Decision making for a child

Decisions for a child in care can be made by a child, a child’s parents, the carer, non-family-based care service or Child Safety staff, depending on the legal arrangements in place for the child and/or the child’s age and ability to understand a decision. 

Decisions for a child in care may be about:

• the child's daily care, which can be made when the chief executive or a suitable person has custody or guardianship of the child
• issues likely to have a significant or long-term impact on the child, which can be made by the child’s guardian.

The person with legal authority to make a decision (or provide consent) for a child in care will vary, depending on:

• the nature of the Child Safety intervention
• the type of decision or consent required—whether it’s a custody or guardianship matter
• if the chief executive has custody or guardianship of a child, who has the delegation to make the particular decision
• the child’s age and ability to understand the decision.

Decision making will take into account:

• the importance or urgency of the decision
• any risk associated with the decision, for example, the potential impact of an activity on the child's safety, belonging and wellbeing
• any costs associated with the decision
• the child’s rights under the charter of rights
• the child’s views and wishes
• the parents’ views and wishes, where applicable and appropriate
• the human rights of the child and the parents
• whether the decision is considered a significant decision for an Aboriginal or Torres Strait Islander child. (Refer to Enable participation of Aboriginal and Torres Strait Islander peoples in decision making.)

When making a decision about a child in care, Child Safety, the non-family-based care service or carer must:

• act compatibly with the charter of rights when making decisions or taking actions
• give proper consideration to human rights when making decisions or taking actions.

(Refer to Obligations under the Human Rights Act 2019.)

Decisions for a child in care are to be made in a timely manner, to: 

• ensure the child has timely access to medical, dental and therapeutic services
• minimise circumstances where the child feels or is seen as different because they are prevented from participating in a developmentally or age-appropriate activity due to a drawn-out approval process.

Determine who has custody or guardianship of the child

If a decision or consent is required for a child in care, determine who has custody or guardianship of the child, based on the nature of the intervention the child is subject to. Refer to the following table.

Facilitate decision making—daily care decisions

A daily care decision is a decision that relates to the day-to-day care of a child in care, regardless of whether the chief executive has custody or guardianship of the child. A daily care decision can be made by either a delegated officer, carer or non-family-based care service, depending on the nature of the decision. A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand (Child Protection Act 1999, Schedule 1).  Further information is provided under specific topic headings in this procedure.

A carer or non-family based care service can make decisions about the following matters for a child placed in their care:

• household routines, for example, meals, nutrition, homework and bed and bath times
• household expectations, for example, keeping a tidy bedroom, and the amount of time using the television and computer  
• to the extent it does not compromise the child’s right to maintain and enjoy their gender identity, the child’s appearance, including 
  • clothing, grooming and hygiene
  • routine haircuts to trim the child’s current hairstyle, excluding a child’s first haircut, which is significant for many parents
• the child’s absence from child care, school, training or employment
• routine issues about school or child care
• daily travel arrangements, for example, travel to and from school or use of the disability school transport assistance program
• occasional babysitting arrangements
• pocket money, consistent with practices in the carer’s family or the non-family-based care service
• accompanying the carer or non-family-based care service staff on outings and social events (if there is no conflict with pre-planned family contact)
• arrangements for the child and their friends to visit each other.

For a child in the custody of the chief executive, some daily care decisions may require the input of the chief executive or the child’s parents. Examples of these types of decisions are:

• medical decisions
• education decisions
• decisions about sport and recreational activities
• decisions about the child's personal appearance.

Consult a senior officer about complex or sensitive decisions

If the decision or request for consent is complex or sensitive, always consult the senior team leader, senior practitioner or CSSC manager, regardless of who can decide the matter or provide consent. This will ensure any potential complexities associated with the decision are evaluated.

When there are specific complex or sensitive decisions that are to be made by a parent, delegated officer or carer or non-family-based care service, record them in the placement agreement. (Refer to Procedure 6 Negotiate the placement agreement.)

Facilitate decision making—guardianship matters

If the parents retain guardianship of a child, consult the child about the decision, having regard to the child’s age and ability to understand and seek a decision or consent about a guardianship matter from both parents, unless all reasonable attempts to locate and consult with a parent have been unsuccessful.

If the chief executive has guardianship of a child, consult the child about the decision, having regard to the child’s age and ability to understand and seek a decision or consent about a guardianship matter from the delegated officer. The level of officer delegated to make a decision or to provide consent varies, depending on:

• the delegations assigned to their position, as outlined in the instrument of delegation
• the requirements of the specific decision detailed in this procedure.

Obtain the delegated officer's decision or consent

If the child is subject to an order granting guardianship to the chief executive, and a guardianship decision or consent is required:

• Explain the decision-making process to the child, having regard to the child’s age and ability to understand, and obtain their views about the matter to be decided.
• Explain the decision-making process to the parents and the carer or non-family-based care service and obtain their views about the matter to be decided.
• Determine who is delegated to make the decision or provide the consent.
• Inform the delegated officer of the decision or consent required and the views of relevant parties.
• Obtain and record the delegated officer’s decision or consent, and if applicable, attach written consent to the relevant event in ICMS.

