National Clinical Assessment Framework for Children and Young People in Out-of-Home Care (OOHC) - March 2011

B.3 Current models of practice - Australia

Page last updated: 05 December 2011

Although each state and territory government has in place a statutory child protection system there are variations in the systems across the jurisdictions. The different systems for each jurisdiction were comprehensively researched and documented in the Report Card on Health 2006.

This section provides a brief outline of current practice in the States and Territories and is based on input provided by each jurisdiction as at November 2010.

Victoria

In Victoria, there is currently no state wide systematic health screening of children in out-of-home care. Children and young people should see a general practitioner and a dentist within a month of entry to out-of-home care but there is no standardised assessment guidance or the expectation of a written report.

The health needs of children are addressed through the Looking After Children (LAC) system that requires periodic review of the progress and the development of a Care and Placement Plan that addresses seven developmental domains, including health and emotional/behavioural development. New LAC Assessment and Progress records are being introduced which will allow better monitoring of outcomes along the LAC domains.

If a health or developmental issue is identified by a general practitioner or others responsible for the care of a child/young person, child protection would refer to a public hospital paediatric clinic or private paediatrician for further assessment. Children and young people requiring assessment of their emotional and behavioural wellbeing may be referred to the child protection therapeutic treatment service, Take Two, to Child and Adolescent Mental Health Services, the Australian Childhood Foundation or to private psychologists.

Assessments are funded through a combination of Medicare, Victorian state funded health services and child protection purchase of private services.

In recognition of the absence of a standardised assessment process, the Department of Human Services piloted a model in one metropolitan region that utilised General Practitioners, paediatricians and the Take Two Intensive Therapeutic Service. Building on the learnings from that work, the department is currently working with the Department of Health to develop a model of assessment and treatment that utilises and streamlines existing health services, with a focus on early detection of health issues, assessment of all domains of child health and timely and coordinated priority pathways into mainstream localised services for ongoing care. The aim is to have an initial health check by a GP followed by a comprehensive multi modal assessment.

Key Learning: Establishment of Health Standards for children and young people in OOHC aim to clarify the roles and responsibilities of practitioners and contribute to improved health outcomes.
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Tasmania

In Tasmania the health needs of children in care are documented in their Case and Care Plan. This is developed upon entry into care and is updated every six months to a year, or when there is a significant event within a child’s life.

In June 2010 an Operational Forum was held with Area Directors, Child Protection Managers and Child Health and Parenting Managers to discuss how the services should continue work together to meet the needs of children aged under five who were under Care and Protection Orders. The following initiatives have been trialled in some parts of Tasmania, and it was agreed that these should become the statewide policy directions for all children entering care for the first time who are under five years of age:
  • a baby (under the age of 6 months) coming into care should receive a child health assessment as soon as possible; and
  • a child (over 6 months of age) coming into care should receive a child health assessment within a 4 week period even if an assessment is not due
  • children in care are to attend all scheduled health and development assessments
  • carers should be encouraged to ensure children have regular engagement with a child and family health nurse
  • all children in care are to have up to date immunisations.
It was also agreed that senior nurses from within the child health service would be invited to attend the Court Application Advisory Group (CAAG) meetings with child protection services, for all children under the age of five years.

These policy directions have been incorporated within a new draft of the “Entering Care Policy and Practice Advice” for Child Protection Workers.

In addition, all children entering care are required to have a baseline medical assessment with a general practitioner within four weeks of entering care. Currently this check is not monitored or co-ordinated. If a health or developmental issue is identified by a general practitioner, or others responsible for the care of child/young person, child protection would refer to a public hospital paediatric clinic or private paediatrician for further assessment.

Further referrals to other services (e.g. psychologists) would be made by the general practitioner or paediatrician as required.

Assessments are currently funded through a combination of Medicare, Tasmanian Department of Health and Human Services and the purchase of private services by child protection services.

Key Learning: A commitment to the ongoing provision of publicly funded services is likely to be required for the successful implementation of the Framework.

