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Meet a child’s health and wellbeing needs

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This page was updated on 24 November 2020. To view changes, please see page updates

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.

Practice prompt

If breastfeeding cannot be supported due to safety or logistical issues advise the mother and father of the decision and the reason for the decision.

Placement matching

Make sure the care service and proposed carer have detailed information about a child’s breastfeeding needs in order to determine the care arrangement best equipped to support breastfeeding, including maintaining frequent (possibly daily) contact with the mother.

Obtain Medicare details

Attention

Medicare Australia requires that each child subject to a child protection order granting custody or guardianship to the chief executive is issued with their own Medicare card.

Only Child Safety can apply for the Medicare card in this circumstance, unless the child is 15 years of age or over, in which case they can apply for their own card.

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

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

Note

Do not obtain the Medicare card from the child’s parents. The child will continue to be listed on the parent’s card, even when Child Safety applies for an individual card for a child in care.

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.

Note

If a child’s Medicare number is not known, a doctor or pharmacist may be able to contact Medicare Australia directly to obtain the Medicare number, including for a child not enrolled with Medicare. This will only be the case if the carer is able to give the doctor or pharmacist accurate information about the personal details of the child and their mother.

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 #CSDMS_Req_MedicareNo@communities.qld.gov.au with 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 ICMS 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 (online) or (print version) 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 post to Department of Human Services, Medicare, PO Box 7856 Canberra BC, ACT 2610.

Note

Email is the preferred and fastest way to return the form.

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 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 #CSDMS_Req_MedicareNo@communities.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

Note

DMS will contact Medicare Australia and request that a replacement card be sent to the relevant CSSC.

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@humanservices.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@humanservices.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 ‘health cards’ section of the child’s health tab in ICMS.  
  • Record the Medicare card details in the Child information form.
  • 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

Attention

A young person who turns 18 can keep their existing Medicare card; however, they will need to update their contact and address details with Medicare Australia. They can do this by calling the Medicare Australia general enquiries line on 132 011 or visiting a Medicare Australia service centre.

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@humanservices.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 Centrelink 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 Centrelink office or on the Centrelink 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.

Practice prompt

When a child with a health care card moves to a new care arrangement, advise Centrelink of the child’s new address and the new carer’s name.

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.

Further reading

For more information, and to confirm current income rates, refer to the Department of Human Services website.

Maintain the child’s immunisation schedule

Child Safety considers childhood immunisation an essential part of a child’s health care needs. Unless a doctor advises there is a medical reason for not proceeding, Child Safety will arrange for children who are subject to a child protection care agreement or a child protection order granting custody or guardianship to the chief executive to receive immunisations in accordance with the recommended schedule of immunisations.

Tip

Vaccinations on the National Immunisation Program Schedule are provided free if a child is eligible for Medicare. The Immunisation Schedule Queensland is available on the Department of Health website.

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 information form and give a copy to the carer.

Note

The Australian Immunisation Register (AIR) is a national register recording the vaccination details of everyone in Australia. An AIR immunisation history statement details what vaccines a child has been given and when.

The AIR automatically generates an immunisation history statement to parents/carers:

  • upon completion of the childhood vaccination schedule (usually around 4 years)
  • if a child’s immunisation is not up to date
  • at important vaccination milestones.

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 ICMS with the immunisation history.

Tip

The child’s My Health Record authorised representative can view the child’s immunisation history by accessing the Documents tab, and opening the Medicare overview via the Health Snapshot page. Refer to Link to a child's My Health Record

Further reading

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.

Note

A delay in providing the immunisation history statement may delay the child in starting  at child care or kindergarten.

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.

Consent forms

There are two types of forms that may be used to provide consent for a child’s immunisation:

  • the Consent for childhood immunisation form
  • the individual immunisation consent forms that clinics operated by local councils and community health centres require the parent or legal guardian to sign. These forms may be available for download from the immunisation provider.

Tip

Children in Year 7 attending a Queensland high school receive information about forthcoming vaccinations available through the School Immunisation Program. The information includes a consent form for the parent or legal guardian to sign.

Obtain consent from the child’s parents 

Attention

If the parents retain guardianship of a child in care, their consent is required to start or maintain the child’s immunisation. In this circumstance, Child Safety staff, approved carers and care service staff do not have authority to sign an immunisation consent form. 

Seek the parents’ views and consent to start or maintain the immunisation schedule for a child in care. If the child’s parents express concern about immunisation:

Practice prompt

If a parent objects to their child being immunised, discuss the grounds for the objection with the medical practitioner.

If the chief executive does not have guardianship of the child, and a parent is unable to be located, does not give consent, or is otherwise unable to consent, seek medical attention for the child and ask the doctor to consider administering the vaccination under the authority of the Child Protection Act 1999, section 97.

When a parent consents to immunisation:

  • Advise them that they can revoke their consent at any time.
  • Have them sign the 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 Consent for childhood immunisation to the immunisation provider’s consent form.

Note

If the local council clinic or child health centre consent form is used, a new form will be needed each time the child is due to receive a vaccination from that clinic.