If the delegated officer is not available and the decision is urgent, obtain the decision or consent from an officer of the same or higher level who has the delegation to make the decision. For example, if the CSSC manager is unavailable, contact another CSSC manager in the region or the regional director.

If a guardianship decision is likely to be particularly sensitive or contentious, the delegated officer may request that the decision be made by a more senior delegated officer.

Communicate and record the decision

Communicate the decision or consent

Once the parent or delegated officer makes the decision or provides consent, inform all parties of the decision, including the child and, if relevant, the rationale for the decision.

Provide advice about review mechanisms

Make sure all parties, including the child, are told how to access applicable review processes, should they wish to have a Child Safety decision reviewed.

Decisions and consents about custody and guardianship matters may be reviewed:

• by a senior officer of Child Safety (Refer to the practice guide Complaints management: First attempt at resolution.)
  or
• through the Child Safety complaints process (Refer to Compliments and complaints.)
  or
• through external review mechanisms, at the request of the child or a person acting on their behalf (for example, a parent or carer), such as through the Office of the Public Guardian.

Make sure the child receives support and assistance in accessing review processes, as required.

Record the decision

Record all relevant information about decisions made for a child in care in a case note in ICMS, including:

• a decision or consent about which a carer or non-family-based care service has sought advice from Child Safety
• the views of the child, parents and carer or non-family-based care service
• guardianship decisions made by parents, including verbal and written consents or refusals and their stated reasons
• guardianship decisions made by delegated officers, including the rationale
• a decision about an application for child-related costs. (Attach relevant documents in ICMS.)

Make decisions about child related costs

When a decision about the use of child related costs for a child in care is required, refer to the relevant policy and procedures:

• Policy Child related costs
• Procedure Child related costs - Health and wellbeing
• ProcedureChild related costs - Education and child care support
• Procedure Child related costs - Travel
• Procedure Child related costs - Child and young person support
• Procedure Child related costs - Carer support.

Change a child's name 

If a child asks to be referred to by a different name, the child's views must be given consideration and supported, if appropriate.

The table below outlines who can make decisions about changing a child’s name and who can apply to have the name registered by the Registry of Births, Deaths and Marriages.

If the decision is made to proceed with changing a child’s name, the following two documents are required for an application to be made:

1. evidence of legal guardianship issued by a court
   and
2. a Queensland magistrates court order specifically ordering for the child’s name to be changed from one specified name to another.

For an Aboriginal or Torres Strait Islander child, consider the long-term impact of the decision on the child’s identity and connection to culture. If a legal change of name is considered to be a significant decision for an Aboriginal or Torres Strait Islander child, taking into account their individual circumstances, arrange, with the consent of the child and family, for an independent person to help facilitate their participation in the decision. (Refer to Enable participation of Aboriginal and Torres Strait Islander peoples in decision making.)

Contact decisions

This section covers the child’s contact with kin (as defined in the Child Protection Act 1999), that is:

• a member of the child’s family group who is a person of significance to the child
• if the child is an Aboriginal child—a person who, under Aboriginal tradition, is regarded as kin of the child
• if the child is a Torres Strait Islander child—a person who, under Island custom, is regarded as kin of the child
• another person
  • who is recognised by the child, or the child’s family group, as a person of significance to the child
    and
  • if the child is an Aboriginal or Torres Strait Islander child—with whom the child has a cultural connection. 

Family contact 

When a child is in care, the chief executive must provide an opportunity for contact between the child and the child’s parents and appropriate members of the child’s family as often as is appropriate in the circumstances. This is referred to as family contact.

All decisions about family contact for a child in care are decisions to refuse to allow, restrict or impose conditions on contact between the child and the child’s parents or member of the child’s family under the Child Protection Act 1999, section 87(2), and are reviewable decisions.

The level and nature of family contact is recorded in the child’s case plan and in the placement agreement. (Refer to Decide the level and nature of family contact. )

Contact with significant persons

A child may also have contact with persons other than family that are of significance to the child.

Decisions about contact between a child in care and people of significance to the child, other than family are not reviewable decisions and do not require formal written notice. These decisions are daily care decisions (Child Protection Act 1999, sections 12-13).

For an Aboriginal or Torres Strait Islander child, contact arrangements will include people of significance to the child under Aboriginal tradition or Islander custom who can help the child’s identity development and connection with the child’s family and community.

Active efforts must be made to apply the Aboriginal and Torres Strait Islander Child Placement Principle when making significant decisions about an Aboriginal and Torres Strait Islander child. Decisions about contact arrangements will have regard to the purposeful, thorough and timely actions required to uphold the child’s right to be supported to develop and maintain a connection with their family, community, culture, traditions and language.  

Make a contact decision

If overnight contact with kin is being sought, refer to Decide the nature of overnight contact with kin.

The table below outlines who can make decisions about family contact, as well as contact decision with persons other than family.

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand, including decisions about contact with their family (Child Protection Act 1999, Schedule 1).

Each time a change is made to family contact arrangements:

• Inform all affected persons of the decision, the reason for the decision and how to have the decision reviewed.
• Inform the child about the review process and support options.
• Provide written notice of the decision to the person affected using the Reviewable decision letter – family contact.
• Provide the child with a letter, written specifically for them, suitable for their age, maturity and capacity to understand.
• Advise the OPG of the reviewable decision within 3 business days by emailing the relevant regional visiting manager. (Refer to the OPG - Regional visiting manager contact details.)
• Save a copy of the letter in iDOCS/Court and legal/Reviewable decisions and link it to the child’s ongoing intervention event in ICMS.