Western Australia

The Western Australian Government in 2008 initiated an across government project for the development and implementation of a model for Health Care Planning for Children in Care. The project arose in response to the findings of the Ford Review (2007) which recommended:

R 63: The Departments of Health and Education be required to develop a Health Plan (covering physical, mental and dental health) and an Education Plan for each child or young person in care.
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In 2009 the Department of Health (DOH) and the Department for Child Protection (DCP) successfully piloted a collaborative health care planning pathway based on the existing DOH universal child health services provided by community health nurses for children 0-18 years of age and their families, and also state-wide dental health services for children 0-17years of age. The pathway also acknowledged and promoted the role of General Practitioners in evaluating and responding to medical needs and in providing pathways to specialist medical services. The pilot found that the pathway:
  • Improved access to existing community based universal child, school and dental health services.
  • Formalised and strengthened local interagency relationships and improved use of client information shared.
  • Highlighted the importance of leadership, coordination and administrative resources at state and local levels to implement and sustain the pathway.
  • Recognised the added administrative tasks for both DCP and WA Health staff.
On the basis of these findings, DCP and DOH committed to a staged statewide implementation of the pathway, to be completed by July 2011. The implementation is supported by an overarching Bi-lateral Memorandum of Understanding (MOU) and operationalised at local level through Local Services Agreements.

The WA Health Care Planning for Children in Care pathway is comprised of the following key steps:

1. Medical Review upon entry into care: Entry to care can occur for a variety of reasons. In situations of acute abuse (sexual, physical, neglect), the medical review should be provided by specialist providers such as the Princess Margaret Hospital (PMH) Child Protection Unit or other providers in rural and remote areas. For children not requiring specialist medical service upon entry into care, a general medical review is recommended within 20 working days.

2. Mental Health screening on entry to care: A Strengths and Difficulties Questionnaire is completed for children aged 4 years and older within six weeks of entering care. (For children under 4 years mental health is included as part of the Community Health Nurse Assessment)

3. Health and Developmental Assessment: Children new to care should be referred to the DOH community health service for a Health and Developmental Assessment. Children already in care should be referred annually as part of the review of the DCP Care Plan. Community child health nurses conduct age-appropriate assessments within 30 working days of receiving the DCP referral, and provide a summary report to the DCP within 5 working days of the assessment appointment.

4. Dental Health Service: Eligible children are enrolled into the School Dental Service. All children under school age receive an oral health inspection by the child health nurse and are referred to the local General Dental Clinic for full oral health assessment.

5. Collaborative Health Care Planning: Within 20 working days of receiving the nurse assessment report, DCP consults with the nurse to develop a ‘health plan’ (actions to address the health care needs of the child for the next 12 months). DCP records the ‘health plan’ in the health dimension of the child’s overall Care Plan, and implements accordingly over the next 12 months..

A key consideration of the WA health care planning model is ensuring the maintenance of the child’s health records. The Child Health Passport has been developed and implemented by DCP to record a child’s health information and provide carers with the information they need to help meet the child’s day-to-day health needs, including attendance at scheduled appointments.

Key Learning: Ongoing monitoring of the pathway during state-wide implementation is required to inform the ongoing development of the WA Health Care Planning for Children in Care Pathway to ensure that the proposed elements can be implemented successfully in a variety of settings given locally available resources and service models.
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South Australia

South Australia commenced a reform of the child protection system in 2004, “Keeping Them Safe,” in response to the 2003 Layton Review findings. One of the key review findings was the need to improve outcomes for children and young people under guardianship of the Minister.

Subsequently, the Rapid Response Service Framework [Rapid Response] was released in 2005 with the aim of ensuring that children and young people under the guardianship of the Minister for Families and Communities have priority access to services whereever possible. Rapid Response places these children and young people firmly at its centre and focuses on providing a holistic, coordinated approach to all aspects of their lives including their health, education and wellbeing.

In recognition that their health status is significantly worse than other children, Health Standards for children and young people under guardianship of the Minster were developed to clarify the roles and responsibilities of the Health Sector in providing services to this group, and ultimately to improve their health outcomes.