Emergent vaccination

In all cases, where an emergent vaccination is required for a child in care, the delegated officer will either:

  • consent to the vaccination
    or
  • seek medical attention for the child and ask the doctor to consider providing the vaccination under the authority of the Child Protection Act 1999, section 97.

Practice prompt

If a parent has objected to their child being immunised, discuss the reasons for the objection with the medical practitioner.

Arrange immunisations

Attention

For a child subject to a child protection order granting guardianship to the chief executive:

  • Approved carers and care services are authorised to make immunisation arrangements.
  • The parents’ consent to immunisation is not 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 arrange for the child’s immunisation.

If a child’s immunisations are due or overdue, ask the carer to facilitate the child’s immunisation or catch-up immunisation from:

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

Tip

In rare circumstances, a child may be exempt from vaccinations, but only if this is verified by a general practitioner and recorded on the Australian Immunisation Register.

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 ICMS health profile and the ‘Important Information’ category in their kicbox account with information about the new vaccination. 

Develop a child health passport

Attention

A child can enter care with previously unknown or undiagnosed illnesses, developmental delays or dental problems due to poor diet, poor prenatal care, exposure to parental substance use, or inadequate past medical care.

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 is placed in 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 Maintain the child’s immunisation schedule)
  • the child’s Medicare card details and if applicable, health care card. (Refer to Obtain Medicare details and Arrange for a health care card)
  • who should complete a health assessment, if necessary.

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 information form in ICMS and:

  • Give a copy to the carer at the beginning of the child’s placement. 
  • Attach the Child information form to the relevant event in ICMS. 
  • File the original on the child’s health care file.

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

Commence a child health passport

Attention

A child health passport is commenced at 30 days and no later than 60 days after a child enters care.

A child health passport is commenced:

  • when Child Safety makes a request in writing for a health or dental professional to complete an appraisal or undertake an assessment of a child’s health and dental needs
    or
  • when confirmation of a medical appointment 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 guides Child health passports and Child health passports flowchart.

Attention

The child health passport folder must move with the child whenever the child moves to a new placement.

Practice prompt

Make all people involved in the child health passport process aware of their responsibility to maintain the confidentiality of health-related information in line with the Child Protection Act 1999, sections187 and 188.

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.

Decide if a health appraisal or health assessment is required

Essential health information obtained from the child’s parent, carer or other sources will be used to decide whether a health appraisal or health assessment is required. To determine this:

  • Establish if the child is currently receiving a health service.
  • Contact the child’s carer or parent to find out if the child has seen a health professional or has accessed any other health services (such as a dentist or the Child and Adolescent Oral Health Services) in the last 12 months.
  • Check ICMS to determine if the child was medically examined as part of an investigation and assessment within the last 12 months.

Note

Early childhood caries (infant tooth decay) can occur soon after baby teeth erupt, usually between 9 months and 2 years. The need for infant dental treatment may be guided by the medical assessment.

A health appraisal is appropriate for a child if:

  • they have seen a health professional (usually the child’s general practitioner) within the last 12 months
    and
  • the health professional has enough existing information about the child to provide a comprehensive report in relation to the child’s day-to-day health needs, general health status, any significant health issues and any follow-up treatment required.

A health assessment is required if:

  • the child has not seen a health professional in the last 12 months
    or
  • the health professional is unable to provide a comprehensive report about the child’s health status without seeing the child.

Arrange a health appraisal

To arrange a health appraisal, forward a Health appraisal letterand any available information or outcomes of recent assessments to the child’s health professional and:

  • ask them to confirm whether they have assessed the child’s health (as outlined in the letter), within the last 12 months
  • request an updated summary of the child’s health needs and health assessments, including any prescribed medication.

Practice prompt

Arrange a health assessment if the health professional advises:

  • The child needs to be seen to complete a health assessment.
  • The child has not seen a health professional in the previous 12 months.

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 12 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: Custody and guardianship (Medical) to provide to the dentist to inform them of who can provide consent for any proposed dental treatment.

Tip

School-age children can receive a dental assessment at no cost through the Child and Adolescent Oral Health Service.

The Medicare Teen Dental Plan provides annual vouchers to cover the initial cost of a teenager’s dental examination.

If the health professional indicates that the child does not require a health assessment:

  • The information they provide becomes the health summary, which forms the basis of the child health passport. At the next case plan review, record the summary in the ‘Child information’ section of the case plan.
  • Negotiate with the child’s carer during the development of the placement agreement that they will maintain scheduled appointments with the identified health professional, if applicable.
  • Prepare the child health passport. (Refer to Develop a child health passport.)  
  • Place the health summary on the health care file, and a copy in the child health passport folder.

Practice prompt

If a child has mental health issues that require intervention and treatment by Child and Youth Mental Health Services, refer to the Interim Memorandum of Understanding between State of Queensland (through the Department of Child Safety, Youth and Families) and State of Queensland (through Queensland Health Child and Youth Mental health Services) 2010–2013. Interim Memorandum of Understanding between State of Queensland (through the department Child Safety, Youth and Families) and State of Queensland (through Queensland Health Child and Youth Mental health Services) 2010-2013.