(Refer to Facilitate, monitor and review family contact.)

When a child protection proceeding in relation to making, extending, amending or revoking a child protection order is before the court, a decision is made under the Child Protection Act 1999, section 87(2), and the person affected by that decision is party to the proceedings in the Childrens Court, provide written notice of the decision to the person affected, using the Letter re: refusal or restriction of family contact (section 99MA).

The senior team leader or CSSC manager is responsible for making sure the legislative requirement to provide written notice of a decision to refuse, restrict or impose conditions on family contact is complied with.

If the level and nature of family contact outlined in the case plan is no longer in the best interests of the child, consider whether a case plan review is required. (Refer to Review and revise the case plan.)

Decide the level and nature of family contact

Decisions about family contact must:

• reflect the goals of the child’s case plan
• be in the child’s best interests
• not place the child at further risk of harm.

To decide the level and nature of family contact consider the following:

• the child’s emotional and physical safety during contact
• the child’s views about the proposed contact and their views about what is in their best interests, having regard to the child’s age and ability to understand
• if family contact is helping to maintain and develop the child’s significant relationships
• if family contact is providing a positive connection between the child and their cultural community
• if the child’s parents are demonstrating an increased capacity to meet the child’s safety, belonging and wellbeing needs
• the type of child protection order the child is subject to
• if the child is residing in a kinship care arrangement that has existing family contact arrangements
• practical arrangements, including
  • transport
  • pick up and drop off times
  • expectations about the contact 
  • the payment or reimbursement of any costs associated with the contact.

To decide on a location for safe and meaningful family contact, work with the child and parents to identify a location:

• the family can easily access
• that will be safe for the child
• that will enable the child and parents to enjoy and participate in the visit.

If there are concerns about the child’s safety with a person who it is proposed will be present during contact, consider requesting the criminal or domestic violence history of that person from the QPS to inform decision making. This may be a parent, adult member of the parent’s household or an adult alleged responsible for harm to the child.

Consider domestic and family violence

If a parent is perpetrating domestic and family violence, consider the following as part of the decision-making process:

• Will family contact be used by the perpetrator to further harm the child or as a means to continue the abuse or control of the non-violent partner or extended family members?
• Is family contact between the child and the perpetrator or extended family members in the child’s best interests?
• Does the child’s behaviour significantly change before, during or after family contact?
• What are the child’s views of the contact? 

If a child is placed with a kinship carer who is a member of the perpetrating parent’s family, assess:

• if the carer is able to meet the child's safety, belonging and wellbeing needs during contact with the perpetrator
• the level of fear the child and family members have towards the perpetrator and the level of control the perpetrator has over the child and family members.

If a child is placed with a kinship carer who is related to the non-violent parent, assess if there are safety concerns for the child or any members of the household when deciding the level and nature of family contact between the child and the perpetrator.

If there are worries about a child's safety during contact, make sure:

• safety planning has occurred with the child, family and network
• the action steps in the immediate safety plan are clear and have been agreed to by all relevant people
• only agreed family contact is occurring and that kinship carers and the child’s parent are not making their own arrangements.

Decide the nature of overnight contact with kin

If it is proposed that a child stays overnight with kin in Queensland or in another state or in New Zealand, the CSSC manager is delegated to decide:

• if the child’s kin will be assessed as a carer, and the stay considered a care arrangement, refer to Procedure 6 Provide and review care.)
  or
• if the stay will be considered contact or a holiday, not requiring the child’s kin to be assessed and approved as a kinship carer.

Provide the CSSC manager with the following information to make the decision:

• the goal and outcomes of the case plan, including how contact complies with the Aboriginal and Torres Strait Islander Child Placement Principle
• the child's views about the contact
• the child's age and vulnerability
• any risk to the child posed by the contact
• the history of previous contact between the child and the child's kin
• the length of stay, location and circumstances of contact
• if a request for approval for the kin to receive the fortnightly caring allowance is required.

The CSSC manager may decide to approve expenditure to meet costs associated with overnight family contact visits with kin. (Refer to the policy Child related costs.)

If the CSSC manager decides the arrangement will be considered a care arrangement subject to regulation of care requirements―approach the child’s kin about submitting an application to become an approved kinship carer. (Refer to Procedure 6 Help the prospective kinship carer to complete a carer application.)

If the CSSC manager decides the arrangement is family contact or a holiday, an assessment for this purpose is still necessary. (Refer to Complete an assessment for family contact or holiday with kin in Queensland or Request an assessment for family contact or holiday with kin interstate or in New Zealand.)

Complete an assessment for contact or holiday with kin in Queensland

To complete an assessment about overnight contact when the child’s kin resides in Queensland:

• Confirm the kin is willing to care for the child.
• Arrange a time to visit and conduct the assessment of the kin.
• Speak to the kin about the contact plans and any worries. 
• Complete a child protection history check on the child’s kin and other household members. Their consent is not required, but tell them that the checks will be completed.
• Complete an assessment interview with the child’s kin.
• Complete the Assessment for the purpose of family contact/holiday form.
• Seek approval of the decision from the delegated officer for intrastate travel. (Refer to Travel decisions.)