The Health Standards apply to all children and young people placed on a Care and Protection order by the Youth Court.

The standards address nine key areas:
  • Initial (baseline) health assessments for children and young people when they come into care
  • Psychological therapeutic services
  • Primary health care services – as a type of service this covers community health services, outreach, and allied health. The manner in which services are delivered will vary significantly.
  • Outpatient / ambulatory services – planned appointments, usually done in hospital but can include community, outreach and visiting services.
  • Emergency hospital services.
  • Inpatient services – medical, surgical and elective admissions.
  • Health’s contribution to Guardianship of the Minister annual reviews – initiated by Families SA when they undertake an annual review of the child in care.
  • Health’s contribution to planning for children and young people leaving care – the process of transitioning to adult services and other youth based services.
  • SA dental services.
The standards specify that a referral will be made for an initial paediatric health assessment within two months of coming into care and that the health assessment will be provided within five weeks of receiving a referral. The focus is on partnership, information exchange, support for the child or young person, priority response, continuity of care and cultural considerations.

The initial health assessment leads to ongoing referral and the development of a health care plan.

Children Youth and Women’s Health Service and SA Dental Services electronically flag the guardianship status of children and young people to ensure they are registered and followed up. Compliance with the standards is measured regularly. An adolescent specific health assessment is provided for young people under guardianship in the Adelaide metropolitan region. The aim is for young people under the Guardianship of the Minister to have a ‘stock take’ of their health status at aged 14 years. This assessment will ensure their health needs are identified and treated prior to the transition planning phase and encourages young people to engage with health providers as they make the transition from care and beyond.

Key Learning: Health Standards for children and young people in OOHC aim to provide priority access to health services and health assessment at critical stages of development, addressing health inequities and contributing to improved health outcomes.
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Queensland

The process for assessing the health needs of children and young people in out of home care in Queensland is called the Child Health Passport initiative. This initiative commenced in 2006 and is led by the Department of Communities – Child Safety Services in partnership with Queensland Health and the primary care and general practice community.

The Queensland Commissioner for Children and Young People and Child Guardian has legislative responsibility for reporting and monitoring the progress of children in out of home care and this includes an audit process of Child Health Passports and Education Support Plans. The Child Health Passport process has three Phases:

• Phase 1 – Immediate health needs.

Identifies the immediate health needs of a child or young person when placed into out of home care including any current medical problems or medications or any allergies that are important to be communicated to the carer who has immediate care and responsibility for the child to ensure appropriate care is provided. This information is obtained by Child Safety Services. This information moves with the child if placement changes.

• Phase 2. – Comprehensive health assessment and health plan

Any child or young person remaining in out of home care for a period of longer than 30 days requires a comprehensive health assessment. This assessment is ideally performed after the first 30 days but within 4 months of the child entering out of home care. The Child Safety Officer with case management responsibility for the child consults with the carer to ensure the assessment is arranged and performed. The assessment can be undertaken by a range of health care providers skilled in the assessment of children and can include GPs, paediatricians, child health nurses or Aboriginal and Torres Strait Islander health workers. The clinician performing the assessment provides a summary of the child’s health needs to Child Safety Services, including any significant findings and referral/s to any other specialist health services according to the assessed needs of the child or young person.

Recommended health assessment domains include:
  • physical & developmental – including vision, hearing & dental screening
  • nutritional assessment
  • immunisation
  • psychosocial and behavioural issues
  • mental health

• Phase 3. – Family health history

This phase occurs over an extended period of time for children and young people remaining in out of home care, and where there is no plan for the reunification of the child with their biological family. This family history is provided to the young person when exiting care as some aspects of the family medical history may be relevant to the child’s future and ongoing health care in later life. Relevant family history includes history of cancer or chronic medical conditions such as diabetes and heart conditions. The health history is compiled over time by the Department of Communities - Child Safety Services with the biological parent/s of the child during family meetings or information regarding family medical history and can be obtained with the consent of the parent/s from health service providers.