Decide who will conduct the health assessment

The child’s general practitioner (GP) should complete the health assessment where possible.

If the child has not seen a GP, identify the most appropriate professional to conduct the health assessment. Consider the child’s:

  • age
  • Indigenous status
  • current living arrangements.

Further reading

Practice guide Child health passports.

If there are limited services available to conduct a health assessment, or where a specific service is required for the assessment, contact the Queensland Health child protection liaison officer (CPLO) to:

  • negotiate a health assessment by a Queensland Health service
  • obtain advice about local services or processes.

Involve the child, parents and the carer in the health assessment

If it is determined that a child requires a health assessment:

  • Speak to the child’s parents and carer about the 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 GP or dentist
    • ask them who they want to accompany them to the appointment.

Practice prompt

If a child refuses to attend a health assessment appointment, record this in a case note in ICMS and continue to work with the child to address their concerns about attending 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 health assessment appointment, if required

To start a health assessment, ask the carer to make an appointment with the preferred health professional or service and request a long consultation.

Prepare the following documentation for the carer to provide to the health or dental professional:

  • the Child information form in ICMS
  • the health summary letter
  • copies of assessments or reports that may inform the health assessment.

Advise the carer to take a copy of the completed letter re: Custody (Medical) or letter re: Custody and guardianship (Medical) to the appointment to inform the medical practitioner about decision making regarding custody and guardianship matters.

The health assessment summary provided by the medical practitioner will include:

  • significant findings from the health assessment
  • a recommended health plan
  • recommended follow-up, including timeframes.

Inform relevant parties and take action

When the health summary is received:

  • Attach a copy of the summary to the relevant event in ICMS.
  • Discuss the outcome with
  • Give a copy of the letter to the carer for the child health passport folder.
  • Place the original letter on the health care file.
  • Arrange any recommended follow-up appointments.

Practice prompt

If a medical practitioner reports that a child under 16 years has a sexually transmitted disease or is pregnant:

Negotiate payment with the health professional

Attention

For an Aboriginal or Torres Strait Islander child, the health professional has the discretion to bulk bill the cost of a health assessment.

For a non-Indigenous child, there is no single Medicare item number for a health assessment, so full payment may be necessary. (A large number of Medicare items may be necessary when assessing the health needs of a child in care.)

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

  • The carer pays for the health assessment, then claims the Medicare rebate. Child Safety reimburses the carer for the gap fee associated with the health assessment.
  • The health professional invoices 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.

Practice prompt

Use the child health passport account code 54355 to cover the initial health assessment and any follow-up health assessments.

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.

Further reading

Create the child health passport

When the health assessment summary from the medical practitioner is received:

  • 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 Health appraisal letter or Health summary letter
    • the Letter re: Custody (Medical) or Letter re: Custody and guardianship (Medical)
    • the letter from the health professional summarising the child’s health needs
    • 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.

Note

The self-adhesive alert sticker is to be placed on the inside cover of the child health passport folder for all medical alerts for the child, including any adverse drug reaction, sensitivities or significant allergies; significant mental health alerts; prescribed psychotropic medications; and significant infections.

Practice prompt

If an alert relates to a life-threatening medical condition, record the medical condition as a serious health condition alert on the child’s person record in ICMS.

Give the child health passport to the carer

Give the child health passport folder to the carer at the start of the child’s placement 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, or register that it has occurred in eDOCS, if available.

Attention

The child’s carer must be informed that the child health passport folder contains confidential information and must be kept in a secure location.

Arrange health follow-up

When the 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:
  • Incorporate the follow-up actions in the next review of the case plan and placement agreement. If the required actions and assessments are significant, consider reviewing the child’s case plan and placement agreement.

Practice prompt

If the required health service is not available through the public health system, seek the CSSC manager’s approval to pay the cost of necessary appointments with a private practitioner, through child-related costs.

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 subsequent health assessment, if possible with the same health professional who completed the original health assessment. Once the health professional has completed the assessment and revised the child’s health status, they will provide Child Safety with a letter outlining the child’s health needs and any required follow-up. This letter is the updated health assessment.

Note

Approved carers and care services are authorised to arrange blood tests (excluding the authorisation of DNA testing of a child) using the Authority to care−guardianship to the chief executive as their authority.

Attention

The health professional will decide if a child is able to provide consent for a particular medical procedure based on the concept of Gillick competency. (Refer to Gillick competency.)

Further reading

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.

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

Record the non-essential health information in the Child information form  in ICMS and:

  • Provide a copy to the child’s carer (excluding parental health history information that is not relevant to meeting the child’s medical needs) 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.
  • 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.
  • Talk to the carer about any medical alerts for the child, including any life-threatening medical condition.
  • Advise Medicare Australia of the child’s new address.
  • Record the location of the child health passport in a case note in ICMS.

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 placement period.