Request an assessment for family contact or holiday with kin interstate or in New Zealand

If the child’s kin resides interstate or in New Zealand, request an assessment for family contact or holiday to be undertaken by the other jurisdiction. (Refer to Procedure 7 Request an assessment of kin for family contact or holiday in another state.)

The CSSC manager will decide if the family contact or holiday will proceed interstate or in New Zealand, taking into consideration the assessment of the other jurisdiction.

Arrange for the contact or holiday if approved by the CSSC manager.

Counselling and therapy decisions

Decisions about counselling and therapy will generally occur as part of the case planning process. (Refer to Case planning.)

A decision or consent regarding counselling or therapy that is not part of the agreed case plan must be provided by the guardian. A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand, including decisions about the child’s health (Child Protection Act 1999, Schedule 1).

The table below outlines who can make decisions about counselling and therapy for a child.

Culture and religion

Details of who can make decisions about the child's observance, maintenance or participation in cultural and religious events and activities are outlined in the table below.

The child’s guardian is responsible for decisions about the child's observance, maintenance or participation in cultural and religious events and activities that are not consistent with the views of the child and their family.

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand. They also have a right to practice one or more religions and to develop, maintain and enjoy a connection to their culture (Child Protection Act 1999, Schedule 1).

Education decisions

The following table provides who is able to make education-related decisions for a child based on whether they are in the custody or guardianship of the chief executive.

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand, including decisions about their schooling (Child Protection Act 1999, Schedule 1).

Employment of a child in the entertainment industry

The decision about a child’s employment in the entertainment industry is made by the child’s guardian.

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand (Child Protection Act 1999, Schedule 1).

Before employing a child in the entertainment industry, employers are required to:

• inform parents about the Child Employment Guide 
• provide them with a copy of the guide, if requested
• have a signed ‘parenting consent form’ from the child's guardian.

If a child is in the guardianship of the chief executive, the CSSC manager is the delegated officer responsible for the decision.  If, after the child’s views have been obtained and considered, the CSSC manager agrees to the child’s employment, the CSSC manager will sign the parenting consent form and make sure it is returned to the employer.

Joining the Australian Defence Force

The consent of the guardian is required for a young person aged under 18 years to join the Australian Defence Force, as outlined in the table below. A young person’s views will be obtained and considered before a decision about consent is made.

Marriage of a young person

The consent of the guardian is required for a young person aged under 18 years to marry, as outlined in the table below. A young person’s views will be obtained and considered before a decision about consent is made.

Medical and dental decisions

Many decisions relating to routine medical matters are considered daily care decisions and can be made by the child’s carer or non-family based care service, regardless of who has custody or guardianship of the child. Significant, invasive or non-routine medical examinations or treatments are the decision of the child’s guardian.

When responding to medical decisions for a child in care, determine whether the decision requires the consent of the child’s guardian, as outlined in the table below. For these decisions, if the chief executive does not have guardianship of the child, the child’s parent is the decision maker.

Also consider whether the child would be assessed as Gillick competent by a health practitioner and able to make the decision themselves. (Refer to Gillick competency.)

If a child in care is not assessed as competent to make the decision themselves, they still have a right to be consulted about, and take part in the decision, having regard to their age and ability to understand (Child Protection Act 1999, Schedule 1). Their views must be considered in decision making (Child Protection Act 1999, section 5E (2)(e)).

Gillick competency

Gillick competency is a legal term referring to a child's capacity to understand and provide consent. Health practitioners carry out an assessment to establish if a child has sufficient understanding and maturity to appreciate the nature, consequences and risks of proposed health care and the alternatives, including the consequences of not receiving the health care. The more complex the health care or more serious the consequences, the stronger the evidence needs to be of the child’s capacity to consent.

If a child is Gillick competent, doctors are not required to notify a parent or carer; however, the parent or carer may be aware of the situation and be providing support to the child.

If a child is not Gillick competent, the consent of the child’s custodian or guardian is required.

An assessment of a child’s Gillick competence is needed for each new health care decision.

Carry out medical examinations or treatment – section 97

The Child Protection Act 1999, section 97, provides the authority for a health practitioner to medically examine or treat a child subject to a child protection order granting custody to the chief executive, including a child subject to a child protection care agreement, without the consent of the child’s parent. 

When seeking the medical examination or treatment of a child by a health practitioner under the Child Protection Act 1999, section 97, provide the health practitioner with a Request to medically examine or treat a child - section 97 letter. The letter confirms the authority of the health practitioner to proceed with medical examination or treatment without the parents’ written consent.

Make a medical decision that requires guardian consent

Medical decisions are only to be made after sufficient information has been obtained from the appropriate health practitioner about:

• the treatment, procedure or surgery
• any possible side effects or restrictions the child may experience
• the rehabilitation requirements
• any follow-up required with a health practitioner.

The delegated officer who provides consent for a guardianship decision about medical or dental treatment (for a child subject to a child protection order granting guardianship to the chief executive) must sign the Consent form—operations and treatment. Attach a copy of the form to the relevant event in ICMS and give the original to:

• the health practitioner
  or
• to the carer or non-family based care service, to provide to the health practitioner.

