Meet a child’s health and wellbeing needs

Support the breastfeeding of a child in care

There is significant medical evidence that demonstrates the physical and psychological benefits of breastfeeding for both a child and their mother. Child Safety promotes and supports breastfeeding for children in care. This includes when a child for whom breastfeeding is established, enters care or when a mother has commenced breastfeeding a new born baby and wishes to continue.

Talk to the parents

Talk with the child’s mother and father about:

• their wishes regarding breastfeeding
• the logistics of making breastfeeding work for a child in care, including, the hygienic 
  • use of breast pumps
  • storage and carriage of breast milk.
• other family members, friends or members of the child’s safety and support network who may be able to support the breastfeeding process
• discussing breastfeeding with their health care provider.

Consult the health care provider

Consult the health care provider caring for the child and mother about any health risks to the child or mother should breastfeeding continue.

Discuss any safety considerations and the logistics of storing and transporting breast milk for the baby’s feeds between contact visits.

Consider the role of the proposed carer

When completing a care arrangement referral for a breastfed baby, and the continuation of breastfeeding is supported, make sure to:

• include information about the proposed breastfeeding arrangement in the care arrangement referral. (Refer to Procedure 6 Complete a care arrangement referral.)
• ask the foster and kinship care service provider to talk directly with the proposed carer, so that their views and capacity to support the arrangement are understood
• consider the practical supports the mother and the carer require – such as the safe transportation and delivery of the breastmilk.

Obtain Medicare details

If a Medicare number for the child was not provided at the time of placement:

• Obtain the number as soon as possible from the child’s parent or Medicare Australia, in line with the Information Sharing Protocol between the Commonwealth and Child Protection Agencies.
• Record the card number and details in the My health and health cards section of the Health tab in the child’s person profile in Unify.
• Update the information in the Child information form (for kinship carers or interstate care arrangements.) 
• Make sure the carer or non-family based care service provider have the child's Medicale number. 

If the child is not enrolled in Medicare, refer to Enrol a child in Medicare or request a new Medicare number.

In these circumstances:

• Apply for a Medicare card for the child, unless the child is over 15 years of age, in which case they can apply for their own card. Refer to Enrol a child in Medicare or request a new Medicare number.
• Advise the carer to keep all receipts (both medical and pharmaceutical) and claim the rebate once the child’s Medicare number is known.

Lack of access to Medicare benefits is not to impact on a child receiving necessary medical attention or medication.

Request information from Medicare  

To request a Medicare number for a child under 15 years of age, send an email to DMS via the email group Medicare_Card_Numbers@cyjma.qld.gov.auwith the subject heading ‘Request for Medicare Number for [child’s name]’ and include the following details:

• the full name of the child
• the child’s date of birth
• any alias details for the child
• the mother’s name, if known.

Once the Medicare number is known, DMS will update Unify and send a return email to the CSSC confirming the Medicare card number.

Enrol a child in Medicare or request a new Medicare number

To enrol a child in Medicare or request a new Medicare number for a child in the custody or guardianship of the chief executive:

• Complete the Medicare enrolment or new medicare number request form.
• Record the CSSC’s postal address as the child’s address.
• Attach copies of the required supporting documents (the proof of birth document must be a certified copy).
• Return the completed form and supporting documents
  • by email to MPS.Eligibility@servicesaustralia.gov.au. In the subject line of the email include Queensland, Child Protection, the name of the child, and the last Medicare card number, if known
    or
• • by post to Department of Human Services, Medicare, PO Box 7856 Canberra BC, ACT 2610.

Children 15 years or older

A child aged 15 years or older can choose whether to have the new Medicare number sent to Child Safety. If they wish for this to happen, they must sign the declaration on the Medicare enrolment or new Medicare number request form.

Alternatively, they can request their own Medicare number by completing an Application to copy or transfer from one Medicare card to another (MS011) form. If the child chooses to have their own Medicare number:

• Medicare records will list their address and contact details, and their own bank account details if they wish.
• Their Medicare number will not be linked to either Child Safety or to the Medicare number shared with their parents.

Request a replacement card for a child under 15 years

When a Medicare card for a child under 15 years of age is lost, request a replacement Medicare number by sending an email to DMS via the email group Medicare_Card_Numbers@cyjma.qld.gov.au. In the subject line of the email include ‘Request for replacement Medicare card for [child’s name]’ and include the following details:

• the child’s name and date of birth
• the number of the lost Medicare card (if known)
• the postal address of the CSSC to which the replacement card is to be sent

Assist a child 15 years or over to request a replacement card 

A child aged 15 years or over who is listed as the cardholder may request a replacement for a lost Medicare card by calling Medicare Australia on 1300 660 035 and correctly answering the security questions. 

Alternatively, they can ask the CSO to provide the Letter to Medicare−lost card, signed by both the child and CSO, which states:

• the purpose of the letter―‘Request a replacement Medicare card’
• the child’s full name and date of birth
• the child’s current Medicare number.

Send the letter to Medicare Australia:  

• by email to MPS.Eligibility@servicesaustralia.gov.au In the subject line of the email include Queensland, Child Protection and the name of the child
  or
• by post to Department of Human Services, Medicare, PO Box 7856 Canberra BC, ACT 2610.

Aboriginal or Torres Strait Islander children

To enrol an Aboriginal or Torres Strait Islander child who does not have a birth certificate (or other identity documents) with Medicare Australia, use the Aboriginal and Torres Strait Islander Medicare enrolment and amendment form.

A Child Safety staff member can act as a referee, confirm the child’s identity on the form and sign it on behalf of Child Safety. The birth parent’s signature is not required to submit the form. Do NOT use the address details on the form. Instead, send the form to Medicare by:

• email to MPS.Eligibility@servicesaustralia.gov.au. In the subject line of the email include Queensland, Child Protection and the name of the child
  or
• post to Department of Human Services, Medicare, PO Box 7856 Canberra BC, ACT 2610.

Update records with the new Medicare details

The Medicare card will be sent to the CSSC with case responsibility for the child. When the Medicare card is received:

• Attach a copy of the card to the health care file. (Refer to Develop a child health passport.)
• Record the card number and details in the My health and health cards section of the Health tab in the child’s person profile in Unify. 
• Record the Medicare card details in the Child information form and provide to the carer so they can include it in the child health passport folder.
• Provide a copy of the updated Child information form to the carer so they can include it in the child health passport folder.
• Upload the card number and details (or scan a copy of the card) to ‘Important Documents’ on the child’s kicbox account.
• Give the Medicare card to
  • the child, if they are 15 years or over and listed as the cardholder
  • the child’s carer.

When a child moves

While a child is in care:

• Each time they move to live with a new carer, obtain the Medicare card from the existing carer and give it to the new carer.  
• If case responsibility is transferred to a new CSSC, update Medicare Australia so the child’s address is recorded as the address of the new CSSC.

When a child is reunified with a parent:

• Notify Medicare Australia using the Letter to Medicare—change of address.
• Make sure the child retains their Medicare card if they are 15 years or over and listed as the cardholder.
• Obtain the child’s Medicare card from the carer (if the carer is the cardholder) and place it on the child’s health care file. Do not give the card to the parent.
• Advise the parent that the Medicare card issued for the child when they were in care is no longer to be used and they will need to make sure that the child is still linked to their Medicare card, or, if the child is 15 years or over, they can apply for their own card.

When a young person turns 18

Advise Medicare Australia if Child Safety continues to receive correspondence about a young person who has turned 18. To do this:

• Call 1300 660 035 or write a letter on Child Safety letterhead and
  • email it to MPS.Eligibility@servicesaustralia.gov.au. In the subject line of the email include Queensland, Child Protection and the name of the child
    or
  • post it to Department of Human Services, Medicare, PO Box 7856 Canberra BC, ACT 2610.
• Provide
  • the young person’s Medicare number  
  • their name and date of birth  
  • the information that they have turned 18 and are no longer in Child Safety’s care. 

Arrange for a health care card

A child in care is entitled to a concession card in their own name to get cheaper medicines and some discounts. The concession card is called either a Foster carer health care card or a Low income health care card.

Foster child health care card

If a child is placed with a foster or kinship carer, advise the carer that:

• Only they can make the application for a ‘foster child’ health care card in the child’s name.
• To make the application they will need to
  • complete a Claim for a health care card form, located on the Services Australia website
  • provide documents to prove they are legally caring for the child, for example, the Authority to  Care and proof of identity for themselves and the child in care.
• They can find the claim form and full details about health care applications at their local Services Australia office or on the Services Australia website.

When a child has a health care card in their own name. The health care card:

• remains with the child even if they move to live with a new carer
• is automatically renewed every 12 months, as long as the child remains eligible
• is exempt from income and asset testing.

Low income health care card

If a child is placed in a care arrangement other than with a foster or kinship carer (for example, with a licensed residential care service), assist the child to apply for a ‘low income’ health care card. Help the child complete the Claim for a health care card form. Make sure they do not tick that they are using the form to claim a ‘foster child’ health care card.

To be eligible for a ‘low income’ health care card, the child:

• must be subject to a child protection order granting custody to the chief executive and residing in an approved care arrangement
• be an Australian resident and residing in Australia at the time the claim is submitted
• have an income below $561.00 per week (figure accurate as at July 2019).

In addition:

• There is no age limit for the ‘low income’ health care card.
• As the child is the applicant, only the child’s name will appear on the card.
• When a child applies for their own ‘low income’ health care card, it is subject to income testing.
• The child will need to apply annually for the low income health care card, to ensure they meet the income test.

Immunisation for children in care

Unless there is a medical reason not to, Child Safety will ensure children in care receive vaccines in accordance with the National Immunisation Program Schedule as well as other vaccinations that are available and recommended by a health practitioner, including where an emergency vaccination is required.

These vaccines include:

• scheduled vaccinations including additional vaccines recommended for Aboriginal and Torres Strait Islander people and children with medical risk factors
• the annual influenza vaccination for a child aged over five years without a medical condition predisposing them to severe influenza
• vaccination against emerging diseases, for example, vaccination against COVID-19.

Refer to the policy Immunisation of children in care.

Vaccinations on the National Immunisation Program Schedule are provided free if a child is eligible for Medicare. State and territory health departments also fund some additional vaccines. Refer to the smmunisation schedule for your area. The Immunisation Schedule Queensland is available on the Department of Health website.

Unless a health practitioner advises there is a medical reason for not proceeding, Child Safety will arrange for a child who is in the custody or guardianship of the chief executive to receive vaccinations in accordance with the recommended schedule of immunisations, recommended health advice and the consent requirements outlined in this procedure.

Implications of not maintaining a child’s immunisation schedule

Early childhood and care services

Proof of a child’s immunisation status is required to enrol them in an early childhood education and care service. If a child is not immunised in line with the National Immunisation Program Schedule, they:

• may not be eligible to attend
  or
• will be precluded at times when a communicable disease is present in the centre.

Family payments

Children of all ages must meet immunisation requirements in order for some family payments available through the Australian Government to be paid, including:

• Family Tax Benefit (FTB) Part A end of year supplement
• Child Care Subsidy and Additional Child Care Subsidy.

Obtain the child’s immunisation history

Children who enter care may have missed one or more of their routine childhood vaccinations, leaving them at risk of significant health consequences. It is important to know the child’s immunisation history as early as possible after they enter care to identify if there are any vaccinations that are due or overdue. 

Ask the child’s parents about the child’s immunisation history, including about any serious adverse reactions to previous vaccinations or any medical condition that may impact on them receiving a vaccination. Record the information in the child's Health tab in the person profile in Unify. For a child who is (or will be) placed with a kinship carer or in a care arrangement interstate, update the Child information form and make sure this information (section A and B only) is given to the carer when the child is placed in their care.

Child Safety can request a record of a child’s immunisations from the AIR Wards of State Skill Group by emailing the AIR request immunisation letter to air@servicesaustralia.gov.au or faxing the request to the AIR on 08 9254 4810. If necessary, contact the AIR Wards of State Inquiry Line on 1800 037 723.

After receiving the child’s immunisation history statement:

• Place it on the child’s health care file.
• Upload a copy to the ‘Important Documents’ section of the child’s kicbox account.  
• Give the carer a copy to file in the child’s health passport folder.
• Update the child’s Health tab in the person profile in Unify with the immunisation history.

Refer to the policy Immunisation of children in care.

Seek consent to immunise a child in care

Immunisation of a child is a guardianship decision. Seek consent for the immunisation of a child in care in accordance with the procedures outlined below.

Consent to immunise a child in the guardianship of the chief executive

For a child subject to a child protection order granting guardianship to the chief executive, approved carers and care services are authorised to consent to the child’s immunisation. The parents’ consent to immunisation is not required. The delegated officer may also provide consent for the immunisation, if required.

If the immunisation provider requires a signed consent form, the carer or care service staff will attach the Authority to care―guardianship to the chief executive form as proof of their authority to consent to the child’s immunisation.

Consent to immunise a child in the custody of the chief executive

When a child subject to a child protection care agreement or child protection order granting custody to the chief executive:

• seek the consent of the parent for the child to be immunised. Child Safety staff, approved carers and care service staff do not have authority to sign an immunisation consent form
  or
• where a parent is unable to be located, does not give consent, or is otherwise unable to consent, seek medical treatment (vaccination) of the child by a health practitioner under the authority of the Child Protection Act 1999, section 97.

Obtain consent from the child’s parents

Seek the parents’ views and consent to start or maintain the immunisation schedule for a child in care or receive other recommended vaccinations.

If the child’s parents express concern about immunisation:

• Discuss the Comparison of the effects of diseases and the side effects of vaccines on the NIP.
• Encourage the parent to phone 13 HEALTH (13 43 25 48) for a discussion with a professional health advisor about the risks and benefits of immunisation.
• Assist them to access Vaccination Matters (information about immunisation) on the Queensland Government website or the Immunisation page on the Australian Department of Health website.
• Consider if it is appropriate for the parent to accompany the child at the immunisation appointment so they can discuss their concerns directly with the immunisation provider.

If a parent will not consent to their child being immunised:

• discuss the grounds for the objection with the health practitioner
• decide whether to ask a health practitioner to treat (vaccinate) the child under the authority of the Child Protection Act 1999, section 97.

If the child’s parents are willing to consent to the child receiving immunisations in accordance with the Immunisation Schedule Queensland and other recommended vaccinations, including in an emergency situation:

• Advise them that they can revoke their consent at any time, however, Child Safety can ask a health practitioner to treat (vaccinate) the child under the authority of the Child Protection Act 1999, section 97.
• Have them sign the Parental consent for childhood immunisation form or the local council clinic or child health centre consent form, if required.
• Provide a copy of the consent form to the carer to give to the immunisation provider as proof of parental consent. Ask the carer to attach the signed Parental consent for childhood immunisation to the immunisation provider’s consent form.

Immunise a child in care

Once the appropriate consent is in place, ask the carer or care service to facilitate the child’s immunisation from:

• a health practitioner (a consultation fee may apply)
• an Aboriginal Medical Service
• local council immunisation clinics (in some areas)
• some local child health centres
• vaccination hubs, where relevant
• a pharmacy
• the school immunisation program (Years 7 and 8 vaccinations only).

Carers are encouraged to take the child to either a bulk billing GP, or an immunisation clinic provided through local councils and some community health centres. For an Aboriginal or Torres Strait Islander child, Child Safety staff will encourage carers to make arrangements with Aboriginal Medical Services.

Take action after a vaccine has been administered

When the child has received a vaccination:

• Ask the carer to 
  • confirm the vaccination has been provided to the child
  • provide any information from the immunisation provider that may impact on future vaccinations
  • update the child health passport with the details of the vaccination received. (Refer to Develop a child health passport.)
• Update the child’s Health tab in Unify and the ‘Important Information’  category in their kicbox account with information about the new vaccination. 

Develop a child health passport

The child health passport contains information the carer needs to meet the day-to-day health needs of the child and for the child to receive effective and coordinated heath care.

A child health passport is required for a child in care subject to:

• a child protection care agreement that has been extended beyond 30 days
• a CAO that has been extended beyond 30 days
• a child protection order granting custody or guardianship to the chief executive (including an interim order).

Gather essential health information

When a child enters care, obtain information from the child, parents, carers and (where necessary) relatives or health professionals, about:

• the child’s immediate health needs, essential medical history and details of
  • their general practitioner
  • any medical specialist
  • any outstanding appointments
• any medication the child may be taking, including the dosage, its purpose and who prescribed the medication
• the child’s oral health history, including if the child has recently seen a dentist or the Child and Adolescent Oral Health Service
• whether the child has a diagnosed or suspected disability and who is involved in meeting their support needs
• the child’s immunisation history (Refer to Immunisation for children in care.)
• the child’s Medicare card details and if applicable, health care card. (Refer to Obtain Medicare details and Arrange for a health care card.)
• whether the child has a My Health Record (Refer to My Health Record.)
• who should complete a comprehensive health assessment.

For more information about gathering a child’s essential health information, refer to the practice guide Child health passports.