Note

Depending on the length or frequency of the overnight stay, arrange for the primary carer to give the child health passport to the short break carer for the duration of the stay.

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 they know how to manage their own My Health Record and a myGov account.
  • Tell them to inform Medicare 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.

Further reading

Australian Government website My Health Record.

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.

Note

The portal cannot be accessed for a child subject to:

  • an intake response, investigation and assessment, assessment care agreement or assessment order
  • support service case, intervention with parental agreement or child protection care agreement
  • a directive order, supervision order, a child protection order granting custody or guardianship to a relative or suitable person or a permanent care order.

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.)

Attention

Harsh fines and penalties apply for inappropriate or unauthorised use of information in a child’s My Health Record. Civil fines can be up to $315,000, and criminal penalties up to 5 years jail time.

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 My Health Record—Becoming an authorised representative for a child, located on the My Health Record webpage.)
  • 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 practice guide My Health Record—Restrict record access and remove parents, located on the My Health Records webpage.)

Practice prompt

Record the name of the CSO who is the child’s authorised representative and the date they were made the authorised representative in the My Health Record (MHR) sub tab of the child’s health tab in ICMS.

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

Note

Although address information is not visible in a child’s My Health Record, a health care provider may include the child’s address in the clinical information they upload or may upload information that could identify the child’s carer, community or locality.

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.

Practice prompt

If a decision has been made to withhold full or partial placement information from the child’s parent, and the risk remains current, restrict the parent’s access to the child’s My Health Record.

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 My Health Record—Restrict record access and remove parents, located on the My Health Records page.)
  • Remove the parent as the child’s authorised representative, if they are already linked to the child’s record.
  • Provide the parent with the information sheet My Health Record—Information for parents of children in care located on the My Health Records webpage, and if possible, advise them of the action taken to restrict their access.
  • Record details of the restriction decision and action taken in the child’s health tab under the My Health Record (MHR) subtab in ICMS.

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.

Practice prompt

When a child in care has a health assessment, including as part of their child health passport, the CSO or carer may ask the health care provider to include the information in the child’s My Health Record.

If the health care provider is not registered with the My Health Record system, the CSO can add the clinical report to the child’s record using the Personal Health Notes screen.

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.

Practice prompt

If a privacy complaint is received about a Child Safety staff member breaching their obligations under the Information Privacy Act 2009, immediately refer the matter to the Information Privacy Team for assessment.

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.

Note

There are three types of access for a nominated representative:

  • general access—the nominated representative views most documents in the record, excluding restricted documents
  • restricted access—the nominated representative views all documents including restricted documents
  • full access—the nominated representative views all documents and can add information to the child’s record.

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 information sheet 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:

Note

If the CSO who accessed the portal to invite the carer to be a nominated representative ceases to be the child’s authorised representative, the My Health Record system will automatically deactivate the carer.

The CSO who is the child’s new authorised representative will need to re-invite the carer to be the nominated representative, if this is still in the child’s best interests.

View a child’s My Health Record   

Attention

Information in a child’s record includes personal and sensitive information about the child. Collection, use and disclosure of this information is governed by a range of legislation including the My Health Record Act 2012, the Information Privacy Act 2009 and the Child Protection Act 1999. Information sharing must comply with this legislation.

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 ICMS
    • 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 shared health summary, 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.

Practice prompt

Do not assume that information in a child’s My Health Record is comprehensive. Health care providers are not obliged to upload clinical information to a person’s My Health Record and not all health care providers are registered with the My Health Record system. Continue to gather information about the child’s health needs from other sources, including the child, parent, carer and health care providers.

Further reading

For guidance on how to navigate a child’s record, refer to My Health Record—Viewing a child’s health information.

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

Attention

It is a strict requirement that when a CSO who is linked to a child’s My Health Record as the authorised representative no longer has case responsibility for the child, they:

  • immediately remove themselves as the child’s authorised representative
    or
  • they are immediately removed as the authorised representative by the senior team leader or CSO with case responsibility for the child.

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

Note

A key feature of the My Health Record system is that once a young person is 14 years of age, they can choose to take control of their My Health Record. If this occurs, the My Health Record system will automatically remove all nominated representatives and authorised representatives (including the CSO) from the child’s 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 sheets Are you over 14? You can manage your own health information and My Health Records—Information for children in care.

Attention

A CSO or other Child Safety staff member is never to be the nominated representatives for a young person aged 14 years or over.

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.

Note

If signs or symptoms of possible disability or developmental delay are present or emerge, investigate and respond to them in a timely way. Access to early intervention support can be the key to a child achieving their optimal development and wellbeing, and can dramatically improve their social, emotional, behavioural or mental health outcomes later in life.

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 Get support for your child on the NDIS website.  The NDIS is administerd 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.

Order type  Child's representative  Child Safety role
Custody to the chief executive parent coordination role 
Guardianship to the chief executive senior team leader  child's representative 
Long-term guardianship—to a suitable person long-term guardian  no role unless requested 
Permanent care order permanent guardian  no role unless requested

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.