When a child is in the guardianship to the chief executive, the carer or non-family-based care service is authorised to:

• consent to the child’s immunisation on behalf of the chief executive
• consent to the child having a blood test, where a health practitioner has requested this to assist in diagnosis or medical intervention (excluding DNA blood testing).

The authority for these activities is included in the Authority to care—guardianship to the chief executive form. Carers are to give a copy of the Authority to care—guardianship to the chief executive to the immunisation provider as proof of this authority. (Refer to the policy Immunisation of children in care.)

DNA paternity testing

DNA paternity testing is a guardianship decision, as outlined below.

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand (Child Protection Act 1999, Schedule 1).

A DNA paternity test can be used if:

• there is uncertainty about a child’s parentage
  and
• it is considered to be in the best interests of the child.

A DNA paternity test should only be undertaken in exceptional circumstances. These may include where significant conflict about the child’s parentage may result in a change in the child’s care arrangement or their usual family situation.

Child Safety does not have the authority to compel any child or adult to undertake a DNA test. In most cases, a DNA paternity test will not be undertaken by Child Safety when a father has been recorded on the child’s registered birth certificate.

In part, this is because there is a presumption contained in the Status of Children Act 1978 that a person listed on the birth certificate is the child’s parent. A mother or father is required to apply to register a birth under the Births, Deaths and Marriages Registration Act 2003. A parent’s name cannot appear on the birth certificate unless the parent signed a birth registration application.

The recording of a father on a birth certificate is therefore considered the primary evidence of parentage of a child. If another person is identified as possibly being the child’s father, consideration of a DNA test to prove paternity will only occur in exceptional circumstances and when it is assessed as being in the child’s best interests.

Child Safety may make 2 types of approval decisions relating to a DNA paternity test:

1. approval for a DNA test for a child subject to a child protection order granting guardianship to the chief executive
2. approval for the financial cost of the DNA test.

Before seeking approval for a DNA paternity test, consult:

• the senior team leader
• the senior practitioner
• the OCFOS lawyer, if relevant.

If the decision about DNA testing for an Aboriginal or Torres Strait Islander child is considered to be a significant decision, arrange, with the consent of the child and family, for an independent person to help facilitate their participation in the decision. (Refer to Enable participation of Aboriginal and Torres Strait Islander peoples in decision making.)

The approval of the child’s guardian is required for a DNA paternity test for a child subject to a child protection order granting custody to the chief executive.

The approval of the regional executive director is required for a DNA paternity test for a child subject to a child protection order granting guardianship to the chief executive.

If approval is to be sought from the regional executive director, prepare a brief outlining the following information:

• who requested the DNA paternity test
• the views of the parent about the test
• why the DNA paternity test is being considered
• the child’s views about the proposed paternity test
• what understanding the family has of a DNA paternity test and the impact of the test outcome
• what emotional support will be offered to the child and family
• who will inform the family of the DNA paternity results
• the potential long-term effect of the DNA paternity results on an Aboriginal or Torres Strait Islander child’s connection to family and culture.

Once a decision is made, attach the brief and corresponding information to the relevant event in ICMS.

If costs for the DNA paternity test cannot be met by the child’s legal guardian, seek approval for the cost from the CSSC manager. The CSSC manager can use their financial delegation to approve the cost of a DNA paternity test if it is consistent with the case plan and the appropriate approval has been obtained.

Medicinal cannabis

Medicinal cannabis has been approved by the Therapeutic Goods Administration for certain medical conditions. It may also be prescribed for purposes that are not approved by the Therapeutic Goods Administration, including to management of behaviours resulting from a disability. These conditions are outlined in the table below.

It may be prescribed to:

• treat a medical condition
• treat the side effects of a medical treatment
• manage behaviours associated with a disability.

Medicinal cannabis is not to be used as the first line of treatment but may be prescribed as an add-on to conventional treatments, for example, a child with treatment resistant epilepsy may be prescribed anti-seizure medication as well as medicinal cannabis.

A child in care with a particular medical condition may also be invited by a medical specialist to participate in a clinical trial of medicinal cannabis. (Refer to Request for a child in care to participate in a clinical trial.)

Use of medicinal cannabis is a guardianship decision. The table below outlines who may approve the use of prescribed medicinal cannabis.

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand, including decisions about their health (Child Protection Act 1999, Schedule 1).

Seek approval for the use of medicinal cannabis

Any use of medicinal cannabis must be through a treating health practitioner (for example, a GP or a medical specialist, such as a paediatrician, neurologist or child psychiatrist). Access to medicinal cannabis from the illicit market (not through a doctor) risks getting a product that is unsafe, has unknown quality and efficacy and is breaking the law.