Key Learning: Establishment of a medical passport may increase the likelihood that a child or young person’s health record will be maintained and passed on following a change of placement.

Northern Territory

The Northern Territory's policy requires that a baseline assessment is conducted during the child's first three months in care. This is a combination of medical, dental, educational and where necessary, psychological assessments. The child's case worker is responsible for arranging any appointments, collecting copies of reports, and collating and analysing the assessment information. This provides the basis for ongoing assessment. There is no specific agency that provides health screening and assessments. Local resources are used and where necessary the Department pays for this.
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Australian Capital Territory

In 2006 ACT Health set up a clinic, located at the Child at Risk Health Unit, to provide nursing health and wellbeing screens for all children aged 0 –14 years entering care. This health and wellbeing screen is a baseline evaluation of the child or young person’s health, not a full paediatric assessment. The Health and Wellbeing Screen provides a holistic nursing assessment, encompassing physical, dental, developmental and behavioural domains. Referrals are made to appropriate health professional as needed. The screen is available annually if there are ongoing concerns which are not being addressed.

The aims of the clinic are:
  • To provide a health and wellbeing screen for children in out of home care
  • To identify the unmet health needs of children in out of home care, and address as appropriate.
  • To obtain an understanding of the health needs of children in out of home care in order to make recommendations for a better health care delivery model.
Referrals to the clinic are made by Care and Protection Services and/or foster care agencies when a child is taken into care.

Key Learning: Co-location of service providers is likely to improve information flows and therefore coordination of care.

New South Wales

The NSW Government’s action plan Keep Them Safe, a Shared Approach to Child Wellbeing 2009-2014 is the NSW response to the Report of the Special Commission of Inquiry into Child Protection Services in NSW (November 2008) and details actions to improve the safety and wellbeing of children and young people in NSW and improve the health of children and young people in out-of-home care.

NSW Health, in collaboration with the NSW Department of Human Services – Community Services, is conducting a staged approach to the provision of comprehensive health assessments for children and young people entering out of home care. A Memorandum of Understanding supports this collaboration.

The following have been established to assist in the delivery:
  • Phase 1 focuses on children and young people entering statutory out-of-home care who will remain in care for longer than 90 days to receive an initial primary health screening/consultation within 30 days of entering statutory out-of-home care and will undergo a comprehensive assessment based on triage and findings of the initial health screening.
  • A Model Pathway for Comprehensive Health Screening and Assessment developed to clarify roles and responsibilities.
  • Eight Out-of-Home Care Coordinators based across the State and one Out-of-Home Care Clinical Coordinator based at The Children’s Hospital, Westmead coordinate and oversee the staged implementation of the delivery of health assessments at the local level.
  • Out of Area Placement Guidelines developed for OOHC Coordinators and Interagency Pathway Coordinators to align with the Pathway and further clarify roles and responsibilities when a child and/or young person who enters out of home care is in a placement outside the Community Services region that has case management responsibility.
Further work is planned to:
  • Add pages to the NSW Health Personal Health Record (or ‘Blue Book’) to record health assessments and treatments in summary form for children in out of home care in order to allow the children and young people to keep personal health records with them.

Recognising the poor health of these children, NSW Health is proactive in providing health screening and assessments and connecting children and young people with general practitioners for ongoing health care. NSW Health aims to work in consultation with general practitioners.

These actions build on existing out-of-home care clinics/services. The aim is to continue to develop a consistent approach, methodology and framework for conducting health assessments across NSW Health for children and young people entering out-of-home care.

Key Learning: Appointing OOHC Coordinators and establishing a memorandum of understanding between coordinating agencies is likely to clarify roles and responsibilities and support implementation of a tiered assessment process.


84 Australian Children and Young people in Care Report Card on Health (2006) Create Foundation 85 Nathanson, D & Tzioumi, (2007), Health need of Australian children in out-of -home care. Journal of Paediatrics and Child Health 43 695-9