Practice prompt

If a child is subject to a support service case, intervention with parental agreement or an order granting custody to the chief executive, there are two relevant NDIA consent forms available when requesting NDIS access or assistance with implementing the NDIS plan. To enable information sharing with the NDIA only, submit the NDIS Consent for the NDIA to share your information form, signed by the child’s parents. If Child Safety is undertaking NDIS activities to support the child and family, submit the NDIS Consent for a third party to act on behalf of a participant form, signed by the child’s parents

The child’s representative will:

  • provide consent for the child to access the NDIS or an Early Childhood Early Intervention (ECEI) service
  • coordinate collection of eligibility evidence to support the completion of an NDIA access request 
  • 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 Consent for a third party to act on behalf of a participant form, signed by the guardian or the young person over 18 years of age, can be submitted to the NDIA.

Practice prompt

In limited circumstances, Child Safety can make a request to become the NDIS Child Representative for a child when Child Safety is not the guardian. Contact the NDIS Interface Team by email at ndissupport @csyw.qld.gov.au for more information on this process.

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 (ECEI) 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:

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 ECEI 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 ECEI provider, the ECEI 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.
  • Contact the NDIS by telephone on 1800 800 110 or at an NDIS office to order an NDIA Access Request Form.
  • Complete the NDIA 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, Part F of the NDIA Access request Form completed by a GP or other health professional.)
  • Fill out the NDIS sub-tab in the child’s ongoing intervention event in ICMS and attach a copy of the NDIS access request form and attachments, as detailed under Record and maintain plan information.
  • Submit the form signed by the child’s representative, along with an NDIS Consent for the NDIA to share your information form or an NDIS Consent for a third party to act on behalf of a participant form for a child subject to a support service case, intervention with parental agreement or an order granting custody to the chief executive, and a copy of the most recent child protection order for the child, by email to the NDIS national access and workload management (NAWM) team.

Note

All correspondence to the NAWM team is to include the words ‘Qld Child Safety’ and the child’s name and participant number (if known) in the subject line.

If there is a delay in receiving the access request form from the NDIA, Child Safety’s version of the  NDIS access request form may be used to lodge the access request. This form is for use by Child Safety only and is not to be shared externally.

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’. Depending on the disability, this may refer to a: 

Paediatrician  Optometrist 
General Practitioner (GP)  Audiologist 
Neurologist Otolaryngologist
Neuropsychologist Otologist
Psychiatrist Physiotherapist
Clinical psychologist (a senior school guidance counsellor may hold this qualification)  Occupational therapist            
Ophthalmologist Speech pathologist 

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 Part F of the NDIA Access 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.

Tip

Make sure the specialist or health professional is familiar with the NDIS process and confident in their role within it prior to completing the NDIA Access Request Form or preparing other NDIS documentation. The following resources clearly explain the role of the specialist or health professional and how they can best provide disability evidence:

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.

Practice prompt

Use the tool Child Safety NDIS planning preparation guide to collect relevant information about the child ahead of the planning meeting. The guide can be shared with and provided to external parties.

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.

Practice prompt

Where relevant, provide the child with the handout Information about the NDIS - Factsheet 1 for young people in care, for information about the NDIS process and what they can expect (having regard to the child’s age and ability to understand).

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.

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.

Note

It is important to use the child’s most challenging days as the reference point when answering questions about the supports the child requires. Some families and carers may hold fears that if they accurately describe the child’s most challenging day it may affect the child’s placement with them. Reassure the family or carer that the NDIS planning process is a place in which they may describe any challenges they are facing in a safe and supportive environment.

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 planning preparation 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.

Note

Most children in care should receive funding for support coordination, with a minimum support coordination amount of 100 hours for a 12-month plan. Refer to the Advocating for support coordination - staff tip sheet to assist in establishing the need for support coordination with the planner at the NDIS planning meeting.

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.

Further reading

The responsibilities of the NDIS are outlined in Schedule I of the bilateral agreement Principles to determine the responsibilities of the NDIS and other service systems and are also referenced in the NDIS Planning Operational Guideline (NDIS Planning Operational Guideline Appendix 1) and in Part 5 of the NDIS (Supports for Participants) Rules 2013.

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.

 

Note

Due to an NDIA system error, plans will often show a ‘draft’ watermark. However, this is the child’s approved plan once issued, unless advised differently by the NDIS planner.

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 price guide 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 (NDIS Provider lists) (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 ECEI 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.

Note

Choose ‘agency managed’ as the plan management option for all children for whom the chief executive has guardianship, in line with the policy Supporting children with disability.

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 tool Child Safety NDIS plan management approval template 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.

Note

The fortnightly caring allowance and high support needs allowance do not need to be reviewed as a result of the child receiving an NDIS plan.

Record and maintain plan information

Record NDIS-related information for a child subject to Child Safety or Youth Justice intervention in the NDIS sub tab of the child’s health tab in ICMS.

This includes:

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

NDIS information (excluding ECEI 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.

Further reading

Refer to the tool ICMS - child protection (NDIS sub-tab) for information on how to use the NDIS subtab in ICMS.