To seek approval for the use of medicinal cannabis:

• Ensure the health practitioner has been informed of all medications that a child has currently been prescribed (and the relevant treating doctors and specialists) prior to them prescribing medicinal cannabis. This information is needed for the health practitioner to assess the risk of interactions between these medications and any possible side effects of the combination of medications.
• Provide the decision maker (either the parent or the delegated decision maker) with the information they require to make the decision, including
  • the purpose of the medicinal cannabis
  • the dosage, route and frequency of the medication
  • the likely benefits and possible side effects of the medication
  • the child’s views about the proposed use of medical cannabis, having regard to the child’s age and ability to understand
  • how the impact and possible side effects will be monitored
  • if there is an initial trial period to monitor side effects (for example, 1 month)
  • what the review period for the treating doctor or specialist is (for example, every 3 months, unless indicated otherwise)
  • if it is prescribed with other medications and the potential side effects of this
  • whether or not the use of the medicinal cannabis has been approved by the Therapeutic Goods Administration
  • the cost of the medicinal cannabis
• Seek written approval, if possible, from the parents if a child is in the custody of the chief executive.
• Seek approval from the delegated officer if the child is in the guardianship of the chief executive
  • via an email if the delegated officer is the CSSC manager or the regional director
  • via a memorandum for approval if the delegated officer is the Director-General.

Once approval has been given:

• advise the carer that the use of the medicinal cannabis has been approved and can proceed
• record the outcome in a case note in the ongoing intervention event in ICMS and attach any written approval in iDOCS.
• advise the child’s safety and support network that the use of medicinal cannabis has been approved.

If the use of medicinal cannabis is not approved, record the rationale in a case note in ICMS and save the memorandum for approval in ICMS.

Seek approval for the cost of medicinal cannabis

If the costs of the medicinal cannabis prescribed for a child in care are to be met by Child Safety, refer to the ‘General health services’ heading of the procedure Child related costs – health and wellbeing.

Request for a child in care to participate in a clinical trial

A child in care with a particular medical condition may be invited by a medical specialist to participate in a clinical trial of medicinal cannabis. Participation in a clinical trial can offer comprehensive medical supervision throughout the trial period as well as cost-free access to the medication.

To seek approval for the child’s participation in a clinical trial of medicinal cannabis:

• seek the child’s views about their proposed participation in the clinical trial , having regard to the child’s age and ability to understand
• seek the parents’ written permission, if possible, for a child subject to a child protection order granting custody to the chief executive, to participate in a clinical trial of medicinal cannabis
• complete an email to the regional director seeking their approval for a child in the guardianship of the chief executive to participate in a clinical trial of medicinal cannabis, when the clinical trial has been approved by the Therapeutic Goods Administration.
• complete a memorandum for approval to the Director-General seeking their approval for a child in the guardianship of the chief executive to participate in a clinical trial of medicinal cannabis, when the clinical trial has not been approved by the Therapeutic Goods Administration.
• provide the following information to the decision maker:
  • the purpose of the medicinal cannabis
  • the participation requirements (for example, the length of trial, the need for regular visits to the doctor/specialist conducting the trial)
  • if other medications be taken at the same time as the trial
  • any associated costs (medicinal cannabis would be free, but are there travel or parking costs for carers to attend appointments)
  • if there are tests and procedures for the child (initial and throughout the trial)
  • the possible benefits and side effects
  • how the side effects will be monitored
  • how the child’s privacy will be protected
• attach the ‘participant information sheet and consent form’ to the memorandum of approval.

Share information with relevant professionals

When a child in care is prescribed medicinal cannabis, provide information about the medication and the possible impacts on the child’s behaviour and functioning, where relevant to:

• Department of Education staff during the education support planning process. (Refer to Make sure an education support plan is developed.)
• a Youth Justice case worker or staff of a youth detention centre
• a service provider or prescribed entity working with a child or family, for example, an NDIS funded psychologist, a behaviour support practitioner or staff of Evolve Therapeutic Services.

Palliative care and end of life medical treatment decisions

Decisions about palliative care and end of life medical treatment will be required for a child in care if:

• the child has a life-limiting illness, either long term or acute, and death is likely or expected
• the child’s life is threatened due to illness, trauma or injury as a result of an accident or self-harm
• the child’s life is threatened due to illness, trauma or injury as a result of harm inflicted by another person.

A child’s guardian has the legal authority to provide consent for palliative care and end of life medical treatment. This includes the decision about what treatment will and will not occur in an acute situation.

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand, including decisions about their health (Child Protection Act 1999, Schedule 1).

The table below outlines who can make decisions about palliative care and end of life medical treatment for a child in care, depending on the type of intervention they are subject to.

End of life medical treatment decisions are to be made in a timely way by the person with the legal authority to make the decisions, informed by:

• appropriate medical expertise
• the views of the child and other relevant parties (carers, parents and Child Safety practitioners).

This will assist the relevant parties to make care and treatment decisions in the best interests of the child and alleviate the child’s pain and suffering.

Refer to Palliative care and end of life medical treatment for the process of responding to a child's need for palliative care and end of life medical treatment.

Passports

If a child in care does not have a current passport and requires one, the Australian Passports Act 2005 requires that the passport application be signed by all persons with parental responsibility, that is, both:

• the guardian
  and
• the person who has custody of the child.

If a person other than a parent has guardianship, the parents are not required to sign the passport application. Inform the parents of the proposed travel and seek their views, if possible.

In addition to the passport application, the Application for an Australian Travel Document B-10 must be completed and signed by either:

• the regional director, if the chief executive has guardianship
  or
• the long-term or permanent guardian.

The table below outlines the forms required, and the people responsible for signing them.