Record the essential health and dental information in the child’s Health tab in the person profile in Unify. Update this information in the Child information form and:

• File the original on the child’s health care file. (Refer to Commence a child health passport.)
• Give an updated copy of the Child information form (section A and section B only) to the kinship carer or interstate care arrangement at the beginning of the child’s care arrangement.
• Upload a copy to Carer Connect. 
• Attach the Child information form to the relevant event in ICMS. 

Record all attempts to obtain the child’s health history in a case note in ICMS.

Commence a child health passport

A child health passport is commenced:

• when Child Safety or the carer gives the Letter - Comprehensive health assessment to the health practitioner requesting they undertake a comprehensive health assessment of the child  
  or
• when confirmation of a medical appointment for the child to have a comprehensive health assessment is received.

The child health passport process does not occur in isolation. It is linked to:

• the child’s strength and needs assessment
• the development and ongoing review of the child’s case plan and related case work.

Refer to the practice guide Child health passports.

When commencing the child health passport process:

• Arrange for the creation of a Child Safety health care file by completing a CSSC file creation request and forwarding it to the CSSC records officer.
• File all original documents relating to the child's health on their health care file.
• File copies of the original documents in their child health passport folder.
• Upload copies of the original documents to the child’s kicbox account. 

Decide who will conduct the comprehensive health assessment

The child’s general practitioner will conduct the comprehensive health assessment where possible. 
If the child has not seen a general practitioner, identify the most appropriate health practitioner to conduct the health assessment. To help decide, consider the child’s: 
•    age
•    cultural identity
•    current living arrangements.

If there are limited services available to conduct a comprehensive health assessment, or where a specific service is required for the assessment, contact the local child protection liaison officer to:
•    negotiate a comprehensive health assessment by a Queensland Health service
•    obtain advice about local services or processes.

Discuss the comprehensive health assessment with the child, parents and the carer 

Before arranging the comprehensive health assessment for a child: 

• Speak to the child’s parents and carer about the comprehensive health assessment and
  • explain the process 
  • tell them they may be asked to provide health information or history, if requested by the health professional
  • tell the parents (if they have guardianship of the child) that they may be asked to give consent for certain procedures or treatment for the child.
• Speak to the child, if age and developmentally appropriate, and 
  • explain the assessment process
  • answer any questions they have 
  • ask for their agreement to attend an appointment with the health professional
  • ask them who they want to accompany them to the appointment.

If a child does not want anyone to attend the appointment with them, and a doctor deems the child Gillick competent for the particular health decision:

• Consider their right to privacy.
• Discuss with them whether information can be shared between the health professional and Child Safety following the assessment.
• Ask the child their views before informing their parents and carer of the outcome of the health assessment and of any further actions required.

(Refer to Gillick competency.)

A decision will be made on a case-by-case basis as to whether the parents attend the health assessment appointment:

• If reunification is the goal of the child’s case plan, parents should be involved in attending medical and dental appointments.
• When deciding whether a parent will attend, consider the views of the child and ensure the decision is consistent with the child’s case plan.

Arrange the comprehensive health assessment 

Ask the carer to make an appointment with the preferred health practitioner and request a long consultation.

Provide the following documentation to the carer to take with them to the appointment:

• the Child information form – Section A and Section B (note that that the carer will not have Section C)
• the Letter - Comprehensive health assessment
• copies of assessments or reports that may inform the comprehensive health assessment
• a copy of the Letter re: custody (medical) or Letter re: guardianship (medical) for information about decision making for custody and guardianship matters. 

Email the following documentation to the practice manager of the medical centre where the appointment has been made:

• the Child information form (Section A, Section B and Section C)
• the Letter - Comprehensive health assessment.

Arrange for a dental examination 

To arrange a dental assessment for a child who has previously received dental services, contact the service provider to obtain details, including any recommended follow up. 

If the child has not received any dental services in the past six months or recommended treatment has not occurred, arrange an appointment for the child with a dentist or dental service. 

Give the carer the Letter re: custody (medical) or the Letter re: guardianship (medical) to provide to the dentist to inform them of who can provide consent for any proposed dental treatment.

Arrange for an optical examination 

To arrange an optical examination for a child, check when their last eye test was conducted. If the child has not received an eye test in the last 12 months, make an appointment with an optical service. 

Take action when the completed comprehensive health assessment is received

Take the following actions when the completed comprehensive health assessment is received:

• upload a copy of the completed comprehensive health assessment onto the child’s kicbox account and Carer Connect
• update the Health tab and if required, the Disability tab in Unify with
  • the date the comprehensive health assessment occurred and details of the health practitioner who conducted the assessment
  • any diagnosed disabilities or medical conditions
• save a copy in the ongoing intervention case in Unify 
• discuss the outcome with
  • the child, if age and developmentally appropriate
  • the parents and the carer (Refer to Discuss the comprehensive health assessment with the child, parents and the carer.)
• give a copy of the comprehensive health assessment to the carer for the child health passport folder
• distribute the completed comprehensive health assessment to other relevant persons, such as the parents (where appropriate), and any other appropriate people in the child’s safety and support network such as the child’s school or childcare service
• arrange any recommended follow-up appointments or take any actions identified in the health management plan. 

Negotiate payment with the health professional

If full payment for the health assessment is required, the following options are available:

• The carer will payay for the health assessment, then claim the Medicare rebate. Child Safety will reimburse the carer for the gap fee associated with the health assessment.
• The health professional will invoice Child Safety directly. (This option must be agreed to by the health professional before the appointment.) For an Aboriginal or Torres Strait Islander child, Child Safety can arrange for a Medicare rebate using the child’s Medicare number.

All other costs associated with meeting the child’s health care needs are met by the carer. (Refer to policy Expenses―Fortnightly Caring Allowance and Interstate foster payments.)

If a child is referred to other health providers for follow-up, such as a dietician, respiratory specialist or speech therapist:

• The carer will pay for one appointment only.
• Child Safety will meet the cost of all additional appointments, using the relevant child-related cost account code.

Create the child health passport

When the comprehensive health assessment is received from the health professional:

• Obtain a child health passport folder from the records officer and print the cover sheet Child health passport―Private and confidential for the front of the folder.
• Attach a self-adhesive alert on the inside cover of the folder for any child with a medical condition. (This sticker is available from the records officer.)
• Place a copy of the following documentation in the child health passport folder
  • the Child information form (excluding section C, which relates to parental health history information that is not relevant to meeting the child’s medical needs)
  • information about any medical alerts
  • the child’s Medicare card
  • the child’s health care card, if applicable
  • the comprehensive health assessment letter request that was forwarded to the health practitioner 
  • the Letter re: custody (medical) or Letter re: guardianship (medical)
  • a copy of the completed comprehensive health assessment from the health practitioner  
  • information relating to the specific health needs of the child including
    • a diagnosed disability
    • any other health-related information that would assist the carer to meet the child’s health needs
  • detailed information about any prescribed medications.

Give the child health passport to the carer

Give the child health passport folder to the carer at the start of the child’s care arrangement or as soon as possible after.

• Do not include information about the child’s family members in the child health passport folder.
• Record in a case note in ICMS that the folder has been given to the carer.
• Ensure that information in the child health passport is uploaded to Carer Connect, so the carer has an electronic record. 

Arrange health follow-up

When the comprehensive health assessment recommends further action:

• Negotiate responsibility for meeting the costs of follow-up appointments and
  • access public health services as the first option
  • access state and federal health schemes, if available and appropriate.
• Organise health services or specialist appointments in consultation with the child and the carer.
• Make sure necessary documentation is provided to the health practitioner when the child attends appointments.
• Consider additional referrals that may assist in meeting the child’s identified needs, for example
  • to Evolve (Refer to Work with Evolve to support a child.)
  • to the National Disability Insurance Scheme (NDIS). (Refer to Respond to a child's disability needs.)
• Incorporate relevant information into the next child’s strengths and needs assessment, for inclusion in the child’s case plan review.
• Incorporate the child’s health needs and associated actions in the placement agreement and determine whether additional supports may be required, including financial support to meet the child’s needs.
• Record the date for the annual review of the child’s next comprehensive health assessment. 

If consent is required for medical tests or procedures during the health assessment or for follow-up appointments, make sure the person responsible for providing consent has:

• sufficient information about the procedure or test, including any risks or implications of proceeding and not proceeding
• the opportunity to discuss concerns about the procedure or test with a health professional before providing consent.

If the child has ongoing health issues or a new health issue arises, arrange a medical appointment, if possible with the same health practitioner who completed the original comprehensive health assessment, if possible. 

Arrange an annual review

Arrange a comprehensive health assessment 12 months from the date of the child’s last comprehensive health assessment with the same health practitioner, if possible.   

Before the child visits the health practitioner for a comprehensive health assessment:

• consider if there is any new health information the health practitioner needs to be aware of
• ensure the child health passport is up-to-date, including the previous comprehensive health assessment and 
• ask the carer to take the child health passport to the appointment. 

Refer to Arrange the comprehensive health assessment.

Gather non-essential health information

Within 12 months of the child being placed in care, or as required due to case circumstances, gather information about:

• any childhood illnesses and hospitalisations experienced by the child
• the child’s developmental progress (Refer to the practice guide Physical and Cognitive Developmental Milestones.)
• the pregnancy history of the child’s mother
• the child’s family health history
• any allergies the child may have
• the child’s updated immunisation history.

Refer to the practice guide Child health passports for information about specific circumstances that prompt the collection of additional health history.

Record the additional health information in the  child’s Health tab in the person profile in Unify, and for kinship or interstate care arrangements, in the Child information form and:

• Provide the updated Child information form (section A and B only) to this child’s carer (section A and B only) for inclusion in the child health passport folder.
• Attach the Child information form to the relevant event in ICMS.
• Upload items that will be useful for a child when leaving care to the child’s kicbox ‘Important Documents’ category.
• Upload any additional information to Carer Connect.
• File the original on the child’s health care file.

Manage the location of the child health passport

If a child moves to a new care arrangement:

• Provide the carer with the child health passport.
• Let the carer know that the child’s health information is uploaded to Carer Connect.
• Talk to the carer about any medical alerts for the child, including any life-threatening medical condition, including any allergies. 
• Advise Services Australia of the child’s new address.
• Record the location of the child health passport in the Health tab in Unify.

If the child is staying overnight in the care of a family member or another approved carer or at a friend’s home, make sure the person is provided with information about all the child’s health needs, including:

• medical alerts
• life-threatening medical conditions
• any medication, appointments or treatment required during the care arrangement period
• Contact details for the child’s current health professional (where applicable) or health services clinic. 

When a child returns to the care of their parents:

• Give the parents the child health passport.
• Ensure all important health information in the child’s health passport is uploaded to the ‘Important Documents’ section of the child’s kicbox account.
• Advise the parents of any medical information and follow-up appointments.
• Update the child’s My Health Record by removing the Child Safety authorised representative and if appropriate, removing parental restrictions that may have been imposed. (Refer to My Health Record.)
• Advise Medicare Australia of the child’s new address using the Letter to Medicare—change of address.

When a child transitions from care to adulthood:

• Provide them with their child health passport.
• Ensure all important health information in the child’s health passport is uploaded to the ‘Important Documents’ section of the child’s kicbox account. 
• Ensure they know how to manage their own My Health Record and a myGov account.
• Tell them to inform Services Australia of their new address, if applicable.

(Refer to Support a young person’s transition to adulthood.)

My Health Record

A My Health Record is an online summary of a person’s key health information. All Australians have a My Health Record, unless they have chosen to opt out of the system.

A My Health Record enables health care providers to have immediate digital access to a person’s health information, anytime, anywhere in Australia.

A My Health Record is not intended to be a person’s entire medical record. Over time it will include information about:

• medical conditions a person has had
• treatments being undertaken
• medicines prescribed and dispensed
• any allergies or adverse reactions experienced
• immunisation records
• test and scan results, such as blood tests and ultrasounds
• hospital discharge summaries
• doctors’ referral letters.

Link to the Children in care portal

The Australian Digital Health Agency has developed the Children in care portal (the portal) to enable Child Safety practitioners to access the My Health Records of children in care and undertake the role of an authorised representative.

Use of the portal is subject to strict privacy and security conditions. The portal can only be accessed for:

• a child under 14 who is subject to a child protection order granting guardianship to the chief executive. The authorised representative will be the child’s CSO
• a child under 14 who is subject to a child protection order (or interim order) granting custody to the chief executive, but only in certain circumstances when the CSO is the child’s authorised representative.  (Refer to Link to a child’s My Health Record.) In most circumstances, the parent will be the child’s authorised representative.

Child Safety practitioners must complete training in iLearn before accessing the portal, and may only access records when they have the legal authority to do so. (Refer to the policy Managing access to My Health Records using the children in care portal.)

Link to a child’s My Health Record

The CSO with case responsibility for a child under 14 years who is in the guardianship of the chief executive will access the portal to:

• create a My Health Record for a child who does not already have one
• link to the child’s record as their authorised representative (Refer to the  tool My Health Record—Becoming an authorised representative for a child.)
• remove the parent from or restrict the parent’s access to the record, if they pose a significant risk to safety
• update and correct the child’s personal details if appropriate
• monitor access to the child’s record
• view information to assist in meeting the child’s health needs.

If a My Health Record is created for a child because they do not already have one, talk to the child, taking into account their age and ability to understand, about:

• what a My Health Record is    
• the reason for creating a record on their behalf
• the information provided to the My Health Record system to create the record
• who is able to access and view their information in the record
• the privacy of their information
• how Child Safety will use and disclose health information to others, such as their carer
• their ability to take control of their record when they turn 14.

The CSO with case responsibility for a child under 14 years who is subject to a child protection order (or interim order) granting custody to the chief executive will only access the portal to link to the child’s My Health Record as the authorised representative if:

• the child has complex health needs and access to their health information will assist the CSO to manage and respond to their health needs. In this situation, the child’s parent will not be removed as the authorised representative
  or
• there is a need to restrict a parent’s access to their child’s record due to a risk of significant harm to the child, their carer or others if the parent has access to the child’s My Health Record. (Refer to the tool My Health Record—Restrict record access and remove parents.)

Restrict a parent’s access to their child’s My Health Record

A CSO with case responsibility for a child under 14 years will access the children in care portal to restrict a parent’s access to their child’s record if:

• the child is subject to a child protection order granting custody or guardianship to the chief executive
  and
• the life, health or safety of the child, their carer, or another person would be put at risk if the parent were to access information in the child’s record and determine where the child lives.

To restrict a parent’s access to their child’s record:

• Seek endorsement of the decision from the senior team leader.
• Restrict access in the portal. (Refer to the tool My Health Record—Restrict record access and remove parents.)
• Remove the parent as the child’s authorised representative, if they are already linked to the child’s record.
• Give the parent the handout My Health Record—Information for parents of children in care, and if possible, advise them of the action taken to restrict their access.
• Record details of the restriction decision and action taken in the My health record and health cards section of the child’s Health tab in Unify.

In circumstances where the portal cannot be accessed and there is an urgent need to restrict a parent’s access to their child’s record, contact the My Health Record helpline on 1800 723 741 and:

• ask the operator to restrict the child’s record
• provide the passphrase you use to access My Health Record
• provide details of the child protection order and expiry date as evidence of your authority to make the request. A copy of the order may be provided, if requested by the operator. 

Regularly review the restriction decision and remove the restriction if the parent no longer poses a significant risk to the child, carer or others.

Manage a child’s My Health Record as the authorised representative

All children in the guardianship of the chief executive will have a My Health Record. A CSO is not to cancel a child’s record or remove clinical documents.

A CSO who is the child’s authorised representative will maintain accurate information in the child’s My Health Record and may add, amend or correct personal information. This may include adding information about a child’s Indigenous status, known allergies or adverse reactions.

It is sound security practice for the child’s authorised representative to regularly log into the children in care portal to monitor access to the record and ensure there has not been unauthorised access. This involves:

• removing any person with representative access who no longer has the need to access the child’s record, such as a former carer or previous CSO
• immediately advising the CSSC manager and contacting the My Health Record helpline on 1800 723 741 if unauthorised access or suspicious activity is identified
• advising the CSSC manager if a privacy breach is suspected. The CSSC manager will decide whether the concern should be referred to the Information Privacy Team and Legal Services.

Invite a carer to be a nominated representative

In some circumstances, it may be appropriate to give the child’s foster or kinship carer access to the child’s record as a nominated representative, to assist in coordinating health care appointments and meeting the child’s health needs.

The decision to give the carer access as a nominated representative will be made on a case-by-case basis, depending on the child’s needs and circumstances, for example if:

• the child is subject to a child protection order granting guardianship to the chief executive and the care arrangement is stable with the intention for it to be long-term
  or
• the child has high or complex health needs and access to the child’s record will directly assist the carer in meeting the child’s health needs.

In assessing whether the carer should have nominated representative access, consider:

• the child’s views about the carer having access to their record
• whether the carer agrees to
  • represent the child’s views and preferences
  • allow their personal myGov account to be linked as the nominated representative
• whether the carer has been made aware of and understands the privacy considerations associated with viewing a child’s record, and the penalties for inappropriate or unauthorised use. Give the carer the handout My Health Record—Information for foster and kinship carers              
• the type of nominated representative access the carer will need.