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 reviews – staff tip sheet will assist with the 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 Review of decisions operational guidelines - which decisions can be reviewed? 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 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 (AAT). 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 AAT.

Further reading

Information about applying for an external review is available on the AAT website.

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 or ECEI 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 pre-planning guide or other pre-planning materials completed prior to the original planning meeting or previous reviews.

Ask these source 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 Information about the NDIS - Factsheet 1 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.

Refer a child to Evolve

Evolve Therapeutic Services (Evolve) is a collaborative partnership between Child Safety and Queensland Health. Evolve’s multidisciplinary clinical teams (located within hospital and health services) provide specialist intensive therapeutic interventions for children in care with severe and complex mental health support needs.

Evolve may provide:

  • a comprehensive assessment and treatment plan to help address the child’s needs and guide the safety and support network’s interaction with the child
  • a crisis response to stabilise behaviour through the development of appropriate coping strategies
  • medium- to long-term therapy to facilitate the child’s ability to form secure attachments
  • education to the child’s safety and support network and associated agencies on the effects of trauma and abuse.

Decide if an Evolve referral is appropriate

A child or young person may be eligible for support through Evolve if they:

  • present with severe and complex psychological or behavioural problems
  • reside in a foster, kinship or residential care arrangement
  • are subject to:
    • a child protection order (including an interim order) granting custody or guardianship to the chief executive
    • a child protection care agreement during an intervention with parental agreement case
      or
    • a support service case to support reunification after the child has been in care or to support a young person aged 18 years in making the transition to adulthood 
      and
  • are experiencing:
    • multiple, intense and persistent emotional or behavioural problems
    • a high level of risk
    • severe functional impairment across a variety of domains
    • additional risk factors.

In deciding whether to refer to Evolve, consider the availability of other mental health services that may provide appropriate support to the child, including Child and Youth Mental Health Services, Headspace, and Assertive Mobile Youth Outreach Teams.

Tip

Information in the child’s strengths and needs assessment and other case planning activities will assist in deciding if an Evolve referral is appropriate for the child. 

Complete an Evolve referral

To refer a child to Evolve:

Evolve staff will advise if the referral is accepted.

Note

The fact that a child with disability receives support from Evolve does not negate the requirement to seek support for the child from the National Disability Insurance Scheme. (Refer to Respond to a child’s disability needs.)

Monitor the intervention

As part of the ongoing implementation of the child's case plan and Evolve plan:

  • Maintain communication with the Evolve service providers and participate in regular stakeholder meetings to develop and review the Evolve plan.
  • Monitor the effectiveness of the intervention to make sure goals are being achieved.
  • Participate in panel activities, such as reviews and case closure meetings.
  • Implement appropriate recommendations from the panel and stakeholder meetings.

Practice prompt

Attach the following documents to the child’s ongoing intervention event in ICMS:

  • a copy of the Evolve referral
  • a copy of assessments, plans and information provided by Evolve.

Further reading

Practice guide Evolve.

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.

If a medical practitioner seeks consent for a child in care to be prescribed a psychotropic medication or to change the type of psychotropic medication prescribed for the child, obtain the following information from the medical practitioner:

  • the child’s diagnosis and the behaviours or symptoms the medication is intended to modify or alleviate
  • the name of the medication, the dosage and the anticipated period of time that the child will be required to take the medication
  • the possible short- and long-term side effects that may be experienced by the child
  • the anticipated date that the medical practitioner will review the use of the medication.

Due to the significance of a decision to prescribe or alter a psychotropic medication for a child in care:

  • Gather sufficient information so the delegated officer can make informed decisions.
  • Consult with the child, the parents and the carers and facilitate their participation in decision making, as appropriate. If the child is Aboriginal or Torres Strait Islander, arrange for an independent person to help facilitate the child’s and family’s participation in the decision. Refer to Decision making for Aboriginal and Torres Strait Islander children.
  • Document all actions and decisions in the:
    • Child information form
    • education support plan
    • case plan
    • child strengths and needs assessment.

As soon as possible after the use of a psychotropic medication is recommended by the medical practitioner:

  • Upload all relevant information regarding medication, recommended dosage and review dates to the ‘Important Documents’ section of the child’s kicbox account.
  • Talk to the child, the parents and the carers to ensure that all relevant people:
    • have information about the diagnosed medical condition requiring treatment with psychotropic medication
    • understand the specific type of medication and possible side effects
    • know when the medical practitioner will review the use of the medication.

Obtain consent

To obtain consent for the use of psychotropic medication for a child in care:

  • Complete the Consent form—Psychotropic medication and obtain the guardian's consent. This will be either:
    • the parents—if the child is in the custody of the chief executive (and therefore the parents have retained guardianship)
    • the CSSC manager—if the child is in the guardianship of the chief executive.  
  • Give the signed consent form to the medical practitioner.
  • Put a copy of the signed consent form on the child’s health file.
  • Give a copy of the signed consent form to the carer to place in the child health passport.

