practitioners should note that without a Medicare card or Medicare number and individual reference number (IRN) then access to the health system is severely restricted and those caring for the child may incur additional costs associated with the provision of the health care.
A Medicare number and IRN are required to access a child's My Health Record.
Health and Education Assessment Co-ordinators (HEACs)
These roles are based in DHHS operational divisions, with a focus on improving systemic responses to health and education assessment, planning and intervention for children and young people in residential care.
The HEAC role involves provision of advice and support to professionals working with young people, as well as the administration of brokerage to support the implementation of health and education plans.
Child protection practitioners should contact the HEAC in their division for guidance and support where required.
Young people with sufficient maturity and comprehension of their medical situation and the proposed treatment are permitted by law to request or refuse treatment without the endorsement of the parent or guardian. The powers of the Secretary or her delegates under s. 597 of the CYFA, do not override this ability.
All children will likely suffer some accidental injury during childhood. Some of these injuries require medical attention and others do not. Parents and practitioners should seek medical advice when in doubt.
If practitioners are aware of an injury that appears suspicious or non-accidental, they must consult with the team manager immediately and arrange for appropriate investigation of the injury. See procedure Medical and forensic examinations for tasks that must be undertaken.
Where Aboriginal health services exist in the area, practitioners should consider using this service for medical examinations and treatment of Aboriginal children.
Practitioners should discuss the available services with the family and child, depending on their age and stage of development, in order for the family and child to provide their view on what service(s) they would prefer to utilise.
For further details regarding the different types of mental health assessments of infants, children and young people see advice Mental health assessments and treatment.
Mental health assessment and treatment, where required, are crucial to a child’s safety, wellbeing and development, and should be prioritised alongside all other physical health related needs.
Considerations for good practice
The child protection practitioner is required to consider all dimensions of a child's life and not only to the extent that the child presents with injuries or allegations of abuse and harm. In accordance with the best interests principles, the practitioner needs to identify and assess the long-term and ongoing health and developmental needs of the child in consultation with health professionals. The practitioner should arrange for relevant health services for the child to enable all developmental issues to be addressed and detail this in the child’s case plan, where concerns have been substantiated. This includes referrals via the GP and liaison with the paediatrician, maternal and child health nurse, specialist children’s services, speech therapist, occupational therapist, specialist medical staff, psychologist.
The LAC document will assist practitioners to focus on a child's health needs and therefore may be a useful reference to be utilised when assessing the health needs of a child who resides in the parent's care and to prompt discussion with a parent regarding their child’s health needs.
Child protection practitioners are not health experts and are expected and required to consult with health professionals in order to obtain expert advice on what, if any, examination and ongoing treatment is required for a child. This information must be shared with the child's carers when the child is residing in care.
For further information on health and health related needs, the Better Health Channel, is an excellent resource for child protection practitioners. This resource contains information on a number of topics including physical and mental health conditions, healthy living and health related services and support available in Victoria.