If it is assessed that the carer should be invited to be the nominated representative:

• Seek endorsement of the decision from the senior team leader.
• Access the portal to invite the carer to be a nominated representative. (Refer to the tool My Health Record—Inviting or removing a nominated representative.)
• Record the decision, rationale and action taken in a generic case note in ICMS with the title My Health Record followed by a description of the subject (for example ‘My Health Record—carer as nominated representative’).
• Immediately remove the carer as the nominated representative when the child leaves the care arrangement. (Refer to the tool My Health Record—Inviting or removing a Nominated Representative.)

View a child’s My Health Record   

The CSO may view the child’s record and:

• gather information relevant to meeting the child’s current care needs
• share information to the extent necessary to meet the child’s health care needs
• use the information to
  • update the child’s Health tab in Unify
  • inform the child’s strengths and needs assessment
  • develop goals and actions in the child’s case plan
  • identify health services required for the child
  • complete the Child information form and the placement agreement to be shared with the carer.

Important information located in the child’s record include: 

• the comprehensive health assessment, for an overview of the child’s health status at a point in time
• the immunisation history records, to show outstanding vaccinations
• the prescription history, for information about current medicines prescribed and dispensed
• known allergies or adverse reactions
• specialist reports
• event summaries and hospital discharge summaries.

Remove Child Safety staff from a child’s My Health Record

If a child under 14 years is reunified to their parent’s care or a child protection order is made granting guardianship to a relative or a suitable person or to a permanent guardian, the CSO will:

• remove themselves as the child’s authorised representative
• remove any parental restrictions placed on the record, if appropriate and no longer required
• provide advice to the parent or guardian about linking to the child’s record so they can assume the role of the child’s authorised representative.

Enable a young person to control their My Health Record

When a child in care turns 14, make sure they are provided with information about how they can take control of their My Health Record, including how to:

• create a myGov account or log in to their existing account
• access the health information on their record
• manage the access, privacy and security settings
• amend any incorrect personal information
• invite a trusted person to be a nominated representative
• suspend or cancel their record if they wish to do so, and the implications of this.

Give the young person the information sheet Are you over 14? You can manage your own health information and the handout My Health Records—Information for children in care.

Respond to a child's disability needs

Identify disability or developmental delay

'Disability’ refers to an intellectual, psychiatric, cognitive, neurological, sensory or physical condition or impairment that has a substantial impact on a child’s ability to learn, communicate, move, participate in social situations or care for themselves.

In children aged 0–6, the term ‘developmental delay’ is used to describe when a child is slower to develop skills in these areas.

To make sure a child with disability or developmental delay who is in care can access the disability supports they are entitled to, it is important to challenge assumptions and beliefs in relation to the child’s presentation. For example:

• Could the child's behaviours be a sign of disability or developmental delay?
• Could trauma symptoms or coping strategies be masking the child’s disability?
• Has a health professional thoroughly assessed the child and identified any possible developmental delays? (Refer to Develop a child health passport.)  
• Could the child benefit from further assessment to rule out disability?

The practice guide Disability types, diagnosis and impairment table shows categories of impairment and indicates possible ways these impairments may present in children.

Developmental delay does not necessarily mean a child will go on to receive a formal disability diagnosis. With the right interventions, a child experiencing developmental delay may receive all the support they need to ‘catch up’ to their peers.

Identifying if a child has a disability can sometimes be difficult, as signs and symptoms of some types of disability can easily be confused with signs and symptoms of neglect or with a child’s response to past trauma.

Seek disability support from the National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) provides reasonable and necessary disability supports for eligible people with intellectual, physical, sensory, cognitive or psychosocial disability, as well as early childhood early intervention supports for children with developmental delay. Refer to Reasonable and necessary supports and Getting help through the early childhood approach on the NDIS website.  The NDIS is administered by the National Disability Insurance Agency (NDIA).

Determine who is the child’s representative

The National Disability Insurance Scheme Act 2013 (NDIS Act) requires that participants under 18 be represented by a parent or guardian. This person is known as the ‘child’s representative’. The following table shows who the child’s representative is for children in care subject to different types of orders.

If a child is subject to the guardianship of the chief executive, although the senior team leader will make decisions as the child’s representative, the CSO will carry out most day-to-day tasks associated with the NDIS.

The child’s representative will:

• provide consent for the child to access the NDIS or an Early Childhood Early Intervention service
• coordinate collection of eligibility evidence to support the completion of an NDIS Access Request Form
• act as the contact point for the child with the NDIS
• make decisions during the planning process, including what to ask for and who should take part
• sign agreements with service providers for supports to be delivered to a child under their NDIS plan.

A parent or legal guardian who is the child’s representative, or a young person aged 18 years or over and subject to a support service case, might seek assistance from Child Safety to undertake certain NDIS activities to support the child and family or the young person. The NDIS Consent for a third party to act on your behalf form, signed by the guardian or the young person over 18 years of age, can be submitted to the NDIA.

Considerations for Aboriginal or Torres Strait Islander families

Disability is a socially constructed concept arising from western culture and society. People from Aboriginal or Torres Strait Islander backgrounds may have a very different understanding or concept of disability, and in many traditional languages there is no word for disability.

Previous negative experiences of discrimination from government services—both mainstream and disability-related—may affect the willingness of Aboriginal or Torres Strait Islander people to self-identify or identify their family member as having a disability. In addition, Aboriginal or Torres Strait Islander carers may fear that coming forward about disability, or the challenging support needs of a child in their care, may affect the child’s placement.

Child Safety is responsible for making sure that an Aboriginal or Torres Strait Islander child subject to ongoing intervention gains the full benefits of the disability supports and services to which they are entitled.

Consider the best way to approach discussions about the NDIS with each family and whoever else the family may benefit from having involved.

Request NDIS access for a child aged 0–6

For children aged 0–6 years, the NDIS operates in partnership with non-government providers as part of their Early Childhood Early Intervention approach. Contact the Early Childhood Early Intervention provider for the child’s location, using the NDIS website to gain access to the NDIS for a child aged 0–6. If contacting via email, include:

• a signed copy of the Early Childhood Early Intervention provider’s referral form
• an NDIS Consent to share your information form or an NDIS Consent for a third party to act on your behalf form for a child subject to a support service case, intervention with parental agreement or an order granting custody to the chief executive
• copy of the child’s birth certificate
• copy of the child protection order.

For a child subject to a protection order granting custody to the chief executive, support the child's parent as the Child Representative to contact the Early Childhood Early Intervention provider for an application form.

If a child requires more support than the early intervention therapies and linking to mainstream supports that can be delivered directly by the Early Childhood Early Intervention provider, the Early Childhood Early Intervention provider will work with the child’s representative to seek access for the child to funded NDIS supports.

Request NDIS access for a child aged 7 and above

To access supports, the child has to meet the NDIS requirements for age, residency and either disability or early intervention. Refer to Providing evidence of your disability on the NDIS website.

To request access to the NDIS for a child aged 7 years and above:

• Conduct an initial check of a child’s eligibility using the NDIS eligibility checklist.
• Gather eligibility evidence.
• Complete the NDIS Access Request Form and attach copies of relevant documentation (such as proof of age (for example, a birth certificate), residency (for example, an Authority to care form, if applicable) and disability (for example, recent assessments).
• Section 2 of the NDIS Access Request Form must be completed by a GP or other treating health professional.
• Record information in the child’s Disability tab in Unify and  attach a copy of the NDIS Access Request Form and attachments, as detailed under Record and maintain plan information.
• For children in the guardianship of the chief executive, submit the form signed by the senior team leader, a copy of the child protection order  and relevant documentation by email to the NDIS national access team.
• For children in the custody of the chief executive or subject to intervention with parental agreement, submit the form signed by the child’s guardian or, if the guardian agrees to Child Safety acting on their behalf, an NDIS Consent to share your information form and an NDIS Consent for a third party to act on your behalf form, a copy of the child protection order, if relevant, and relevant documentation, by email to the NDIS national access team.
• For a young person over the age of 18 and subject to a support service case,  submit the form signed by the young person or, if the young person agrees to Child Safety acting on their behalf an NDIS Consent to share your information form and an NDIS Consent for a third party to act on your behalf form, and relevant documentation, by email to the NDIS national access team.

Gather evidence of disability and of significant impact of disability

The NDIS requires evidence of disability to be provided by a ‘treating doctor or specialist’.

The practice guide Disability types, diagnosis and impairment table provides guidance on which professionals are best suited to provide evidence about different disability types.

Some conditions once diagnosed require no further evidence of significant impact. These conditions are known as List A conditions.

Some conditions will almost always require further evidence of significant impairment. These conditions are known as List B conditions.

A specialist or health professional may use Section 2 of the NDIS Information Request Form to provide disability evidence. (The NDIS defines ‘health professional’ as a physiotherapist, occupational therapist, speech pathologist, psychologist or nurse.) Alternatively, you can provide this information as attached letters, assessments or reports. Either the form or the attachments need to include information about any treatments the child has already received or is receiving.

If one of the above doctors or specialists is not available, submit the evidence of disability that is available along with any notes explaining the reasons for this, and the NDIS will make an assessment of what further documentation may be required.

Receive access decision

In response to the access request, the NDIA will advise the child’s representative in writing of whether:

• the request has been accepted
• further information is required in order to make a determination
• access requirements have not been met.

If access requirements have not been met, the NDIA will provide reasons and the child’s representative may choose to request a review of the decision. (Refer to Request the NDIA to review a reviewable decision.) A new access request may also be submitted at a future date with new evidence to meet the access criteria.

If a response has not been received within 4 weeks of lodgement, follow up first with the child’s representative and then with the NAWM team.

Prepare for NDIS planning

Once access to the NDIS is confirmed for a child, an NDIS planner or local area coordinator will contact the child’s representative to schedule a time to develop their NDIS plan. This will usually happen at a face-to-face meeting.

Schedule a planning meeting

If a child is subject to the guardianship of the chief executive, the NDIA planner or local area coordinator partner will contact the CSO or senior team leader to schedule a planning meeting.

When considering the time and date of the planning meeting, allow enough lead-in time to gather information to support the child at the meeting, and consider the availability of:

• the child, where appropriate
• the child’s parents, where appropriate
• the child’s carer
• the transition officer (where appropriate and available for a child aged 15–18 years).

Communicate with stakeholders and gather information ahead of planning meeting

The NDIS provides disability supports that are specific to a child’s disability or developmental delay and are additional to the needs of similar-aged children in similar care arrangements.

To secure all the supports a child requires from their NDIS plan, make sure the people attending the planning meeting:

• have a good understanding of, and are clear about the child’s daily support needs and what is or could be considered disability support
• are well prepared with a list of existing supports and services that the child needs included in their NDIS plan
• are clearly able to link the requested supports (especially new supports) to the child’s functional impairments and goals for development.

Gather information about the child’s disability needs and supports from all relevant sources, for example:

• the child
• family members
• the carer
• the kindergarten teacher, school teacher or guidance officer
• child care centre or family day care staff
• transition to school reports
• treating doctors, specialists or therapists
• complex support needs allowance application, child related costs or child related costs—placement and support (CRC-PaS) review documentation.

Ask the child’s family and carer to consider and make notes about:

• how the child’s disability or developmental delay affects their 
  • ability to undertake the tasks of daily living (for example, showering, dressing, eating meals and getting ready to leave the house)
  • communication
  • relationships
  • behaviour
• the supports and services the child already uses each week and the supports and services that are missing
• the child's goals and aspirations for the next 12 months
• any disability-specific supports that would help them better understand the child's needs and build their capacity to care for them.

Ask the child to imagine and tell someone or write down what would make their life better in 6 months time, what would make their life better in 12 months time and what help they might need to get there.

Articulating the correct goals for a child is important to ensure all their required disability supports are included and sufficiently funded to support the child. Refer to the tool Setting goals in NDIS plans – staff tip sheet for guidance on how to prepare for, and articulate a child’s goals at, the NDIS planning meeting.

A child with a disability may require more support than a similar-aged child to learn about sexual development and healthy relationships. 

Conduct a pre-planning meeting

Once all available information has been gathered and stakeholders have had an opportunity to consider the supports and services they want to seek for the child, invite all stakeholders to attend a pre-planning meeting (either in person or via Skype). 

If the child’s parent or guardian is the child’s representative, they will decide who attends the planning meeting with the NDIA, and they may choose not to involve the child’s carer or other stakeholders. In this circumstance, a pre-planning meeting is particularly important in bringing everyone together and agreeing on priorities before the planning discussion with the NDIS planner or local area coordinator.

At the pre-planning meeting, make sure all parties are aware of:

• the NDIS planning process and what will happen at the meeting
• the practice guide NDIS planning meetings: example questions that will be asked and how and who will answer them
• the child’s support needs across all areas of life 
• the child’s existing disability supports (including those funded by Medicare, or under the complex support needs allowance, child related costs, CRC–PaS or other)
• the child’s goals for the next 6 and 12 months
• Child Safety’s choice of agency management for all NDIS plan budgets for children and young people for whom Child Safety is the child’s representative, in line with the policy Supporting children with disability
• the preferred support coordinator or support coordination organisation for the child if known.
• the importance of accurately describing the ‘most challenging day’.
• the language and terminology used by NDIS and how this may differ from the terms they are used to. Refer to the tool Mapping Child Safety and NDIS language - staff tip sheet.

It is beneficial to discuss support coordinators ahead of the NDIS planning meeting, and to notify the NDIS planner of the preferred support coordinator at the meeting. Where this is not possible, support coordination options can be investigated and a support coordinator chosen after the plan is approved. (Refer to Implement the NDIS plan.)

Attend an NDIS planning meeting to develop an NDIS plan

Attend the NDIS planning meeting with the child and other stakeholders

Make sure the following information and documents are available at the meeting as they may be requested:

• the child’s full name and address
• the name, phone number and email address to be used to contact the child’s representative (for example, a Child Safety regional NDIS-specific email address)
• the Government ID of the senior team leader who will perform the child representative role for children subject to guardianship orders
• a copy of the child protection order
• a copy of the child’s birth certificate
• a copy of the Australian Naturalisation certificate, if the child was not born in Australia
• passport or travel documents with a valid Australian Permanent Residency Visa or Protected Special Category Visa, if the child is not an Australian citizen
• a copy of the originally submitted access request and any additional eligibility documentation or reports providing evidence of the child’s disability support needs
• notes from the pre-planning meeting, including information about the child’s existing supports, support needs and identified gaps in supports and goals
• copies of the completed Child Safety NDIS pre-planning guide.

Participate in the NDIS planning meeting

The meeting is made up of the following parts:

• introductions—make the NDIS planner aware of the child’s custody and guardianship arrangements and identify the child’s representative
• assessment questions may be asked to determine the impact of the child’s disability—make sure each of these questions is answered based on the most challenging day experienced in the past 30 days
• questions determining existing service use—refer to the tool Mapping Child Safety and NDIS language - staff tip sheet —make sure all relevant supports from all previous funding sources are included, for example  
  • transport subsidies
  • medical or disability aids and equipment
  • therapies received, including through Medicare treatment plans, the hospital system or Evolve, and whether these are ongoing or time-limited
  • community activities including hobbies, clubs, after-school care and vacation programs
  • disability-related training provided to staff or carers
  • other funded disability supports covered by the high support needs allowance, complex support needs allowance or CRC–PaS arrangement
• questions related to setting of goals—the NDIS planner may help to craft the wording of the goals for the plan. Make sure the recorded goals accurately reflect the discussion and that all required funded supports for the child discussed at the pre-planning meeting are able to be clearly linked to them
• questions relating to challenging behaviours and positive behaviour support—ensure the NDIS planner knows if the child exhibits any challenging behaviours so that funding can be included in the NDIS plan for a positive behaviour support plan to be developed by an NDIS-approved practitioner. Bring copies of incident reports to support the claim for behaviour support funding if these are available
• questions related to plan management and coordination—make sure funding for support coordination is requested and that agency management is requested for plan funding (or encouraged, where Child Safety is not the child’s representative). Notify the NDIA of the preferred support coordinator for the child if one has been chosen
• wrap up and future actions—before the meeting closes, make sure the NDIS planner  
  • has been provided with accurate contact details for the CSO and the child’s representative
  • summarises the information they have gathered at the meeting so that attendees can confirm its accuracy and make sure nothing that was discussed is missing.

NDIS support for a young person in contact with the youth justice system

If a young person with disability is subject to  a child protection order and in contact with Youth Justice, they are still have access to the required disability supports from the NDIS if they are eligible.

When a young person is an NDIS participant, is living in the community and is subject to a child protection order and in contact with youth justice, the NDIS is responsible for providing:

• coordination of NDIS supports in collaboration with the supports offered by the youth justice system, including for victims, witnesses and alleged offenders with disability
• supports to address behaviours of concern (offence-related causes) and reduce the risk of offending and reoffending. This includes social, communication and self-regulation skills, where these are
  • additional to the needs of the general population
  • required due to the impact of the person’s impairments on their functional capacity
  • additional to reasonable adjustment
• reasonable and necessary supports in line with the usual NDIS planning process, which may include assistance with planning, decision making, scheduling, communication, self-regulation and community living. Refer to Reasonable and necessary supports on the NDIS website.