Participate in review of medication

When a child in care is prescribed psychotropic medication:

  • Request that the medical practitioner provide information about the outcome of the scheduled review of the medication.
  • Encourage the child, the parents and the carers to participate in the review, as appropriate.  
  • Make sure the psychotropic medication is discussed in the review of the case plan or child health passport.

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 caseworker (if the child is in contact with the youth justice system)
  • staff from a youth detention centre (if the child is subject to a detention order or has been remanded in custody.)

Develop a positive behaviour support plan

Positive behaviour support aims to meet the developmental needs of children in care who exhibit behaviours of concern or challenging behaviours. This behaviour may be the result of a child’s disability or be caused by a range of factors including trauma and mental health issues.

Positive behaviour support assists a child to learn acceptable behaviours through the implementation of positive strategies by their carer, such as:

  • role-modelling
  • positive reinforcement
  • skill development
  • de-escalation strategies
  • collaborative and inclusive approaches.

At the earliest point possible, using information in the tool Placement risk assessment, identify children who display or are at risk of displaying behaviours that may have a negative effect on themselves or others. This will enable Child Safety to effectively plan to meet their behavioural needs.

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 (refer to Decide if an Evolve referral is appropriate) or, for children who are NDIS participants or are likely to become NDIS participants, refer to an NDIS-registered specialist behaviour support provider.
  • Develop a positive behaviour support plan in a Word document, unless one has been developed by a clinician as part of the case plan or an NDIS-registered specialist behaviour support provider as part of an NDIS plan.
  • Review the effectiveness of the positive behaviour support plan at the same time as the case plan and placement agreement. (For children who are NDIS participants, positive behaviour support plans should be reviewed as per NDIS Quality and Safeguards Commission Guidelines.)

Tip

Attach the positive behaviour support plan to the ongoing intervention event in ICMS.

A positive behaviour support plan for children who are not NDIS participants may include case work support for carers. It will assist with planning and implementing strategies to manage behaviours through positive responses such as:

  • redirecting
  • changing the environment
  • removing privileges or attention for a period of time
  • organisation of referrals to therapeutic services.

A positive behaviour support plan for children who are NDIS participants will include:

  • preventative/environmental strategies
  • skill building/teaching strategies
  • reinforcement/motivation strategies
  • response strategies 
  • details of any restrictive practice to be used that is not a prohibited practice― refer to the policy Positive Behaviour Support  
  • a ‘fade out plan’ to reduce and eliminate the use of any restrictive practices.

Note

If, during the implementation or review of the positive behaviour support plan and case plan, it is identified that the carer requires further support or additional training, respond to this and document the response in:

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

For children who are NDIS participants, disability-specific training for their carers may be funded through the child’s NDIS plan.

Practice prompt

If age and developmentally appropriate, involve the child in the development of the behaviour support plan. (Refer to the practice kit Care arrangements.)

The child’s carer will be informed that a child’s positive behaviour support plan must be consistent with the Statement of standards, the Charter of rights for a child in care and the policy Positive Behaviour Support.

Respond to suicidal behaviour

Child Safety aims to ensure that a child who demonstrates or has demonstrated self-harming or suicidal behaviour is responded to in a way that:

  • safeguards their immediate safety to the extent possible in the circumstances
  • prevents harm from occurring or reduces the risk of harm
  • promotes their ongoing safety, belonging and wellbeing by assisting them to address the harmful behaviours and underlying causes.

Identify if a child is at risk of suicide

A child will be identified at risk of suicide when one or more of the following criteria are met:

  • The child displays or discloses a history of one or more suicide attempts.
  • The child expresses suicidal thoughts or it is assessed that the child has suicidal thoughts.
  • It is assessed that the child’s self-harming behaviour—actual, threatened or expressed―places them at risk of suicide.
  • It is assessed that the child’s involvement in risky or dangerous behaviour is linked to suicidal thoughts.
  • The child is diagnosed with depression or exhibits behaviour or symptoms that may be associated with depression, and it is assessed that:
    • the child presents as suicidal
    • actual or threatened self-harming behaviour places them at risk of suicide.

Identify the child’s vulnerability and suicide risk factors

When considering if a child is at risk of suicide, review the child’s history in ICMS and identify if there are any factors that indicate vulnerability, such as:

  • previous suicide risk alerts
  • information or behaviour that indicates an escalation or intensification in the pattern or severity of the child’s self-harming or suicide risk behaviour
  • child protection history that confirms or highlights additional risk factors such as:
    • previous deaths of children or adults in the family
    • serious or repeated injuries
    • mental health issues
    • a change in behaviour or personality.

Further reading

If doubt exists that a child is at risk of suicide:

  • Talk with the senior team leader or senior practitioner for advice and direction to assess the risk of suicide.
  • Talk with relevant professionals who have knowledge either of the child or of suicidal behaviour, such as treating healthcare provider/s, 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).