If parental consent is required and either or both parents decline to sign the passport application, or are unable to sign, discuss the matter with the senior team leader, who may seek advice from Legal Services Branch.

Foster and kinship carers will be reimbursed for the purchase of a passport for a child, including the cost of the application and the child's photograph.

Personal appearance

A child’s personal appearance is a daily care decision. The child has the right to have their views considered in relation to their personal appearance, including haircuts, clothing, jewellery and ear piercing. If the decision may become contentious, the carer or non-family-based care service should consult the CSO with case responsibility.

A child in care has the right to develop and maintain and enjoy their identity, including for example, their gender identity (Child Protection Act 1999, Schedule 1). Children and young people in care will be supported to safely explore and express their gender identity, including through their choice of clothing. (Refer to the policy Children and young people with gender and sexual orientation diversity.)

The CSO or senior team leader may decide to:

• ask the child's parents to make the decision
• make the decision, after considering the views of the child, their parents and the carer.

Publication of information by the media

Regardless of who has guardianship of a child, the Child Protection Act 1999, section 189 requires that a person must not, without the written approval of the chief executive, publish information that identifies, or is likely to lead to the identification of, a child as:

• a child who is, or has been, the subject of an investigation under the Child Protection Act 1999, section 14
• a child in the custody or guardianship of the chief executive
• a child for whom an order is in force.

The person who wishes to publish the information—usually a media representative—is responsible for contacting Child Safety to seek approval.

Social, sporting and recreational activities decisions—daily and overnight

Decisions about the involvement of a child in care in social, sporting and recreational activities depends on the nature of the activity and the type of intervention.

A carer or non-family-based care service may make daily care decisions about a child’s involvement in social, sporting and recreational activities (see Daily care decisions in the table below).

A child in care has a right to be consulted about, and take part in decisions that affect them, having regard to their age and ability to understand. They also have a right to engage in play and recreational activities, appropriate to the child (Child Protection Act 1999, Schedule 1).

When a child is in the custody of the chief executive, the child’s parent is required to make the guardianship decisions outlined in the table below.

Seek approval for high or very  high risk activities

Decisions about a child participating in a high or very high risk activity are the responsibility of the child’s guardian. Examples of high or very high risk activities include—but are not limited to—white water rafting, rock climbing, abseiling and high ropes courses.

When a request is received for a child to participate in a high or very high risk activity:

• obtain and consider the child’s views about their participation in the high or very high risk activity
•  tell the child about the approval process, including who is responsible for the decision 
• tell the child that a decision will be made or obtained in a timely way, to ensure that if consent is given, any delay in communicating the decision will not prevent the child from undertaking the activity
• advise the child of the decision, once it is made.

(Refer to Guardianship decisions (child in the guardianship of the chief executive) in the table above.)

Gather information about the activity

Gather the following information:

• the nature, qualifications and credentials of the organisation or individuals providing the activity
• what protective strategies can be taken to minimise the level of risk including
  • the level of adult supervision to be provided during the activity
  • the supply and enforced use of compulsory safety equipment, for example, whether a Type 1 personal flotation device is available when participating in boating activities
  • the child's access to necessary safety equipment, for example, if the carer non-family-based care service will assist the child to have a mouthguard fitted
• the potential hazards and risk level of the activity. (Refer to Determine the level of risk.)
• the insurance provisions provided in the event of an accident.

Determine the level of risk

The risks associated with high and very high risk activities may be mitigated by the use of protective equipment, or participation under specific guidelines (age restriction, adult supervision, and codes and regulations).

High risk and very high risk activities may be defined as activities where:

• there is a high risk of injury to the child or other people if the equipment or procedures associated with the activity are not used in the prescribed manner
• there is a risk of severe injury to the child or other people
• there is a high likelihood, high probability or frequency of an injury or event occurring, or a significant consequence or impact if it does occur
• a high level of adult supervision of all aspects of the activity is required.

Discuss with a 16- or 17-year old their participation in the activity, with a view to the young person increasing their decision-making skills. Check the activity’s indemnity form, as some activities may allow consent by a 16- or 17-year old.

Gather information about the suitability of the activity for the child

Gather sufficient information to determine the suitability of the activity for the child, including the views of the child, parents and carer about:

• the activity
• the suitability of the activity for the child’s age, developmental level and experience.

Seek consent from the child's guardian

Consent for high or very high risk activities can be given by the carer or non-family-based care service, the parents or the senior team leader, depending on the type of child protection order and who is organising the activity. (Refer to the Education decisions (Guardianship decisions (child in the guardianship of the chief executive) table and the Social, sporting and recreational activities decisions—daily and overnight (Guardianship decisions (child in the guardianship of the chief executive) table.)

Parents retain guardianship

If a child is in the custody of the chief executive and a request is received for the child to participate in a high or very high risk activity:

• Contact both parents to advise of the request and seek their consent.
• Explain to both parents the nature of the activity and the hazards and risks for the child.
• Provide the parents with a copy of any written information obtained from the organisation offering the activity.