For a young person who is an NDIS participant and in youth detention (including on remand or as a result of a sentence or other court order), the NDIS is responsible for providing the following supports, when the supports required are due to the impact of the young person's impairments on their functional capacity and additional to reasonable adjustment:

• coordination of NDIS supports with the supports offered by the justice, disability, education, health, community services and other systems (including Child Safety)
• aids and equipment (excluding fixed aids such as hoists or specialised beds)
• allied health and other therapy directly related to a young person's disability, including for young people with disability who have complex, challenging behaviours
• disability-specific capacity and skills-building supports that relate to a young person’s ability to live in the community after release
• supports to enable young people to successfully re-enter the community
• staff training in custodial settings where this relates to an individual child’s disability needs.

For a young person in detention, consider who else may need to be involved in the NDIS planning process and when the best time may be to schedule the planning meeting.

Make contact with the senior CSO—youth justice liaison as early as possible in relation to NDIS access and support for the young person, as they may be best placed to gather eligibility evidence and attend the planning meetings with the NDIS.

The senior CSO—youth justice liaison will also be able to make sure discussion and monitoring of NDIS supports is included in stakeholder meetings while the young person is detained and assist with establishing NDIS supports for the young person following their transition back into the community.

Implement the NDIS plan

Following the planning meeting the NDIA planner will approve an NDIS plan for the child and provide this to the child representative (by post unless specifically requested via email).

The plan will show NDIS funding allocated against one or more of three support budgets:

• core budget—for supports related to daily living, community access, and the child’s longer-term goals
• capital budget—for assistive technologies and equipment, for example, wheelchairs, vehicle or home modifications
• capacity building budget—supports to build skills and independence, for example, therapies.

Determine whether a plan review is required

On receiving the plan, check that all the required supports discussed and agreed at the planning meeting have been funded. The NDIS support calculator and the NDIS Pricing arrangements and price limits can assist in checking funding amounts. If funding for support coordination has been requested, this will show against the capacity building budget and a Request for service form will often be included with the plan if the support coordinator has not already been nominated at the child’s planning meeting.

If not all required supports have been included in the plan (for example, if support coordination funding is insufficient, or the requested funding has not been included for development of a positive behaviour support plan for the child), the child’s representative has 90 days to lodge a request for a plan review. (Refer to Manage an NDIS plan review.)

Engage a support coordinator

The support coordinator is the first provider engaged as part of the plan. The support coordinator’s role is to help the child and the child’s representative implement their plan.

Children involved with Child Safety should be allocated funding for support coordination in their capacity building budget.

It is important to choose a good support coordinator, and to clearly outline in the service agreement with them what services they will provide and how they will charge for their services. The support coordinator will:

• research and provide options for service providers to deliver services under the plan
• prepare service agreements where required with those providers
• provide reports to the child’s representative about use of plan funding once the plan is being implemented
• coordinate progress reports and other input from service providers ahead of scheduled plan reviews.

A support coordinator can be nominated at the planning meeting or later. If a support coordinator is not chosen at the planning meeting, a Request for service form may be included with the child’s plan. Advise the NDIA planner of the chosen support coordination provider.

Include the Addendum to service agreement for support coordination and provide the Incident reporting guide for providers of NDIS-funded supports when signing the service agreement with the chosen support coordinator, to make sure Child Safety requirements are met by the provider.

Some Child Safety regions have identified preferred support coordination providers. In addition, the NDIS can provide a list of registered support coordinators operating in the local area.

The NDIS also regularly publishes the full list of NDIS registered providers (Provider finder). Note, providers may or may not be operating locally. When searching this list, filter for support coordinators using the ‘Provider by Group—QLD’ tab and filter ‘Registration group’ on ‘Assist Life Stage Transition’ and ‘Support Coordination’.

Upon receipt of the Request for service form, the support coordinator will accept the Request for service and make contact with the child’s representative to set up an implementation meeting. It is important that all the significant people in the child’s life attend the implementation meeting with the support coordinator.

At the meeting, the support coordinator will explain the plan and gather information to form the basis of the recommendations they make to the child’s representative about service providers for the child.

If support coordination has not been funded, the Early Childhood Early Intervention provider or local area coordinator can provide support to implement the plan. If support coordination funding has not been included and you believe it should have been, a plan review can be requested. (Refer to Request the NDIA to review a reviewable decision.)

Refer to Offices and contacts in your area on the NDIS website for a list  of local area coordinators.

Engage service providers

The support coordinator will provide information to the child’s representative about providers in the area who may be a good match to deliver the required services under the child’s plan.

Use the Disability Support Guide to search for required service providers in the local area.

In certain circumstances, Child Safety may choose an NDIS-registered plan manager (rather than the NDIA) to manage part of an NDIS plan for a child, to enable use of a non-NDIS registered provider. This may occur only when no suitable NDIS-registered provider is available to provide the required support, or when a child has an existing relationship with a non-NDIS registered provider and transferring to an NDIS-registered provider to deliver the service would be detrimental to the child.

Use the template Child Safety NDIS plan management approval to seek relevant approvals. Plan management may only be approved for services when the child does not have a positive behaviour support plan that needs to be implemented by the service provider.

Establish service agreements with all providers delivering services under the plan. 

Most providers have developed their own service agreement templates that they ask NDIS participants to sign. Review each agreement carefully and add to or amend it if required to make sure all parties are in agreement about:

• confidentiality
• start and end dates of the agreement
• use of Child Safety's policy Critical incident reporting and procedure Critical incident reporting
• communication with the support coordinator, the child’s representative and the CSO, including the frequency of feedback and how this will be provided (verbal or written)
• the agreed support being provided to the child
• current agreed fees charged and the number of hours of support provided to the child, including what happens if a child is unable to attend an appointment
• what happens if 1 party wishes to end the agreement. Explore how much notice is required (generally 2 weeks) and if there are any exit fees. Include that if the service provider ends the agreement, they are to provide a written report outlining the support already provided to the child.

The senior team leader is delegated to sign the NDIS service agreements for children subject to guardianship to the chief executive. Use the tool Service agreements - staff tip sheet to check agreements before signing.

Review the placement agreement, including Child Safety-funded supports

The child’s NDIS plan provides funding for reasonable and necessary disability supports. Refer to Reasonable and necessary disability supports on the NDIS website.

Review the placement agreement for the child once the NDIS plan is available. Make sure the placement agreement captures roles and responsibilities in relation to the implementation of, and communication about, the NDIS plan.

It is important that funding provided to support the child’s placement is reviewed as soon as the child has an NDIS plan to make sure Child Safety is not duplicating NDIS-funded supports. Refer to the policy Complex support needs allowance, procedure Complex support needs allowance and the Individualised placement and support (CRC-PaS) - Business rules.

Record and maintain plan information

Record NDIS-related information for a child subject to Child Safety or Youth Justice intervention in the child’s Disability tab in Unify.

This includes:

• the NDIS participant number
• access requests and decisions
• plans
• review decisions
• annual scheduled reviews
• historical information, including previous plans.

NDIS information (excluding Early Childhood Early Intervention details) is shared between Child Safety and Youth Justice. For children also subject to youth justice orders, the CSO is responsible for recording the child’s NDIS information, although youth justice staff may help to maintain it.

Monitor the NDIS plan

To inform case plan review and placement meetings, the child’s NDIS support coordinator will provide Child Safety with a report of how the child’s plan funding is being spent. Where relevant, the child’s NDIS support coordinator may attend these meetings.

At case plan review and placement meetings, discuss the child’s NDIS plan and how the services funded in the plan are helping the child progress towards their goals in the NDIS plan.  

If areas of improvement are identified, many changes to NDIS supports can be made during the life of the plan by the child’s representative directly with providers without a review by the NDIA, as plan funding can generally be used flexibly within the core and capacity building budgets. These changes may include:

• changes to service providers (including support coordinators)
• changes to service types
• changes to frequency of a service.

More significant changes may require the NDIA to review the plan. (Refer to Manage an NDIS plan review.)

Manage an NDIS plan review

A plan review is a process in which the NDIA performs a re-assessment of a participant’s support needs and prepares a new plan on behalf of the participant.

There are three types of review of an NDIS plan:

• unscheduled review—participant-initiated (where the participant or representative requests a review and the NDIA delegate agrees to the review)
• unscheduled  review—delegate-initiated (where the NDIA planner initiates a ‘desktop’ review)
• scheduled reviews—these are scheduled as part of the NDIS planning cycle.

The NDIS plan reassessments and reviews will assist Child Safty staff with requesting and preparing for NDIS reviews.

Request the NDIA to review a reviewable decision 

The majority of decisions made by the NDIA under the NDIS Act are ‘reviewable decisions’. Those who are able to request a review of a decision and who may be directly affected by a decision include:

• a prospective participant
• a participant (including participants who are children)
• one or more people with parental responsibility for a child
• a child's representative, or a person seeking to a be a child's representative
• a child's guardian
• a plan or correspondence nominee, or a person appointed, or seeking to be appointed as a plan or correspondence nominee
• a registered provider of supports, or a person or organisation that applies to be a registered provider of supports
• a person who owes a debt to the NDIA.

As a party affected by a decision, the most common scenarios where the child’s representative may need to request a review of the decision are when:

• the NDIA has determined that a child does not meet NDIS access criteria
• the NDIS has refused a request for a participant-initiated plan review.

The NDIA must give written notice of a reviewable decision to each person directly affected by the decision. Refer to Reviewing our decisions on the NDIS website for the full list of reviewable decisions.

Make the first attempt to seek a review directly with the planner who developed the child’s plan. If they agree, the review can be actioned more quickly as a ‘desktop’ review.

If the planner does not agree to a desktop review, seek an internal review. To seek an internal review:

• Make a request in person, by telephone on 1800 800 110, or by email to enquiries@ndis.qld.gov.au or directly to the NDIA planner.
• Send or deliver a written request by post or email to the NDIA.

The NDIA provides an optional application template (Application for a review of a decision), located on the How to request an internal review of a decision page of the NDIS website.

The request must be made within 90 days of the decision being made. The decision remains in effect while the decision is reviewed.

A formal request for a review of a decision that is not a ‘desktop’ review:

• must be conducted by a staff member who was not involved in making the original decision
• must be conducted ‘as soon as reasonably practicable’
• should include an opportunity to explain why a different decision should be made and to provide any additional information or evidence.

Following the review, the NDIA is required to advise the person who made the request of the outcome in writing.

Request an external review of an NDIS decision

There is a further right of external review by application directly to the Administrative Appeals Tribunal. Seek advice from the senior team leader and seek advice from the NDIS Interface team by email at NDISSupport@csyw.qld.gov.au before preparing to make a request to the Administrative Appeals Tribunal.

Request or manage a change of circumstances review

A participant or their representative may request a review of their plan at any time. The NDIA delegate then decides whether the plan will be reviewed. This decision is a reviewable decision. (Refer to Request the NDIA to review a reviewable decision.)

Some examples of when the child’s representative may need to request an unscheduled review include if:

• there is a significant increase or decrease in the child’s support needs
• there is an urgent requirement for an additional service type not already included in the plan
• an important life transition is approaching, such as the child leaving school or leaving care.  Note: Lodge a plan review request at least 6 weeks prior to the child’s eighteenth birthday).   

Discuss the request for review with the child’s support coordinator first, as a request for review is unlikely to be accepted without evidence of a change in circumstances or additional information (such as an updated functional assessment being provided about the child’s need for support). The NDIA will generally not accept requests for plan reviews within 3 months of an existing review date, but may bring forward the date of a scheduled review.

The NDIA must decide whether to review a plan within 14 days of receiving a request from a participant or their representative. If they do not make a decision, the NDIA is taken to have decided not to review the plan, and a request for a review of a decision can be lodged. (Refer to Request the NDIA to review a reviewable decision.)

The review will create a new plan. Record the previous and new plan information in ICMS. Refer to Record and maintain plan information.

The NDIA may also initiate an unscheduled review if they have reason to do so. A delegate of the NDIA may decide it is appropriate to review when there is:

• a change in the participant’s circumstances
• feedback from the NDIA’s monitoring activities (for example, the planner in contact with a child’s representative realises an error has been made)
• something has changed in relation to how the child would be assessed under the NDIS Act (for example, the effectiveness of a support to assist a participant to achieve their goals and aspirations, value for money relative to alternative supports, or what it is reasonable to expect family or carers to provide).

Manage a scheduled plan review

The NDIA, Early Childhood Early InterventionEarly Childhood Early Intervention, orECEI or local area coordinator is likely to make contact up to 3 months prior to a child’s plan expiry date to set a date and time for a plan review meeting. The plan review meeting is likely to be set well before plan expiry so a new plan can be approved before the current plan finishes.

If the child’s NDIA planner does not make contact within 4 weeks of a child’s plan expiration date, contact the NDIA to follow up.

It is important not to assume that existing services will be rolled over automatically into a new plan at the review. The NDIA requires evidence that each service is delivering benefits to a child and continuing to contribute to the child achieving their goals.

Facilitate progress reports ahead of a plan review

Work with the support coordinator (or directly with each service provider if no support coordinator has been allocated) to organise for progress reports to be developed and submitted by all funded support providers ahead of the review meeting. 

Progress reports are required for each service accessed during the life of the current plan. The reports should show:

• evidence of benefit of the service to the child
• progress towards the goals that the service was funded to achieve in the current plan
• the outcomes for the child that the service will be working towards in the coming year
• any recommendations for an increase or decrease in the amount of the service for the child.

The support coordinator is also required to provide a report on how they have been supporting the child over the period of the plan. The NDIA provides support coordinators with a template for this. Ensure the child’s representative receives and reviews this report and confirms its accuracy prior to the support coordinator lodging the report with the NDIS.

Communicate with stakeholders and gather information ahead of a plan review

As with the initial planning meeting, a child is likely to receive a better plan at review if the people attending their review meeting:

• have a good understanding and are clear about what the child’s support needs are
• are well prepared to explain how existing supports and services are benefitting the child and should continue
• are able to link any new requested supports clearly to the child’s functional impairments and goals for development.

Gather information to assist the review from all relevant sources, for example:

• the child
• family members
• foster and kinship carer or residential care service staff
• kindergarten/school teachers, guidance officers
• child care centre and family day care staff
• doctors or specialists
• complex support needs allowance application/CRC-PaS review documentation
• the Child Safety NDIS pre-planning guide or other pre-planning materials completed prior to the original planning meeting or previous reviews.

Ask these sources to consider and provide information about whether there have been any changes in:

• how the child’s disability or developmental delay affects their  
  • ability to undertake the tasks of daily living (for example, showering, dressing, eating meals and getting ready to leave the house)
  • communication 
  • relationships
  • behaviour
• the supports and services that would benefit the child
• the child’s goals and aspirations for the next 12 months
• the disability-specific supports that would help them to better understand the child’s needs and better care for them.

Where relevant, provide the child with the The National Disability Insurance Scheme Information for young people in care about the NDIS process and what they can expect (having regard to the child’s age and ability to understand).

Ask them to imagine and tell someone or write down what would make their life better in 6 months and 12 months time and what help they might need to get there.

A review will create a new plan. Record the previous and new plan information in ICMS. (Refer to Record and maintain plan information.)

Respond to disability support needs for a child in an emergency or crisis

Action in relation to a child’s NDIS support may be required in an emergency or crisis situation, for example:

• the sudden illness or hospitalisation of the carer
• a sudden or severe escalation of challenging behaviours related to the child’s disability that are unable to be managed within the existing care arrangement
• an immediate and critical need for equipment or equipment repair to sustain the existing care arrangement.

If a child is an NDIS participant, the child’s representative can work with their support coordinator or the local area coordinator to move funds within their NDIS plan to respond to the crisis. This may include the purchase of emergency short-term accommodation (respite) or another support. The support coordinator or local area coordinator can also assist with a request for an urgent plan review if the child’s circumstances have changed enough to warrant this.

Manage contact with the NDIA

Strict privacy provisions govern who the NDIA will speak to about an NDIS participant. To enable the NDIA to speak with a CSO about a child in care, the NDIA may request:

• a copy of the child’s child protection order
• a copy of the CSO’s government identification
• an email from a state government email address (a Child Safety regional NDIS-specific email address is preferred).

Make a complaint about the NDIS or an NDIS service provider

To make a complaint in relation to the NDIS, an NDIS provider or an NDIS partner, contact the  NDIS interface team by email for advice, ahead of following the  NDIS Quality and Safeguards Commission instructions. Make sure the complaint includes:

• the CSOs contact details
• details of the child's representative
• the child's name
• the child's NDIS plan number.

Seek disability support from the National Injury Insurance Scheme Queensland

The National Injury Insurance Scheme Queensland (NIISQ) provides necessary and reasonable treatment, care and support for people who sustain eligible serious personal injuries in a motor vehicle accident in Queensland, regardless of who is at fault in the accident. 

The NIISQ is also engaged by Queensland workers’ compensation insurers to manage treatment, care and support for eligible workers who sustain a work-related serious personal injury under the Workers Compensation and Rehabilitation Act 2003. Refer to Work related accidents on the NIISQ website.

