The Framework provides guidance to jurisdictions on an approach to organising responses to the health needs of children and young OOHC, which is based on a tiered structure spanning three phases:
- Preliminary Health Check
- Comprehensive Health and Developmental Assessment
- Ongoing monitoring and assessment.
Importantly, each assessment should be informed by previous assessments and services provided in the meantime and to ensure the unique health needs of each individual are met.
The Framework recognises that completion of each level of assessment may take more than one visit to a practitioner and should therefore not be equated with a single contact.
Whilst assessments will be conducted on a case-by-case basis, the proposed focus of assessment of both the Preliminary Health Check and the Comprehensive Health and Development Assessment are outlined in Table 1 below.
Health assessments not in scopeAt the point of entry to care, children and young people may receive immediate medical assessments for specific purposes often associated with the investigative process or the immediate care of the child. At this stage of the statutory child protection process decisions about care arrangements are often not well informed and planning is subject to the outcome of the investigative process or Court Orders. The Framework is focussed to that point when the child or young person’s placement in care is likely to continue.
However, while not in scope, it is important that service providers note and seek to access the information from the initial health assessments. For example, many children will have been the subject of an emergency assessment – often in a hospital environment - by a specialist under the auspices of the relevant child protection agency as part of an investigation or intake processes. This assessment may serve to determine if the child/young person requires immediate medical/dental treatment as a result of abuse or neglect and/or gather forensic evidence. Similarly, some children may require an initial health check as part of the entry to OOHC process, especially if there is a limited knowledge about the child’s health. This would include children who have chronic conditions where their medications or health records could not be obtained by the caseworker, infants who may need formula feeds or nutritional supplements and children with an acute condition requiring immediate clinical assessment. Wherever possible, the Case Worker and the biological parents should be involved or consulted during this assessment.
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The Framework assumes that all relevant information generated by these assessments will be made available to services providing subsequent assessments under the Framework.
2.3.1 Preliminary Health CheckThe Preliminary Health Check aims to establish the ongoing relationship between the child, carer and the primary health care provider. This primary health care provider should provide screening and preliminary assessment of the child or young person across physical health, developmental and psychosocial and mental health domains.
Importantly, this relationship will establish continuity of care and enable support of both the child and carer over time.
Assumptions have been outlined previously about the emergency assessments or initial health checks undertaken as part of the investigation/intake process, and the medical evidence identifying this population as being particularly vulnerable. Based on this, it is recommended that the Preliminary Health Check should be commenced as soon as possible and ideally no later than 30 days after entry to OOHC.
The information obtained during the Preliminary Health Check will allow the commencement of a Health Management Plan for the child or young person (see section 3 Coordination and continuity of care) with any immediate health, dietary, emotional difficulties, sensory deficits and/or behavioural concerns identified and where possible addressed via appropriate measures or referrals initiated.
The outcome of the Preliminary Health Check should provide guidance on the composition of the multi-disciplinary team required to complete the Comprehensive Health and Developmental Assessment outlined below. At this stage any relevant health information should be consolidated to establish the child or young person’s health record (see section 3). This should include any information obtained during assessments undertaken prior to and during entry to OOHC processes.
2.3.2 Comprehensive Health and Developmental AssessmentThe Preliminary Health Check should provide advice on the clinical specialities required and timing of the Comprehensive Health and Developmental Assessment. Another consideration would be whether practitioners likely to provide specific health assessments (see section 2.3.3) are included at this earlier stage.
The Comprehensive Health and Developmental Assessment should ideally be completed on all children and young people within 3 months of their entry to OOHC.
It is important that the Comprehensive Health and Developmental Assessment not be unnecessarily delayed. However, evidence suggests that, for some individuals, there may be difficulties in progressing comprehensive assessments in the first month of a new OOHC placement. Inaccurate results may be obtained for developmental and psychosocial assessments because, during this time, the child or young person is adapting to their new environment and may be overcoming acute trauma from abuse or neglect or trauma associated with entry to OOHC.
The Comprehensive Health and Developmental Assessment should go beyond basic screening to provide in-depth examination and assessment across each domain. It is also imperative that children and young people in OOHC receive the appropriate assessment from competent practitioners – particularly in relation to ‘Psychosocial and mental health’ elements - and their carers are provided with support.
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If, during the assessments, the practitioner(s) identifies any concerns, the appropriate referral should be made – for additional assessment and treatment - and this should be documented in both the proposed Health Management Plan and included in the child/carer-held health record (see section 3). Particular attention should be paid by the Care Coordinator (Health) to ensure that appointments for specific assessments are made and attended and that the outcomes of those assessments contribute to the health record.
2.3.3 Ongoing monitoring and assessmentChildren and young people entering OOHC are likely to have complex health needs that will require follow up assessment at regular intervals.17 The frequency of follow up assessments should be a clinical decision for each individual and have both case dependent and age-dependant considerations.
Ongoing monitoring should be aligned to the recommended timing for the general population as outlined in the jurisdictional parent-held child personal health record. This essentially provides more frequent follow up assessments for babies, toddlers and infants (‘Under 1’ and ‘1-5 years’) than for older children and young people.
Furthermore, recognising the unique health needs of this vulnerable population, additional assessments should be conducted following a change of care placement and on transition from care.
In addition to recognising the clinical health needs of the child, this approach accommodates cases where the child or young person may have reduced requirement for assessment (e.g. individuals in a stable placement where their health needs are being met and/or whose development is on-track).
Appropriate psychological assessment and/or treatment should be provided to children and young people identified to be experiencing emotional or educational difficulties during any assessment.
Each individual Heath Management Plan (see section 3 below) should be reviewed by a paediatrician at least once every two years.
17 American Academy of Pediatrics (2000) Developmental issues for young people in foster care Pediatrics, 106:1145-49