If the parents provide consent for the child’s participation in the activity:

• Make sure the parents sign the consent form provided by the organisation offering the activity. If a form has not been provided, give each parent the Guardian consent form for high risk and very high risk activities to sign.
• Place a copy of the signed consent form on the child's file and attach a copy to the ongoing intervention event in ICMS.
• Tell the child and the carer or non-family-based care service that the parents have given consent.
• Give the original signed consent form to the organisation offering the activity.

If the parents do not consent to the child’s participation in the activity:

• Record each parent's decision on the consent form, place the form on the child's file and attach a copy to the ongoing intervention event in ICMS.
• Inform the child and the carer or non-family-based care service that the parents have not provided consent, and the child cannot participate in the activity.
• Inform the organisation offering the activity that the child is not permitted to participate in the activity.

Chief executive has guardianship

If consent is needed from the senior team leader (because the activity is not being undertaken by a school or club or an Australian tourism operator) for the child to participate in the activity:

• Complete a Request for a child or young person to participate in a high risk activity, including the draft letter outlining Child Safety’s decision.
• Submit the request to the senior team leader.

Inform the senior team leader if a parent opposes the child's participation in the activity, so their views can be considered in the decision. The senior team leader may seek the guidance of the CSSC manager about the decision. If the senior team leader or CSSC manager approves the activity, record the parent’s views and the rationale for the decision in a case note.

If the senior team leader approves the child’s participation:

• Place the approved form on the child's file.
• Inform the child, the carer and the child's parents of the approval.
• Give the organisation providing the activity the signed letter advising of Child Safety’s consent.

If the senior team leader does not approve the child’s participation:

• Place a copy of the form on the child's file.
• Inform the child, the carer and the parents of the decision not to provide consent.
• Provide the organisation with the signed letter advising of Child Safety’s decision, stating that the child does not have permission to participate in the activity.

Travel decisions

Consent for decisions regarding travel for a child is dependent on:

• who has custody and guardianship decision-making responsibilities for the child
• whether there are any costs associated with the travel
• the destination—intrastate, interstate or overseas
• the duration of the travel.

Refer to the tables in Travel decisions – chief executive has custody, Travel decisions – chief executive has guardianship, and Travel cost approval.

Unless travel costs are likely to be sought, a carer or non-family-based care service is not required to advise Child Safety of the travel they can consent to, however, if the carer and a child in care, or a child in care, will be away from their usual residence for an extended period, for example, on holiday, advise the carer they are required to provide their contact details to the CSO with case responsibility.

If interstate or overseas travel is to occur for the purpose of family contact or a holiday with kin, refer to the requirements to involve the interstate liaison team outlined in Contact decisions.

If a child needs a passport to travel, refer to Passports.

Travel decisions – chief executive has custody

The table below outlines who can make travel decisions for a child in the custody of the chief executive. This does not include the cost of travel. The Financial delegate approval for travel costs table outlines who can make decisions about the cost of travel for a child in care.

* The parent, as guardian of the child is the decision maker for these decisions. Where the parent is not able to be located, is not willing to make decisions for the child, or is not able to make decisions due to health or mental health issues, the Child Safety officer indicated is able to make the decision.

Where there is conflict about these decisions between a parent and Child Safety, a carer or a family member, that impacts on a parent’s decision making, work with the parents to achieve an outcome that is in the child’s best interest.

(Refer to Overseas travel costs for more information about decision making for overseas travel for a child in care.)

Travel decisions – chief executive has guardianship

The table below outlines who can make travel decisions for a child in the guardianship of the chief executive. This does not include the cost of travel. (Refer to Travel cost approval for who can make decisions around the cost of travel for a child in care.)

(Refer to Travel cost approval for more information about decision making for overseas travel for a child in care.)

Travel cost approval

The table below outlines the financial delegate for approving travel costs for a child in either the custody or guardianship of the chief executive.

Overseas travel

The consent of the guardian is required for a child in care to travel overseas. (Refer to the Travel decisions – chief executive has custody, Travel decisions – chief executive has guardianship tables.)

If there are costs to be met by Child Safety for overseas travel for a child (for example, for overseas airfares, accommodation costs and domestic flights) prior approval must be sought from the financial delegate. (Refer to the Financial delegate approval for travel costs table, and the policy Child related costs and the procedure Child related costs – Travel.)

Approval for these costs will be considered only:

• to maintain family contact where it is assessed to be essential for the wellbeing of the child or to support a reunification plan
• to enable a gifted child to participate at an international level in their field of excellence, for example, sporting or academic competitions
• in cases where exceptional circumstances demonstrate that overseas travel is essential to maintaining a child’s safety, best interests and wellbeing.

Approval for overseas airfares and accommodation costs will not be given for a child in care to participate in school excursions to an overseas country.

The CSSC manager may approve incidental costs for overseas travel, such as passport fees, visas and travel insurance. Prior approval for eligible child-related costs must be obtained from the CSSC manager.

If Director-General approval is required for overseas travel costs, any applicable letters of advice to the carer will be:

• prepared by the CSSC
• signed by the regional director and forwarded to Executive Services with the approval request.

If a child in care has been approved to travel overseas and the carers are covering the costs of the travel, prepare an accompanying draft letter for the regional director’s signature. The letter will:

• be addressed to either the carers or the child who is travelling (whichever is appropriate in the circumstances)
• include the carer’s name and address.

Forward the draft letter for the regional director’s signature to the regional office.