If you are working with a child or family member who is a NIISQ participant, they will have a support planner or support coordinator who you can speak to about their treatment care and support.

The Child Protection Act 1999, Chapter 5A, part 4, includes provisions which enable Child Safety and a prescribed entity or service provider, such as NIISQ, to share information for the purpose of meeting the wellbeing needs of a child and family subject to Child Safety involvement.

If a child or family you are working with has been injured in a motor vehicle accident and you require information about NIISQ, refer to Are you eligible? and Apply to become a NIISQ participant on the NIISQ website.

Work with Evolve to support a child

Evolve Therapeutic Services (Evolve) is a collaborative partnership between Child Safety and Queensland Health, that provides planned and coordinated therapeutic intervention to children in care. Evolve aims to:

• improve emotional wellbeing
• support the development of skills
• enhance the participation in education and the community.

Evolve has multidisciplinary clinical teams that are responsible for providing clinical therapeutic supports and interventions to children in care with severe and complex mental health needs. 

The Evolve clinicians provide:

• an initial and comprehensive assessment, including a mental health risk assessment
• crisis response for children with immediate needs (if indicated from mental health risk assessment)
• Evolve care planning and care plan reviews
• specialist consultations for carers to support their caring role
• education on the effects of trauma and abuse
• medium- to long-term therapeutic interventions to facilitate the child’s ability to form secure attachments and engage in educational/vocational activities
• referrals to other specialist mental health services as needed.

Determine if a child is eligible for Evolve

A child may be eligible for referral to Evolve if they are:

• experiencing significant concerns with their mental health or social or emotional wellbeing and
• subject to an interim or finalised child protection order granting custody or guardianship to the chief executive
  or
• subject to intervention with parental agreement, including a child protection care agreement.

Decide if an Evolve referral is appropriate

If a child meets the eligibility criteria, discuss the proposed referral with the following people to decide if an Evolve referral is appropriate:

• the senior team leader
• Evolve staff (including child’s eligibility, characteristics, indicators, and any local intake arrangements)
• the child, to
  • ascertain their views and willingness to work with Evolve
  • obtain their consent to the referral, if the child is aged over 14 years and considered Gillick competent (Refer to Gillick competency.)

• with the child’s parent and, if the child is in the custody of the chief executive, obtain verbal consent for the referral and information sharing with Evolve
• for an Aboriginal or Torres Strait Islander child, consult with the cultural practice advisor, where possible 
• the child’s private therapist or psychologist, where relevant
• the child’s safety and support network, where possible.

Complete a referral to Evolve

To refer a child to Evolve:

• complete the Evolve Therapeutic Service Referral Form
• ensure the form includes the written consent of the child’s guardian or the delegated decision maker, which will be either
  • the child’s parent, for a child in the custody of the chief executive
  • the CSSC manager, for a child in the guardianship of the chief executive
• ensure the form includes the written consent of the child, if the child is aged of 14 years and considered Gillick competent (Refer to Gillick competency.)
• collate and attach the supporting documents to the referral, which will assist Evolve in making the decision about whether to accept the referral and help with the initial assessment and therapeutic intervention. These documents include (where relevant)
  • the assessment and outcome form, detailing why the child is subject to ongoing intervention
  • child strengths and needs assessment
  • parental strengths and needs assessment
  • the child’s case plan and the most recent review report
  • family group meeting minutes
  • psychosocial assessment reports or other allied health assessments and reports
  • the child’s education support plan
  • a genogram
  • the most recent care arrangement referral
  • a summary of the child’s care arrangement history
  • the child’s NDIS plan
  • any other documents contained in the child’s records that provide information about the child’s trauma history, including
    • harmful sexual behaviour or sexual abuse
    • domestic and family violence
    • misuse of alcohol or drugs
    • mental health concerns
    • intergenerational trauma.
• sign the form and have the senior team leader sign the form
• submit the referral via email to the relevant Evolve team
• record the completed Evolve Therapeutic Service Referral Form in the child’s ongoing intervention event in ICMS.

If Evolve advise that a child’s referral has been accepted, record the acceptance in the child’s ongoing intervention event in ICMS.

Respond when a referral is not accepted by Evolve

If Evolve advise that a child’s referral has not been accepted, Evolve will also advise:

• the reasons why a referral is not accepted, which will be either
  • the child does not meet the eligibility criteria
  • another service is more suitable
  • Evolve does not have current capacity to accept the referral
• what other services may be suitable for the child
• how to access those services. 

Record Evolve’s decision not to accept the referral, including any advice and recommendations about alternative services, in the child’s ongoing intervention event in ICMS.

Communicate the outcome to the child’s safety and support network and pursue any alternative referrals recommended by Evolve.

Monitor and support the intervention

Once Evolve have accepted a referral, Evolve will be responsible for assessment, therapeutic care planning and interventions, including:

• an initial and comprehensive assessment, including a mental health risk assessment
• crisis responses for children with immediate needs, if indicated from a mental health risk assessment
• review of the child’s clinical care needs, which involves the Evolve multi-disciplinary team and consultant child and adolescent psychiatrist
• engagement with the child, carers and stakeholders
• work with Child Safety staff to convene stakeholder group meetings
• development and review Evolve care plans
• specialist consultations with carers and other relevant stakeholders
• the provision of information and education to the child’s safety and support network on the effects of trauma and abuse.

During Evolve’s intervention:

• maintain communication with the Evolve clinicians
• review Evolve assessment reports, three-monthly reviews and seek clarification when required
• upload assessment reports and three-monthly reviews into ICMS
• participate in regular stakeholder meetings, which may be incorporated into safety and support network meetings
• implement recommendations and actions from stakeholder meetings and Evolve review meetings
• support and encourage carers and stakeholders to actively engage with the Evolve services
• contribute to case closure decisions
• raise issues or concerns with Evolve staff in a timely way, including any planned or emergent accommodation change. 

Respond to issues

Respond to issues about the operation of Evolve services in a timely and respectful manner, prioritising the needs and best interests of the child.

If an issue with Evolve is unable to be resolved, raise the matters with a senior team leader, senior practitioner or CSSC manager as soon as possible, who will discuss the issue with the relevant Evolve team leader or Queensland Health staff.

If the issue remains unresolved, the CSSC manager will table the issue with the Evolve Local Steering Committee.

Unresolved local issues can be escalated by the regional director to the Evolve Statewide Interagency Governance Committee.

Develop a positive behaviour support plan

When a child has at risk behaviour, development of a positive behaviour support plan: 

• recognises that at risk behaviour is often related to environmental factors such as interpersonal relationships, the physical environment and the level of support and services being received
• is a holistic approach with a focus on understanding the purpose of the behaviour and increasing positive behaviours through skill development rather than punishing negative behaviours
• uses proactive rather than reactive or crisis driven strategies. The focus is on skill development and modifying the environment or context to better support the child and reduce the need for them to engage in at risk behaviour.

A positive behaviour support plan may include case work support for carers. The plan will assist with planning and implementing strategies to manage behaviours through positive responses such as:

• primary preventative strategies that aim to change the environment and improve quality of life for the child. These strategies include building strong relationships, recognising positive behaviours rather than negative ones, focussing on strengths, clear and consistent boundaries and assisting with problem solving.
• skill development in areas such as communication, self-regulation and coping
• graded approaches to responding to at risk behaviour.  This includes identifying early warning signs of at risk behaviour and effective strategies to alleviate the situation when the behaviour presents low risk.
• non-aversive reactive strategies that aim to bring about resolution and return to safety when the child engages.

When a child has mainly low and moderate risk behaviours, the safety and support network can develop strategies for managing the child’s behaviour.

When a more structured positive behaviour support plan is required, it may be developed by:

• an NDIS registered behaviour support practitioner - for a child who is an eligible NDIS participant eligible, or
• a clinician or a professional with appropriate capabilities, for example, appropriately qualified staff of the residential care provider, a private psychologist, or a mental health clinician.

Contact local Specialist Services staff (SDSpecialistServices@csyw.qld.gov.au) for further information about who may be suitable to develop a positive behaviour support plan for the child.

When a child is not an eligible participant for the NDIS

A positive behaviour support plan cannot include prohibited or restrictive practices. If prohibited or restrictive practices are being considered for a child who is not an eligible participant for the NDIS, follow the informal safeguarding process, and if necessary, the formal safeguarding and escalation process. (Refer to Respond to the use of prohibited or restrictive practices for a child in the guardianship of the chief executive.)

For these children, any use of prohibited or restrictive practices will be recorded in a plan to manage crisis situations, not in their positive behaviour support plan.

Advise the child’s carer that the strategies in the positive behaviour support plan must comply with the requirements as set out in the Statement of standards, the Charter of rights for a child in care and the policy Positive Behaviour Support.

When a child is an eligible participant for the NDIS

For children who are NDIS participants, the development of the positive behaviour support plan and training carers and staff on the strategies in the plan and monitoring the plan may be funded through the child’s NDIS participant plan.

The positive behaviour support plan written by an NDIS positive behaviour support plan writer for a child who is an eligible participant of the NDIS, may include prohibited or restrictive practices. Refer to Respond to the use of prohibited or restrictive practices for a child in the guardianship of the chief executive.  

If a child in the custody of the chief executive is an eligible participant for the NDIS, a parent, as guardian, will sign the positive behaviour support plan, so it can be lodged with the NDIS Quality and Safeguards Commission in the following circumstances:

• the child’s positive behaviour support plan is written by an NDIS positive behaviour support plan writer
  and
• the plan contains the planned use of prohibited or restrictive practices.

If a child in the guardianship of the chief executive, the senior team leader will sign the positive behaviour support plan so it can be lodged with the NDIS Quality and Safeguards Commission in the following circumstances:

• the child’s positive behaviour support plan is written by an NDIS positive behaviour support plan writer
  and
• the plan contains the planned use of prohibited or restrictive practices
  and
• the formal safeguarding and escalation and process has been followed and completed. Refer to Respond to the use of prohibited or restrictive practices for a child in the guardianship of the chief executive.  

Monitor and review the child’s positive behaviour support plan

Respond to a carer’s need for further support or additional training to assist them respond to the child’s at risk or challenging behaviour during the implementation of the child’s positive behaviour support plan. Record relevant information and responses in:

• the foster carer agreement, for a foster carer
• the placement agreement, for a kinship carer.

Review the positive behaviour support plan within the recommended review timeframe or, where there is no recommended timeframe, a minimum of 12 monthly, to ensure the effectiveness of the plan and consider the extent to which:

• adjustments to environmental factors have helped reduce the child’s behaviours
• positive behaviours have increased due to skill development and proactive strategies
• the carer has been able to access training and support to increase their ability to positively manage the behavioural
• referrals to Evolve, a psychologist or other services have helped effect change.

Include relevant information from the behaviour support plan and the review of the plan in the child’s case plan.

Where possible, align the review of the positive behaviour support plan with the review of the child’s case plan to ensure all relevant and updated information is available.

Respond to a child’s challenging or high risk behaviour

As soon as possible after a child is placed in care, use information in the tool Placement risk assessment, to identify if the child is likely to engage in challenging or high risk behaviour. Use this information to identify strategies and services that can respond to the child’s behavioural needs and ensure these are included in the case planning process.

If a child’s strengths and needs assessment has identified significant needs in the behaviour or emotional stability domains:

• Complete a referral either to Evolve or to a psychologist for the high risk behaviour. (Refer to Decide if an Evolve referral is appropriate.)
• Engage an NDIS-registered behaviour support practitioner, for children who are NDIS participants. If the child’s plan does not include behaviour support, request a plan review and seek funding. (Refer to Manage an NDIS plan review.)

If a child engages in challenging or high risk behaviour as a result of a disability or a range of factors including trauma and mental health issues:

• Ensure that a positive behaviour support plan is developed for the child that provides strategies to assist with responding to the high risk behaviour early in the escalation, where behaviours present lower risk to the child or others. (Refer to Develop a positive behaviour support plan and the policy Managing high risk behaviour.)
• Be aware that for children who are NDIS participants, disability-specific training may be funded through the child’s NDIS plan for their carers.
• Use the child’s safety and support network to collectively assess, manage and review the high risk behaviour in order to promote the successful use of positive behaviour support and identify, and then eliminate or reduce the use of restrictive practices.
• Ensure carers or care service staff
  • have access to the positive behaviour support plan
  • are aware that the use of physical restraint (with the exception of some high risk physical restraints) and restricted access to items can only occur as an emergency response, where there is immediate risk of harm to the child or others
  • are aware of the reporting requirements for any use of a prohibited practice or an emergency use of a restrictive practice.

In limited circumstances, where a child engages in behaviours of such intensity, frequency, and duration that, without intervention, they present an immediate risk to themselves or others, the emergency use of a restrictive practice may be required to manage risk. Refer to the policy Managing high risk behaviour which:

• defines prohibited practices and the emergency use of restrictive practices
• outlines the reporting requirements for the use both prohibited practices and the emergency use of restrictive practices.

Management of psychotropic medication

Psychotropic medications are used to treat psychiatric disorders. They are not disorder-specific, but they provide clinical benefit for a range of psychiatric disorders and symptoms.

The most common types of psychotropic medications used to treat psychiatric disorders are:

• antidepressants
• antipsychotics
• anxiolytics
• mood stabilisers
• hypnotics
• stimulants
• cognitive enhancers.

The decision to prescribe or alter a psychotropic medication for a child in care is a serious decision. When a child is in the guardianship of the chief executive, the CSSC manager, holds responsibility for making the decision and needs to give careful consideration prior to consenting to the treatment being given to the child.

Gather information to inform the decision

When a doctor prescribes psychotropic medication or changes the type, frequency or dosage of psychotropic medication previously prescribed to a child in care:

• Collate all the information required by the guardian to make a decision, including:
  • The information provided by the doctor in Part A of the Clarification of purpose for psychotropic medication form, including the name of the medication, the dose range, the method and frequency of administration, the reason for the medication, the condition it is being prescribed for, the benefits of taking it, the consequences of not taking it, the side effects and any recommendations to minimise the risk of side effects.
  • The reason for seeking the medication, including the child’s specific circumstances and the effectiveness of previous treatments and behaviour support strategies.
• What other strategies are proposed if the medication is primarily for controlling behaviours, for example, the safety and support plan, positive behaviour support plan, access to therapeutic services, and support to improve sleep hygiene. If the medication is being prescribed for the primary purpose of controlling a child’s behaviour, refer to Respond to the use of prohibited or restrictive practices for a child in the guardianship of the chief executive.
• Talk to the child, the parents and the carers or residential care service staff and facilitate their participation in decision-making, as appropriate. This will include providing them with information or access to information to help them consider the risks and benefits of the proposed treatment, including
  • the diagnosed medical condition requiring treatment
  • the specific type of medication and possible side effects
  • when the doctor would review the use of the medication, if relevant.
• If the child is Aboriginal or Torres Strait Islander, ask the child and their family if they want an independent person to help facilitate  their participation in the decision. If the child or family consents, collaborate with them to arrange an independent person’s involvement. (Refer to Enable participation of Aboriginal and Torres Strait Islander peoples in decision making.)

Seek consent – parents have guardianship

If a child is in the custody of the chief executive and it appears that the doctor is prescribing the use of the medication primarily to control the child’s behaviour, immediately contact the local Specialist Services Clinician. Alternatively, contact Specialist Services for support and advice by emailing SDSpecialistservices@cyjma.qld.gov.au.

If prohibited or restrictive practices are being considered for a child in the custody of the chief executive, follow the informal safeguarding process to actively recognise and eliminate the use of prohibited or restrictive practices with a child wherever possible. (Refer to Informal safeguarding.)

To seek consent for the use of a psychotropic medication or to change the type, frequency or dosage of psychotropic medication previously prescribed to a child in the custody of the chief executive:

• Provide the Parental consent for psychotropic medication form to the doctor with a request that they complete Part A of the form, sign the form and return it to the relevant CSSC.
• When the form is returned from the doctor, complete Part B of the Parental consent for psychotropic medication form and ensure all relevant information is detailed.
• Provide the Parental consent for psychotropic medication form to the parent seek their consent to the psychotropic medication.
• If the parent consents, they will select ‘consent’ and sign Part C of the form.
• If the parent does not consent to the medication, they will select ‘do not consent’ in Part C and sign the form.

If the parent does not consent to the use of psychotropic medication, work with the parents to understand their concerns about the use of the medication and involve the parents in developing a plan to meet the child’s needs.

Seek approval – chief executive has guardianship

To seek approval to administer prescribed psychotropic medication or to change the type, frequency or dosage of psychotropic medication previously prescribed to a child in the guardianship of the chief executive:

• Enter the child’s details into a Clarification of purpose for psychotropic medication form and any known information into Part B of the form.
• Provide the Clarification of purpose for psychotropic medication form to the doctor with a request that they complete Part A of the form, sign the form and return it to the relevant CSSC.
• When the form is returned from the doctor, ensure all relevant information is detailed in Part B of the form
• Provide the Clarification of purpose for psychotropic medication form to the CSSC manager for completion.
• The CSSC manager will
  • complete Part C of the form
  • make the decision to either approve or not approve the administering of the prescribed psychotropic medication, including the rationale for the decision to not approve, if relevant (Refer to Medical and dental decisions.)
  • sign Part C of the form.

If a child is in the guardianship of the chief executive and it appears that the doctor is prescribing the use of the medication primarily to control the child’s behaviour, refer to the required process outlined in Respond to the use of prohibited or restrictive practices for a child in the guardianship of the chief executive.

Follow up after the consent decision is made

If the parent or the CSSC manager does not approve the request:

• Give the signed form to the doctor.
• Put a copy of the signed form on the child’s health file.
• Talk to the child, the parents and the carers or residential care service staff about the decision.
• Seek advice about best available alternative options for the child.

As soon as possible after the parent consents to, or the CSSC manager approves, the use of a psychotropic medication:

• Give the signed form to the doctor.
• Put a copy of the signed form on the child’s health file.
• Advise the child, the parents and the carers or residential care service staff that use of the psychotropic medication can go ahead.
• Give a copy of the signed form to the carer or residential care service staff to place in the child health passport.

In addition, following consent by a parent or approval by the CSSC manager:

• Ensure all parties understand how the medication is to be administered, stored and any instructions about how the child is to be monitored and supported once the medication commences.
• Document all actions and decisions and ensure that the information is included in the Child information form in ICMS or in the word version of the Child information form.
• Provide the updated Child information form (parts A and B lonly) to the kinship carer and the non-family-based service provider.
• Update the child’s Health tab in Unify under Medical conditions so that carers can access the information through Carer Connect. To do this
  • Select ‘other’ in the medical conditions drop down list
  • Record the start date and review date
  • Record relevant details of the medication approved and the purpose of the medication. 
• Upload all relevant information regarding the medication, recommended dosage and review dates to the ‘Important Documents’ section of the child’s kicbox account.

As part of ongoing case work:

• Make sure the prescription of psychotropic medication is discussed (including whether it is effective, whether there are any concerns about the medication and when the use of the medication will be reviewed by the doctor) and included as part of the child’s
  • case plan
  • health assessment
  • education support plan
  • child’s strengths and needs assessment.
• Ensure the case plan details how frequently the use of psychotropic medication needs to be reviewed by the child’s doctor and ensure contact is made with the doctor to complete the review.
• Consider the impact of the psychotropic medication on the child’s positive behaviour support plan, if relevant. (Refer to Develop a positive behaviour support plan) and the policy Managing high risk behaviour if the medication is being prescribed to control the child’s behaviour.

Review of psychotropic medication

Review initiated by a doctor

If a review of the psychotropic medication is initiated by a doctor:

• Contact the doctor to
  • confirm the review date for the medication
  • decide who will participate in the review
  • request that information about the outcome of the review be provided to Child Safety.
• Contact the child to advise them of the review.
• Encourage the child, the parents and the carers or residential care service staff to participate in the review, as appropriate.
• Attend the review of psychotropic medication for the child, to ensure all relevant information is provided to the doctor.

Review initiated by Child Safety

If the psychotropic medication has been prescribed primarily for controlling behaviour, it is a chemical restraint and therefore a restrictive practice, and must be reviewed every 6 months, and more frequently if required.

Initiate a review of the psychotropic medication if the doctor does not initiate a review, to monitor the child’s progress and where possible, reduce the need for the use of the chemical restraint. (Refer to Respond to the use of prohibited or restrictive practices when the child is in the guardianship to the chief executive.)

To initiate a review:

• Contact the doctor and ask for an appointment to review the child’s psychotropic medication.
• Contact the child, the parents and the carers or residential care service staff and facilitate their participation in the review, as appropriate.
• Decide who will attend the appointment, including the child, the parents, the carers or residential care service staff, and the senior team leader if the CSO is unable to attend.  
• Request that information about the outcome of the review be provided to Child Safety.

Arrange for the review prior to the review of the child’s case plan if possible, so any updated information can be included in the case plan.

Share information with relevant professionals

When a child in care is prescribed psychotropic medication, information about the medication and the possible impacts on the child’s behaviour and functioning can be provided to:

• Department of Education staff. Information can be given to staff at the child’s school and during the education support planning process. Refer to Make sure an education support plan is developed
• A Youth Justice case worker (if the child is in contact with the youth justice system) or staff of a youth detention centre (if the child is subject to a detention order or has been remanded in custody)
• 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.

Respond to the use of prohibited or restrictive practices for a child in the guardianship of the chief executive

Follow the process outlined below when a child is in the guardianship of the chief executive and:

• use of a prohibited or restrictive practice is being considered to respond to the child’s behaviour, or
• information is received from a carer or direct care staff member about the use of a prohibited or restrictive practice.

The use of any prohibited or restrictive practice must be least restrictive, necessary and proportionate to the child’s presenting high risk behaviour, in accordance with the child’s human rights.

Informal safeguarding

Safeguarding refers to the process of Child Safety taking action to promote the safety and wellbeing of children in care and protect them from harm, when responding to their challenging or high risk behaviour, in particular, the use of a prohibited and restrictive practice.

The purpose of informal safeguarding is to actively recognise and eliminate the use of prohibited or restrictive practices with a child wherever possible. Complete informal safeguarding prior to commencement of the formal safeguarding and escalation process. (Refer to Formal safeguarding and escalation.)

When it is identified that a prohibited or restrictive practice (including chemical, physical, environmental, mechanical, seclusion and/or containment) has been, or is being considered for use with a child:

• advise the senior team leader, senior practitioner and CSSC manager
• the CSSC manager will consult with the regional specialist services clinician and together they will lead a process of gathering relevant information to inform decision making, including
  • information about the prohibited or restrictive practice from relevant sources
  • why the practice is being considered
  • when the practice was first introduced
  • the initial reason for the practice occurring
  • the reason for the practice continuing
  • the case plan goals for the child
  • the child’s current strengths and needs assessment.

When the prohibited or restrictive practice is in relation to chemical restraint (use of medication for the primary purpose of managing the child’s behaviour), refer to Management of psychotropic medication.

Conduct an internal case consultation

Once relevant information about the child’s circumstances has been gathered, the senior team leader and CSSC manager will organise an internal consultation with the following staff to discuss how safeguarding for the child will occur:

• the CSSC manager
• the regional specialist services clinician
• the regional practice leader
• the Aboriginal and Torres Strait Islander practice leader
• the principal specialist services clinician, if requested.

As part of the case consultation:

• consider the following information
  • the goals of the child’s case plan
  • the current child strengths and needs assessment
  • any cultural considerations for an Aboriginal or Torres Strait Islander child
  • a review of critical incidents and previous standards of care matters
  • the child’s positive behaviour support plan
  • the impact of the prohibited or restrictive practice on the child.
• answer the following questions
  • Does the child have a current NDIS plan?
  • Is there a current positive behaviour support plan in place?
  • For an Aboriginal or Torres Strait Islander child, how well are the child’s cultural needs for connection to family and community being met, taking into account the 5 elements of the Aboriginal and Torres Strait Islander Child Placement Principle.
  • Are there any plans in place to reduce and eliminate the use of the practice?
  • Is there a plan to manage crisis situations? (Refer to Formal safeguarding and escalation.)
  • Is there a practice which must be or can be ceased immediately?
  • Are any of the child’s human rights being breached?
  • Does the use of the prohibited or restrictive practice cause harm to the child or constitute a standards of care issue (Refer to Procedure 6 Respond to concerns about the standards of care or harm to a child in care.)
  • Is internal legal advice required from Legal Services? (Refer to Seek internal advice from Legal Services.)

Seek internal advice from Legal Services

Following the internal case consultation, consult Legal Services if any of the following circumstances apply:

• The child is over the age of 16, and the positive obligations under the Criminal Code Act 1899, section 286 no longer apply.
• There are multiple restrictive practices being used, including the use of prohibited practices.

In other circumstances, seeking internal advice from Legal Services following the case consultation is an optional step. Legal advice may assist with clarification, navigation and management of complex service delivery.

To seek legal advice, contact the Director, Legal Services by telephone to arrange a consultation. The CSSC manager and the regional practice leader will coordinate the consultation with Legal Services to discuss:

• child’s circumstances
• any plan that has already been developed to reduce and eliminate the prohibited or restrictive practice 
• the interface between the prohibited or restrictive practice, the Child Protection Act 1999, the Criminal Code Act 1899, the Human Rights Act 2019, and the Work Health and Safety Act 2011
• any proposed plan to reduce and eliminate the prohibited or restrictive practice.

Complete the behaviour risk assessment

Following the internal case consultation, and legal consult, if sought, undertake a collaborative case consultation with the regional specialist services clinician and the child’s safety and support network to determine whether the child’s behaviour can be managed without the use of a prohibited or restrictive practice.

As part of the collaborative case consultation:

• consider
  • the behaviour management strategies being used with the child, or being considered for use
  • why these behaviour management strategies are being used
  • the reason for the use of the behaviour management strategies
  • whether there is evidence to indicate that the use of any prohibited or restrictive practice is least restrictive, necessary and proportionate to the child’s presenting high risk behaviour, in accordance with the child’s human rights
  • how the practices are understood in the overall context and individual circumstances of the child.
• complete the Behaviour risk assessment.

When completing the Behaviour risk assessment, answer the following questions to help identify the level of the risk of each behaviour to the child or to others and appropriate strategies to ensure the safety of the child or others in the future:

1. What behaviour causes harm to the child or others? (Identify the risk)
2. How often does the harm occur? How serious is the harm? (Assess the risk)
3. What are the most effective and least restrictive practices to manage the risk that is reasonably practicable at the time? (Control the risk)
4. Are the practices working as planned? (Review the risk).

Take action following the completion of the behaviour risk assessment 

If the behaviour risk assessment determines that the child’s behaviour can be managed without using prohibited or restrictive practices, ensure their positive behaviour support plan includes all the agreed strategies to respond to the challenging or high risk behaviour.

Instigate the formal safeguarding and escalation process if, following completion of the behaviour risk assessment, the outcome of the assessment indicates:

• the child is behaving in a way that poses known foreseeable risk of harm to themselves or others
• the use of a prohibited or restrictive practice is required to manage the child’s behaviour, as it has not been possible to eliminate the use of the prohibited or restrictive practice during the informal safeguarding process.

Formal safeguarding and escalation

When a decision has been made to instigate the formal safeguarding and escalation process:

• ensure the child has a current positive behaviour support plan or that a process to develop one has commenced (Refer to Develop a positive behaviour support plan.)
• work with the specialist services clinician and the safety and support network to develop a plan to manage crisis situations, where the child is repeatedly demonstrating high or extreme risk behaviour that presents known foreseeable risk.
• brief the Director-General, for noting that the child will be supported outside of the current policy position.

Complete a plan to manage crisis situations

Ensure the plan to manage crisis situations is:

• individualised for the child and their needs
• informed by the level of risk assessed for each behaviour and is the least restrictive to keep everyone safe
• clearly identifies the point at which there is known foreseeable risk of harm for the child or others associated with the behaviour (in crisis)
• describes a range of strategies to manage the risk presented by the behaviour
• considers any of the child’s individual needs, as outlined in the policy Managing high risk behaviour
• in keeping with the child’s human rights and is
  • proportionate to the level of risk presented by the behaviour
  • reasonable in all the circumstances of the behaviour
  • in place for the shortest amount of time.

Provide a copy of the plan to all relevant stakeholders.

Brief the Director-General

To brief the Director-General, complete:

• the template Formal escalation – Director-General briefing note for information
• Attachment 1 - Legal context for responding to prohibited and restrictive practices, and
• the Formal safeguarding and escalation checklist.

The CSSC manager will progress the Formal escalation - Director-General briefing note for information and the checklist, which outlines the safeguarding decision process.

Monitoring and review

Once the briefing note for information has been noted by the Director-General:

• Work with other relevant Child Safety staff and the safety and support network to determine the appropriate monitoring process that will be built into case work with the child, for example, during home visits and case plan reviews.
• Plan for regular reviews of the behaviour risk assessment to determine whether there has been a decrease in the level of at risk behaviours, as a result of implementing the positive strategies included in the child’s positive behaviour support plan, that allows for a reduction or elimination of the use of a prohibited or restrictive practice.     
• This review will also consider
  • any critical incidents and information about the child’s behavioural presentation
  • any reports to the CSSC or CSAHSC about the emergency use, or use of prohibited or restrictive practices made by the carer or direct care staff member
  • the outcome of any organisational review processes undertaken by the foster and kinship care service or care service that occurs following incidents
  • whether the plan to manage crisis situations is still appropriate or required as the level of at risk behaviour reduces.
• The CSSC manager will contact the regional Investment and Partnerships team to inform them that
  • the service provider involved in service delivery to the child is working outside of policy as outlined in the brief and
  • this does not constitute a breach of contract or the standards of care.
• If the care arrangement is with a licenced care service, Investment and Partnerships will send an email to the Child Safety licensing mailbox mail CS_Licensing@cyjma.qld.gov.au advising them of the
  • use of prohibited or restrictive practices for a child in the guardianship of the chief executive
  • child’s name and date of birth
  • name of licenced organisation
  • name of carer or care service location
  • address of the care arrangement
  • date the Director-General brief was noted.

If there is a significant change in behaviour that leads to additional practices being considered, a new escalation process may need to be considered.

Oversight group

When service delivery to the child is complex and a high standard of service delivery is required to care for and manage risk to a child and others, and there is a high level of risk that the care arrangement may break down, the regional director may nominate senior staff to be part of an oversight group for the child to assist the child’s safety and support network. This can be made up of both Child Safety and other stakeholders.

Standards of care

If there are ongoing concerns about the behaviour management strategies being used by a carer or care service at any stage, determine:

• whether the concerns are in keeping with the child’s behaviour support plan and any plan to manage crisis situations
• whether the concerns constitute a standards of care issue (Refer to Procedure 6 Consult to consider the response.)
• whether the child’s rights under the charter of rights are being upheld
• what action is required to ensure the use of more appropriate behaviour management strategies.

Respond to a child’s smoking or vaping behaviour

A carer or Child Safety staff member must not actively support a child to smoke or vape. This includes:

• supplying cigarettes or vaping devices
• setting aside an area specifically for a child to smoke or vape
• enabling or advising a parent to supply the child with cigarettes or vaping devices for the period of their care arrangement.

A carer or Child Safety staff member cannot physically stop a child from smoking or vaping but are obliged to actively discourage the behaviour. 

If a child presents with a nicotine addiction due to smoking or vaping, seek medical advice before implementing any strategy to manage the child's condition. This includes using nicotine replacement therapy products or similar treatments. 

Support a young person who is considering a termination of pregnancy 

Child Safety staff do not make decisions about termination of pregnancy. The Termination of Pregnancy Act 2018 enables a female of any age to make their own decision to have a termination of pregnancy.  

Support and reassure the young person

A young person who is pregnant and considering a termination of pregnancy may be worried and anxious. To support and reassure the young person:

• listen to their story without judgement
• be conscious of your own bias when speaking with them
• do not influence their decision
• ask them who they would like to support them in making their decision, including members of their safety and support network
• encourage and, where requested, assist them to see a health practitioner without delay.

If the young person’s carer is aware the young person is considering a termination of pregnancy, provide the carer with information about termination of pregnancy support and services to enable the carer to adequately support and reassure the young person.

Support the young person to see a health practitioner

If a young person requests a termination of pregnancy, support the young person to see a health practitioner without delay. A health practitioner will:

• Make an assessment of the gestation period.
• Obtain a full picture of the young person’s individual circumstances, including their medical history.
• Assess whether the young person has the capacity to make their own decision about terminating the pregnancy (through an assessment of Gillick competence).
• Follow mandatory reporting requirements (if required).
• Refer the young person to obtain further examinations such as blood tests, ultrasounds and counselling services.
• Provide the young person with information about their available options to help them make a decision.

Determine if a report needs to be made to the Queensland Police Service

Child Safety has a legislative responsibility to immediately notify the QPS when it reasonably believes that harm to a child may have involved the commission of a criminal offence. This includes where a young person aged less than 16 years is pregnant – 16 years is the age of sexual consent in Queensland.

To make a report to the QPS, refer to Procedure 1 Report information to the Queensland Police Service.

Refer to the practice guide Schedule of criminal offences.

Support the young person to access counselling services   

A health practitioner will offer, provide, or refer the young person for psychological support and counselling before and after a termination of pregnancy.

In addition, as part of the young person’s case plan: 

• organise health appointments or specialist appointments in consultation with the young person
• support the young person to have the necessary documentation for appointments with a health practitioner, if required
• arrange additional referrals that may meet the needs of the young person
• provide the young person with options for education and information about contraception
• seek approval for meeting the cost of health appointments, as required.

Refer to Case planning and the Adequate sex education section of the practice kit Child sexual abuse.

Support a child at risk of suicide or non-suicidal self-injury

Child Safety will respond to children who are at risk of suicide and non-suicidal self-injury and will:

• work collaboratively with the child’s family, carers and other professionals to safeguard the child’s immediate safety to the highest extent possible in the circumstances
• promote the child’s ongoing safety, belonging and wellbeing 
• assess the potential underlying causes or contributors of the child’s distress in order to reduce the risk of harm or prevent harm from occurring
• identify and use a child and family’s strengths and protective factors to assist with the child’s ongoing wellbeing and recovery
• for an Aboriginal or Torres Strait Islander child
  • respond to their ongoing social and emotional wellbeing and promote their connectedness to family, culture, Country and community 
  • apply the Aboriginal and Torres Strait Island Child Placement Principle to the standard of active efforts.

Identify if a child is at risk of suicide 

Be aware of, and identify, the risk factors and warning signs that may indicate the child’s vulnerability to suicide.

Risk factors

The risk factors that increase the child’s vulnerability to suicide may be static or dynamic.

Static risk factors include:

• the child has previously attempted suicide
• a child’s family member has died by suicide or had a history of suicide attempts
• a child’s family member has been diagnosed with a mental illness 
• a child’s family member has concerns regarding alcohol or other drug use
• a death by suicide of someone known to the child 
• the child has a chronic or terminal illness
• the child has experienced sexual abuse
• the child has lost a friend or family member through death or other loss.

Dynamic risk factors include:

• the child has access to means of harming themself
• the child is experiencing emotional distress
• the child is feeling hopeless
• non-suicidal self-injury is increasing in frequency or intensity
• the child has been acting impulsively and may be engaging in risk taking behaviour
• mental health concerns, which may include a diagnosis of mental illness
• the recent loss of a family member or friend through death, the ending of a relationship or other perceived rejection
• the child is experiencing bullying
• the child is disconnected from family or friends, isolated or feeling lonely
• the child has recently been discharged from mental health care through the hospital or emergency department for suicide or non-suicidal self-injury
• the child is experiencing a significant life transition such as transition to adulthood, placement change, entering care, leaving juvenile detention, discharge from hospital
• anniversaries and significant dates such as loss or death of a family member, Christmas, birth of sibling, entry into care, family members birthdays, court dates
• the child has experienced trigger relating to previous sexual abuse, such as, court dates, contact with the alleged perpetrator.

Additional risk factors for an Aboriginal or Torres Strait Islander child include:

• a lack of connection to culture, Country, community or people and opportunities that help create links between the child and their culture or family 
• separation from, or lack of support from, family, including extended family
• a lack of the safety and belonging experienced through positive relationships with community and family
• intergenerational trauma resulting from past government policies and practices
• a child’s experiences of discrimination, bullying and racism
• an increased risk of exposure to suicide by another person due to the higher numbers of suicide by Aboriginal and Torres Strait Islander people.

Additional risk factors exist for children with diverse sexual orientation, gender identity and expression include:

• a lack of support from family or carers which affirms personal identity including misuse of the child’s preferred pronouns or name
• rejection from family, friends, or community 
• a lack of professional information or support in response to gender dysphoria 
• experiences of discrimination, bullying or abuse relating to their personal identity. (Refer to the practice guide Children with gender and sexual orientation diversity and the policy Children and young people with gender and sexual orientation diversity.)

Warning signs

Warning signs may indicate the child has moved from thinking about suicide, to acting on their thoughts, include changes to the child’s behaviour or personality, such as:

• difficulties sleeping
• talking or writing about death, dying or suicide
• low energy and feelings of hopelessness
• no future plans
• increased risk taking behaviour
• a decline in schoolwork or school attendance
• giving away personal items
• withdrawal from friends or others
• increased alcohol or other drug use
• an increased frequency or intensity of non-suicidal self-injury
• for an Aboriginal or Torres Strait islander child, increased frequency or intensity of sorry cutting or lore markings. 

If doubt exists about whether a child is at risk of suicide:

• Talk with the senior team leader or senior practitioner for advice about how to respond to identified risk of suicide and if there is a need to create a suicide alert.
• Contact your local CYMHS service or call 1300 MH CALL for advice.
• Talk with relevant professionals who have knowledge either of the child or of suicidal behaviour, such as treating healthcare providers, school staff, police, and staff or representatives from relevant government or non-government agencies.
• Talk with other relevant people, such as the child’s carer, members of the child’s safety and support network and parents, if appropriate.

Refer to the Responding to a child at risk of suicide—flow chart for a brief overview of the steps required when responding to a child at risk of suicide.

Identify if a child is at risk of non-suicidal self-injury

Non-suicidal self-injury refers to self-injury without an intention to die. It is not always easy to tell the difference between non-suicidal self-injury and a suicide attempt. The only way to know the difference is to ask the child if they wanted to suicide, die or kill themselves, or why they injured themselves.

Be aware of, and identify, the risk factors and warning signs that may indicate the child’s vulnerability to non-suicidal self-injury.

Risk factors

The risk factors that increase the child’s vulnerability to non-suicidal self-injury may be static or dynamic.

Static risk factors include:

• the child has previously engaged in non-suicidal self-injury
• the child has peers engaging in non-suicidal self-injury
• there is a high level of family conflict.

Dynamic risk factors include:

• the child is experiencing mental health concerns which may include a diagnosed mental illness, depression or low mood or emotional distress.
• the child has difficulty managing emotions and stress with limited coping skills and acting impulsively (taking action before considering consequences)
• the child has low self-esteem or perfectionism
• the child feels hopeless
• the child is experiencing relationship issues or has felt rejected by a significant person
• the child’s alcohol or other drug use has increased.

Warning signs

Warning signs that indicate the child may have engaged, or is engaging, in non-suicidal self-injury behaviour include:

• Frequent or unexplained scars and wounds, such as cuts, burns, scratches, and bruises appearing anywhere on the body, such as the arms, torso, and legs.
• Unexplained bandaging on the body.
• Frequent wearing of long-sleeved clothing or trousers at inappropriate times, such as in warm weather, or a reluctance or refusal to participate in activities resulting in skin exposure, such as physical education classes or swimming.
• Collection of items which could be used to self-injure or to clean wounds after self-injuring
• Frequent need for privacy and secretive behaviour.
• Unexplained withdrawal from activities or deterioration in academic performance or personal care.
• Changes in mood, including frequent irritability, hostility, and anger, uncontrollable crying, or feeling very sad.
• Frequent mention of self-injury in creative writing, artwork, journals, internet postings, emails, texts, or in communication with others (including jokes, rumours, and threats).
• Frequent risk taking involving physical risk to a child that exceeds normal adolescent behaviour, or a frequent disregard for personal safety.
• Increased risk taking and impulsive behaviour.

If doubt exists that a child is at risk of non-suicidal self-injury:

• Talk with the senior team leader or senior practitioner for advice and direction to assess the risk of non-suicidal self-injury.
• Contact your local CYMHS service or call 1300 MH CALL for advice.
• Talk with relevant professionals who have knowledge either of the child or of non-suicidal self-injury behaviour, such as treating healthcare providers, school staff, police, and staff or representatives from government or non-government agencies.
• Talk with other relevant people, such as the child’s carer, safety and support network and parents (if appropriate).

Respond to a child at risk of suicide and non-suicidal self-injury

When it is identified that the child is at risk of suicide or non-suicidal self-injury, work with the child’s safety and support network to:

• talk to the child (Refer to Talk to the child.)
• respond to the immediate safety of a child expressing suicidal thoughts (Refer to Respond to the immediate safety of a child expressing suicidal thoughts.)
• record the relevant alert (Refer to Record an alert.)
• develop a risk management plan for the child (Refer to Develop a risk management plan.)
• update an open alert for the child, if required (Refer to Update an open alert for the child.)
• monitor the child and the risk management plan, if required (Refer to Monitor the child and the risk management plan.)
• conduct a meeting to review a risk management plan, if required. (Refer to Conduct a meeting to review a risk management plan.)

Talk to the child

Before talking to a child who is at risk of suicide or non-suicidal self-injury:

• consider whether you or another trusted person is best placed to talk to them
• plan for the conversations to take place in a safe and timely manner
• consider your needs and what will assist you to stay calm and focussed during difficult conversations with the child
• advise your senior team leader that you are going to talk to the child about suicide or non-suicidal self-injury and about any supports that may be needed for the contact with the child
• read and be informed by information contained in current or historic alerts, safety plans, or risk management plans that are available
• consider the time of day and what supports or services will be available, if needed.

When talking to a child who is at risk of suicide or non-suicidal self-injury or who has been harming themselves:

• stay calm in order to provide the child with a sense of acceptance, comfort and reassurance
• ask the child if they have been thinking about ending their life or killing themselves
• if there are signs the child has been self-injuring, ask them if they have been hurting themselves
• ask if there is a professional they have already had contact with who can help support them
• talk to the child about their future plans, hope and dreams, to assess if the child has no hope for the future
• if suicidal thoughts are disclosed, ask the child if they have made a plan to end their life
• try to identify if the child has access to the means to end their life.

After talking to the child:

• acknowledge how you feel after a difficult conversation
• consider any supports you need to access for yourself
• prioritise any actions that need to be taken to ensure the child's immediate safety
• refer to Respond to the immediate safety of a child expressing suicidal thoughts if required
• refer to Record an alert and Develop a risk management plan for further information about creating or updating an alert or a risk management plan
• advise relevant members of the safety and support network about the outcome of the conversation and any further supports or actions required.

Respond to the immediate safety of a child expressing suicidal thoughts

If a child expresses suicidal thoughts and the child can be kept safe:

• Ensure they are not left alone. Arrange for someone to stay in the same room or within sight of the child until supports are put in place.
• Stay calm and talk to the child about actions you can both take to keep them safe.
• Make the environment safe by removing the means of suicide or arrange for another person to do this.
• Consider contacting a crisis support service with the child.

When steps have been taken to ensure the child’s immediate safety, provide the child with support and care. This includes:

• contacting an existing treating professional if available
• referring to the child’s existing safety plan or risk management plan if either of these have already been completed
• contacting CYMHS or 1300 MH Call for advice
• ensuring the child is informed about the availability of crisis support.

If the child cannot be kept safe or professional help is not available, call 000 or arrange for the child to be taken to the nearest hospital, if safe to do so.

Ensure a child receives emergency medical attention if they:

• have attempted suicide or, have been interrupted or about to act on a suicidal intention
• present as intoxicated, agitated, psychotic, impulsive or highly distressed
• are uncooperative or unresponsive.

When suicide risk is identified, you must identify and respond to the potential factors which contribute to a child’s distress, including abuse or neglect, bullying or lack of social and emotional wellbeing.

Safety planning with a child

A safety plan is a tool that may be used to provide a child with a list of practical and specific actions to take if they are feeling distressed, upset, suicidal, or feel they may harm themselves.

If a child is willing to engage in the development of a safety plan, consider who is best placed to complete the safety plan with the child. This might be a treating mental health professional, residential care staff, Child Safety practitioner or other key adult in their life who has received training about how to complete a safety plan.

If the child has a treating mental health professional, ask them for a copy of the child's safety plan, if one exists. 

Attach a copy of the child’s safety plan to the document tab in the Risk management plan in Unify.

Respond to an Aboriginal or Torres Strait Islander child 

When responding to suicide risk for an Aboriginal and Torres Strait Islander child, consider the following actions as part of the response:

• review the child’s cultural support plan 
• request guidance from your cultural practice advisor
• consider referrals to culturally appropriate services
• seek the child’s consent to involve an independent person regarding their current and future care needs where appropriate
• apply the Aboriginal and Torres Strait Islander Child Placement Principle to the standard of active efforts in all areas of decision making and planning for the child.

Record an alert

Prior to recording an alert in Unify, consult with the senior team leader to: 

• assess the nature and significance of the information received
• determine if an alert for suicide risk or non-suicidal self-injury risk is required
• consider the rationale for recording an alert 
• identify the immediate actions to be undertaken, and if required, any ongoing actions, interventions and supports to be put in place to ensure the child’s safety.

If a child is identified as being at risk of suicide, non-suicidal self-injury, or both suicide and non-suicidal self-injury (even when the risk is not imminent), and there is no current alert in place for the child:

• create a new case in Unify within 24 hours of the risk being identified by selecting one of the following case types
  • Suicide risk alert
  • Non-suicidal self-injury risk alert
  • Suicide and non-suicidal self-injury risk alert
• complete all of the fields relevant to the alert in Unify
• commence the development of a risk management plan, in consultation with the child’s safety and support network and their treating mental health clinician (or private treating therapist) as soon as possible after the alert is recorded (Refer to Develop a risk management plan.)
• seek senior team leader endorsement of the alert.

After recording the alert, develop and monitor a risk management plan. (Refer to Develop a risk management plan.)  

Respond when a child is subject to Child Safety and Youth Justice intervention

If a young person is subject to both Youth Justice and Child Safety intervention:

• the agency who identifies the risk is responsible for administration of the alert including creating, reviewing and closing the alert in collaboration with the other agency
• only one alert and one risk management plan will be in place for the child, and the alert, risk management plan and attached documentation is shared by both agencies
• ensure both Child Safety and Youth Justice provide input into decisions about recording, developing, reviewing and closing the alert and risk management plan.

If Youth Justice records an alert and develops a risk management plan for the child, and the child’s Youth Justice intervention ends, and the child remains subject to Child Safety intervention, the alert and risk management plan will be reallocated to Child Safety, who will continue working with the child.

Alternatively, if Child Safety records an alert and develops a risk management plan for the child, and Child Safety intervention ends, and the child remains subject to Youth Justice intervention, the alert and risk management plan will be reallocated to either the Youth Justice caseworker or the detention centre, if a young person is in a detention, who will continue working with the child.

Develop a risk management plan

The purpose of a risk management plan is to:

• ensure the safety and support network collaborate to identify strategies to reduce the child's distress and increase their sense of identity, connection and belonging
• guide actions aimed at ensuring the child’s immediate safety needs and managing the timely provision of health or therapeutic assessment and support 
• document who will take responsibility for each of the actions required
• document a plan to review and monitor the ongoing risk of suicide
• share information with the child’s safety and support network and relevant health professionals and services about the immediate and longer-term actions and interventions to be undertaken
• consider strategies to remove the means to suicide.

To develop a risk management plan:

• consult with Youth Justice staff, if the child is subject to Youth Justice intervention, and the child’s safety and support network and health professionals to
  • gather and share information promptly and purposefully 
  • complete the risk management plan in a timely manner
• include the cultural practice advisor for an Aboriginal or Torres Strait Islander child in the consultation 
• complete all fields in the Risk management plan in Unify, focussing on the safety and ongoing support needs of the child
• ensure that each person is clear about their role in keeping the child safe
• identify a proposed review date, which must be within 3 months if the child is subject to ongoing intervention, or within 30 days if the child is subject to an investigation and assessment
• if a safety plan exists, attach it in the documents tab in the Risk management plan in Unify
• finalise the Risk management plan in Unify and seek senior team leader approval for the plan
• share the plan with anyone affected by the plan or responsible for actions in the plan and for supporting or treating the child. This includes the child, relevant professionals, family, significant others, carers, relevant members of the safety and support network, and the cultural practice advisor, if relevant.

Update an open alert for the child

If there is already an open alert for the child in Unify and further risk of suicide or non-suicidal self-injury is identified:

• record the current incident in the open alert in Unify and include the date, location of incident, and the details of the incident
• inform and collaborate with Youth Justice if there are changes in circumstances for the child and the child is subject to Youth Justice intervention
• update any other information to include the current risk and circumstances
• consult with the senior team leader and where relevant, change the alert type in Unify to reflect the current situation for the child
• seek senior team leader endorsement for the new alert type
• consider whether a review of the current risk management plan is required
• record a decision to continue with the current risk management plan, where the risk management plan remains current
• update the review date for the alert and risk management plan to a maximum timeframe of 3 months, or within 30 days if the child is subject to an investigation and assessment
• seek senior team leader approval for any updates to the risk management plan.

The senior team leader is responsible for approving the Risk management plan in Unify as soon as possible. 

Monitor the child and the risk management plan

Monitor and discuss the risk management plan and agreed actions:

• as part of case work with the child
• when there are changes to the child’s circumstances
• when reviewing or considering updates to the case plan
• when meeting with the family, carers and the safety and support network.

Ensure case work activities include maintaining the child’s safety, social and emotional wellbeing, connections to family and supports, and supporting their sense of identity, connection and belonging.

Amend or update the risk management plan when required.

Conduct a meeting to review a risk management plan

Review and update the risk management plan:

• with the child’s safety and support network at a minimum of every 3 months, or earlier if required
• whenever the child’s situation or needs change significantly.

To review the risk management plan:

• Convene a meeting and include the child’s safety and support network. 
• Make sure printed copies of the current risk management plan are available.
• Share the current risk management plan with the child's safety and support network, including relevant professionals, at the review meeting.
• Ensure the cultural practice advisor is involved in the review for an Aboriginal and Torres Strait Islander child.
• If treating health services are unable to attend, seek their views and input prior to the meeting and share these at the meeting. 

As part of the review, discuss and document the following:

• whether the agreed strategies have met the child’s needs
• any significant changes in the child’s circumstances – whether these are protective factors or risk factors
• whether the dynamic risk factors for suicide and or non-suicidal self-injury are still current
• strategies to meet the child’s ongoing safety, belonging and wellbeing needs 
• whether it is necessary to review or update
  • the child’s case plan
  • the placement agreement―to reflect how the carer will support the child as outlined in the risk management plan (Refer to Procedure 6 Negotiate the placement agreement)
  • the child health passport. (Refer to Develop a child health passport.)

If the child does not have a treating professional because they have declined to engage with services, consult with the senior team leader and senior practitioner about what additional steps may be required, given there is no treating practitioner, to ensure the review process is able to adequately review the plan and meet the needs of the child. 

At each review, decide whether to:

• close the alert (Refer to Close a suicide and non-suicidal self-injury alert.)
  or
• keep the alert open and update the risk management plan. 

Close a suicide and non-suicidal self-injury alert

Close a suicide and non-suicidal self-injury alert when changes have occurred for the child that indicate risks have been mitigated or reduced and the risk management plan is no longer needed. To determine this:

• consult with
  • the cultural practice advisor, for an Aboriginal and Torres Strait Islander child
  • the senior practitioner
  • the child’s safety and support network
  • Youth Justice staff, if the child is subject to Youth Justice intervention 
  • the child’s treating health professional, if the child has one
• create a Case review in Unify and review the risk management plan 
• assess if the static risk factors have been mitigated or reduced where possible—some static risk factors will remain unchanged, and these need to be noted in the Case review summary in Unify, for future reference following closure of the alert
• assess if the dynamic risk factors have been mitigated or reduced including:
  • the child’s level of emotional distress has significantly reduced
  • the child’s mental health has improved (although they may continue to have a mental health diagnosis, they are accessing necessary treatment and there are no current concerns about suicidal or non-suicidal self-injury)
  • the child has a robust safety and support network
  • the child has an increased sense of safety and wellbeing including a decrease in feelings of worthlessness and hopelessness
  • the child talks about future hopes and dreams and looks positively towards the future.

If closing the alert is the agreed outcome, following discussion with the child’s safety and support network: 

• seek the endorsement of the senior team leader to close the alert
• record relevant information in Unify

To close an alert in Unify:

• record the date of the decision to close the alert as the end date
• summarise the actions undertaken to close the alert
• fully document the rationale for closing the alert 
• seek the senior team leader’s verbal approval of the decision in the Reason for closure field.

Postvention support

Postvention refers to the care and support provided following the suicide death of a person known to a child, such as a family member, carer, peer, or community member.

Following the suicide death of a person known to a child:

• provide support to the child
• consider updating the risk factors recorded in Unify regarding the child's risk of suicide
• decide if a suicide risk alert or risk management plan needs to be created or updated
• consider who else needs to be advised of the death that has occurred as a suicide prevention strategy for others known to the child
• consider referrals and any additional supports that may be needed.

Palliative care and end of life medical treatment 

A child in care may require palliative care and end of life medical treatment 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.

Support the child

Make sure a child who receives a diagnosis about a life-limiting illness is given support appropriate to their age and circumstances. Support is to be provided at the time of diagnosis and throughout the illness, as needed to assist the child in coming to terms with the diagnosis.

Support may include contact with significant people, or access to counselling or other services.

Paediatric palliative care

Paediatric palliative care refers to care given to a child who has a life-limiting illness. This is the sort of disease or condition that cannot be cured and requires symptoms to be managed. The purpose of palliative care is to give a child with a life-limiting illness:

• a tailored approach to care by a team of health professionals who come together to meet the child’s medical, physical, emotional, spiritual, social and practical needs
• support when it is most needed
• an improved quality of life.

Each child receiving paediatric palliative care will have a treatment plan developed by medical professionals in conjunction with the child’s guardian. Make sure the treatment plan is included in or attached to the child’s case plan. (Refer to the Palliative Care Australia website.)

When making decisions about palliative care:

• Discuss what is required to meet the child’s medical, physical, emotional, spiritual, social and practical needs.
• Identify where palliative care can best be provided, for example, at home (either the parents’ or carers’ home), in a hospital or in a hospice. Many people choose to die at home in a more natural environment. Palliative care can be provided at home, even if the child requires constant care; but encourage the guardian to be guided by the advice of medical professionals. Sometimes the welfare of the child is best served by them remaining in hospital
• Identify the child’s needs and the assistance that could be offered by agencies to support the child’s in-home care (such as medication and care needs).
• Consider whether the completion of a paediatric acute resuscitation plan (PARP) by the hospital is required, if this has not already occurred. The PARP replaces any previous not for resuscitation order that may have been in place.

End of life planning

If the death of a child in care is likely or expected, early planning is essential and will include: 

• the development of a treatment plan for the child by the doctors, in consultation with the child, parents, carers and Child Safety staff, if appropriate
• the completion of a PARP that documents what treatment will and will not occur in an acute situation
• decisions about organ donation, if applicable
• decisions about the child’s contact with parents, family members, carers and Child Safety staff.

The child may make these decisions, if Gillick competent. (Refer to Gillick competency.) If the child is of an age and has the capacity to express their views and is willing to do so, make sure their views are considered in the decision, along with the views of their parents.

Treatment plans

The doctors treating a child who has a serious or life-limiting illness will develop a treatment plan for the child. Make sure the child, parents, family members, carers and other significant people are included in the planning process, as relevant. Early consultation with the important people in the child’s life to develop the treatment plan will reduce the likelihood of conflict at a later time when decisions need to be made and people are distressed.

If it is not possible to reach agreement about the child’s medical treatment plan:

• Always resolve disputes between parties, including Child Safety, in favour of the best interests of the child, as informed by medical expertise.
• Advise disputing parties to seek legal advice if they oppose or do not wish to consent to a recommended medical treatment.

Paediatric acute resuscitation plans

A PARP is completed by medical staff if:

• it is reasonably expected that a child may suffer an acute deterioration or critical event in the foreseeable future
  and
• resuscitation options may need to be considered.

The PARP is to be completed as early as possible to avoid the need for decisions to be made in a crisis. The PARP includes a resuscitation management plan that records the treatment that should and should not be provided. This ensures that all parties are clear about what will occur when end of life decisions are needed. The plan is completed by the medical practitioners and has four sections:

• clinical assessment—which records the clinical assessment of the child’s condition
• resuscitation management plan—which documents what treatments will and will not be provided in specific circumstances
• consenting details—which records what the child and the parents (guardians or delegated officer) have consented to
• clinician authority—which documents a senior medical practitioner’s or paediatrician’s involvement in any decision to withhold or withdraw medical treatment.

The PARP may last up to 12 months; however, if a child’s circumstances change, a paediatrician or senior medical officer will decide whether a new PARP is required.

Provide information about the child to the hospital

If a child in care is admitted to hospital with a life-threatening medical condition, or their medical condition deteriorates to the extent that their life is threatened, provide necessary verbal information to hospital staff. Provide relevant confirming documentation as soon as possible, including:

• details and a copy of the child protection order, if applicable
• the effect of the order, including
  • who has custody and guardianship of the child
  • who can legally provide consent for medical procedures and decisions about end of life medical treatment, if the child is not considered Gillick competent. (Refer to Gillick competency)
• a copy of either the Letter re: custody (medical) or the Letter re: guardianship (medical)
• a copy of the current PARP, if applicable
• the names and contact details for all people relevant to the child, including the child’s guardian
• the role and contact details of the CSAHSC, should the hospital require a decision or consent outside business hours.

Notify the Queensland Police Service

If the child’s medical condition may be the result of harm that involved the commission of a criminal offence relating to the child (the Child Protection Act 1999, sections 14(2) and (3)), immediately notify the QPS using the Police referral.

Complete other reports

If the life of a child in care is threatened as a result of an illness or trauma:

• Complete a Child Safety After Hours Service Centre: After hours referral form. Update the referral information as the child’s circumstances change to ensure the CSAHSC always has access to current information.
• Complete a Critical incident report if required. Refer to the policy Critical incident reporting to decide if and what type of critical incident report is required.
• Decide whether a notification is to be recorded and consider if the child’s medical condition may be the result of harm, either self-inflicted or by another person. (Refer to Procedure 1 Decide if a notification response is appropriate.)

Contact with the Coroner

If the child's medical condition has a natural cause and is not offence-related, and the child is to be cared for at home, advise the person who has guardianship of the child to talk with treating doctors about the involvement of the QPS at the time of death. If the chief executive is the child’s guardian, the CSO will talk to the treating doctors.

Treating doctors can:

• advise the State Coroner of the circumstances of the child’s medical condition and decisions made in relation to treatment
• seek permission from the Registrar of the State Coroner to not involve the QPS at the time of the child’s death.

This will allow for the child’s body to be moved directly to a funeral home after death, and for ceremonies and funerals to proceed without the delay of an unnecessary forensic investigation.

Provide information to the child, parents and carers

In circumstances where the child’s death is able to be predicted:

• Seek guidance from medical staff about the range of end of life decisions that need to be discussed with the relevant parties.
• Facilitate discussion between the child, their parents if possible, their carers and Child Safety staff about the end of life decisions that are required.
• Seek advice around cultural protocols for sharing information for an Aboriginal or Torres Strait Islander child. (Refer to Sad news sorry business.)
• Seek the child’s views about proposed funeral arrangements, if the child is of an age, has the capacity and is willing to express their views. This should occur in conjunction with the child’s parents and in line with cultural or religious protocols and practices.

If the child’s medical condition is unexpected or sudden, make sure the child, their parents and carers are given information at the earliest possible time about the recommended care and treatment options.

In addition:

• Advise the child, parents and carers of their rights and responsibilities regarding decisions about end of life medical treatment and decisions following the death of the child.
• Determine whether the child or the parents wish to discuss organ or tissue donation, and if so, refer them to the child’s medical practitioner for advice and information.
• Give information about services that may provide emotional and practical assistance.
• Advise what assistance Child Safety is able to provide with the child’s funeral arrangements. (Refer to Take action after the death of a child in care.

Respond to end of life matters—guardianship to the chief executive 

If a child is subject to a child protection order granting guardianship to the chief executive and decisions about end of life medical treatment are required—including what treatment will and will not be provided in an acute situation—consent must be sought from the Director-General (as the chief executive).

Carry out the following actions and obtain sufficient information to enable the Director-General to make a decision:

1. Contact all relevant parties to seek their views about the options for end of life medical treatment—refer to 1. Contact with relevant persons.
2. Request that a medical case conference be convened so the best options can be discussed—refer to 2. Request that a medical case conference be convened.
3. Complete a Director-General brief for approval, outlining issues relevant to the option being recommended—refer to 3. Prepare a Director-General brief for approval.
4. Advise relevant parties of the Director-General’s decision about end of life medical treatment—refer to 4. Advise relevant parties.

1. Contact with relevant persons

Immediately upon the receipt of advice that a child is facing death due to illness or trauma:

• Inform the CSSC manager of the child’s medical condition.
• Contact Legal Services and obtain legal advice about the situation.
• If the child is Aboriginal or a Torres Strait Islander, contact a local Aboriginal and Torres Strait Islander support agency or a Child Safety practitioner able to provide cultural advice. This is to ensure that cultural protocols are observed in communicating the child’s circumstances to the child’s family.
• Make sure all relevant parties are aware of the situation.
• Determine whether the child’s current medical needs are being responded to appropriately.

2. Request that a medical case conference be convened

Ask the treating medical practitioners for a medical case conference to be convened to develop or update the child’s medical treatment plan, and:

•  Arrange for all relevant persons to attend, including:
  • the Director-General or the delegated officer
  • the child (taking into account their age, ability to understand and their medical condition)
  • the treating medical practitioners
  • the parents and carers, unless this is inappropriate in the circumstances
  • the hospital’s social worker, who may or may not already know the child and family
  • if the conference is for an Aboriginal or Torres Strait Islander child:
    • the hospital’s Indigenous Liaison Officer
    • an independent person (with the consent of the child and family) to help facilitate the child’s and family’s participation in the decision-making process. Refer to Enable participation of Aboriginal and Torres Strait Islander peoples in decision making.
• Assist the child and the parents to communicate their wishes, including about cultural and religious protocols and practices. If required, arrange for an interpreter.
• Fully explore options for the treatment and/or withholding of treatment, so that the child (if Gillick competent) or the delegated officer can provide informed consent to the proposed medical treatment plan.
• Request a letter of advice from the treating doctor, outlining the proposed treatment and recommended option.
• Determine whether further advice from Legal Services is required, for example, to explore whether consenting to a recommended option is in the child’s best interest.

It may be difficult for all parties to reach agreement at the medical case conference, given the highly emotive nature of the circumstances.

3. Prepare a Director-General brief for approval

To obtain consent to end of life medical treatment or the withholding of treatment:

• Complete a briefing note seeking the delegated officer’s decision.
  • Use the practice guide End of life decision-making guide to make sure all relevant information is included.
  • Attach the Consent form—operations and treatment.
  • Attach the PARP, if required.
• Forward the briefing note to the Director-General for approval.

If approved, the Director-General will sign the:

•  Consent form—operations and treatment
•  PARP, if required.

4. Advise relevant parties

Once the decision is made the CSO will:

• inform all relevant parties of the decision, taking into account cultural protocols for an Aboriginal or Torres Strait Islander child. (Refer to Sad news sorry business.)
• provide the original, signed Consent form—operations and treatment to the hospital
• return the signed original PARP to the hospital
• attach a copy of the signed Consent form—operations and treatment and PARP in ICMS.

Respond to end of life matters after hours - guardianship to the chief executive

If medical treatment decisions are required after hours, medical staff will contact the CSAHSC to facilitate contact with the delegated officer or if they are unavailable, a delegated officer, in order to:

• discuss the child’s medical care needs  
• obtain the required consents.

If practicable, this discussion will occur at the hospital and include the child, the parents and the carers, if the child has been in their care for a significant period of time.

If the Director-General or a delegated officer is unable to attend the hospital in person, either the Director-General or the delegated officer will:

• contact the child’s parents, carers and if possible, the child to discuss the treatment options
• consider the child’s previously expressed views about their medical treatment, if contact with the child is not possible
• sign and provide the hospital with the completed
  • Consent form—operations and treatment
  • PARP, if required
• forward a copy of the signed forms to the CSSC for attaching to the child’s file.

If the child’s condition dramatically changes or deteriorates, it may be necessary to urgently obtain further consents for additional treatments or to cease or withhold treatment. If this occurs, reconvene or arrange for the hospital social worker to reconvene a medical case conference to:

• update the medical treatment plan
• determine whether the end of life medical treatment decisions that have been consented to by either the child (if Gillick competent) or the delegated officer need to be amended.

The reconvened conference may occur in person or by telephone and will include:

• the Director-General or a delegated officer
• the child (taking into account their age, ability to understand and their medical condition)
• the parents
• the carers
• the treating medical practitioners. 

Respond to concerns about a guardian’s decision making

If it is assessed that a parent or long-term or permanent guardian is unable to make decisions in the best interests of the child, due to issues of competence, availability, willingness or a causal relationship to the child’s illness or trauma, the CSSC manager will:

• contact Legal Services
• immunisation
• seek urgent advice about the most appropriate action for the child’s circumstances.

Provide support to parents, siblings and carers

In order to provide support to the family and carers, Child Safety will:

• offer grief counselling and practical support to all persons affected by the imminent death of the child
• offer support to carers, who may be required to spend lengthy periods of time at the hospital supporting the child through the final stage of their life. This support may include:
  • assistance with travel costs 
  • short break care for other children in the care arrangement
  • assistance with meals and other household tasks and activities 
• offer assistance for the child’s siblings to visit the child, and provide the siblings with the opportunity to talk through their feelings
• consult with Aboriginal or Torres Strait Islander Hospital Liaison Officers, health workers or an Aboriginal and Torres Strait Islander Health Service, to ensure that cultural customs are understood and respected for an Aboriginal or Torres Strait islander child
• offer support to parents and other significant family members with travel, meal costs and accommodation, especially if they do not reside near the hospital.

Record case information, including after the child’s death

Record all details, actions, forms and decisions relevant to palliative care and end of life medical treatment in ICMS. Make sure copies of all official forms, consents and letters are attached to the relevant event in ICMS.

There are additional requirements for managing client records following the death of a child. Make sure these requirements are adhered to. (Refer to Take action after the death of a child in care.)

Decisions after the child’s death

While decisions about palliative care and end of life medical treatment are the responsibility of the guardian, the child protection order will lapse once the child dies.

Therefore, decisions about funeral arrangements and other decisions to be made after the child’s death are the responsibility of the parents.

Make sure all relevant people, especially the parents and carers, are aware of this. (Refer to Take action after the death of a child in care.)

If the child has a long-term or permanent guardian, encourage the parents and the long-term or permanent guardian to talk about funeral and other arrangements as early as possible before the child’s death. If there is disagreement, support the long-term or permanent guardian in negotiating with the parents for some meaningful participation in the funeral ceremony.

Ensure everyone, including the long-term or permanent guardian, is clear about the arrangements in advance.

Ensure Child Safety responds promptly to provide any assistance as agreed in relation to funeral arrangements.