Decide whether to record a suicide risk alert

When deciding to record a suicide risk alert, consult with the senior team leader to:

  • assess the nature and significance of the information received
  • determine if a suicide risk alert is required
  • consider the rationale for recording the suicide risk alert
  • identify the immediate actions to be undertaken, and if required, the:
    • ongoing actions
    • interventions
    • supports to be put in place to ensure the child’s safety.

Record a suicide risk alert

When a child discloses or displays suicide risk behaviour, or when it is assessed that the child meets the criteria for a suicide risk alert, create a suicide risk event in ICMS and record a suicide risk alert (SR1) within 24 hours of the incident, disclosure or assessment.

If applicable, include the name of the diagnosing doctor and date of the diagnosis.

Practice prompt

Consider whether a critical incident report also needs to be recorded in line with the policy Critical incident reporting.

Note

The suicide risk alert is not activated in ICMS until after the team leader approves the suicide risk alert (SR1) form in the suicide risk event.

If the child is subject to ongoing intervention, the suicide risk event is to be allocated immediately to the CSO with case responsibility and all relevant information is to be forwarded to that CSSC.

Develop a suicide risk management plan

Develop a suicide risk management plan with the child, their parents, carers and other significant people, if possible. The complexity, number and extent of actions in the suicide risk management plan can vary and depend on:

  • the point at which the plan is instigated:
    • at intake ―the notifier may be the only person responsible for implementing the immediate suicide risk management plan actions (for example, removing available means of suicide, not leaving the child alone and seeking help from a general practitioner)
    • during an investigation and assessment―the parent may be the only person responsible for implementing the immediate suicide risk management plan actions
    • during ongoing intervention―a range of people may be undertaking actions with the child in the immediate and medium- to long-term suicide risk management plans (for example, child protection and youth justice staff, carers and health workers)
  • the nature and significance of the information prompting the suicide risk alert. If a child is physically injured or hospitalised as a result of their suicide risk behaviour, the immediate suicide risk management plan actions may be carried out by a range of people relevant to the current situation and context (for example, a general practitioner or other healthcare provider, parent, youth worker or other identified support person). The people responsible for implementing the ongoing actions identified in the medium- to long-term management plan may differ from those identified in the immediate management plan, particularly if the child’s circumstances change
  • the child’s circumstances. The number and extent of people responsible for implementing the suicide risk management plan will depend on:
    • the child’s characteristics and individual situation, such as ethnicity, behaviour, health or special needs, and relationships with others
    • the people able and willing to undertake actions to protect and support the child. For example, an Aboriginal or Torres Strait Islander child involved with Child Safety and the youth justice system may have child safety, youth justice and Family Wellbeing staff responsible for certain actions within the suicide risk management plans.

Develop an immediate suicide risk management plan

An immediate suicide risk management plan is recorded within the Suicide risk alert (SR1) form in ICMS. (Refer to Record a suicide risk alert.)

Time sensitive

The maximum duration of an immediate suicide risk management plan is 2 weeks.

The purpose of the immediate suicide risk management plan is to:

  • document the immediate actions and interventions to be undertaken in response to the child’s suicide risk alert
  • guide short-term casework activities aimed at ensuring the child’s immediate safety needs and managing the timely provision of health or therapeutic assessment and support until the medium- to long-term suicide risk management is developed.  

The immediate suicide risk management plan must contain:

  • information about the strategies and/or referrals to assess the child’s medical and/or mental health needs, such as a healthcare provider, Queensland Health’s Child and Youth Mental Health Service, and Evolve Therapeutic Services 
  • the activities relevant people will undertake, aimed at ensuring and monitoring the child's immediate safety. For example, document the roles and activities of those closest to the child in daily life such as their carer, parent, youth worker and those with other areas of expertise (such as mental health counsellors and drug and alcohol service representatives).

Immediate suicide risk management plan for a child at intake or during an investigation and assessment

When a suicide risk alert is generated at intake (as part of an intake enquiry or child concern report) or during an investigation and assessment, and the child is not subject to ongoing intervention, record the actions the notifier or parent agrees to undertake in the immediate suicide risk management plan.

If the notifier or parent does not agree to undertake actions:

  • Record the notifier’s or parent’s response and the rationale for their decision.
  • Consider whether a notification (or additional notified concerns) needs to be recorded, for example, because:
    • without the notifier agreeing to act, there is no one taking necessary actions for the child’s safety
      or
    • a parent’s lack of commitment to the actions in the plan requires assessment.

Child Safety does not have ongoing involvement or monitoring of a child unless they are subject to an ongoing intervention case. This means it is critical that, during the intake or investigation and assessment response, all available options for securing the child’s immediate physical safety are clearly explored with relevant people and agencies, including (where applicable) the notifier.

If there is doubt about the level of risk and necessary action, refer to Identify the child’s vulnerability and suicide risk factors.

If necessary, take action to ensure the child’s safety and refer to Procedure 1 Decide if a notification response is appropriate and Procedure 2 Respond if a parent will not consent to actions required―temporary assessment order.

Consider referrals to services

Children who display suicide risk behaviour, or who are at risk of suicide, may already have involvement with services with expertise in addressing or reducing such behaviours.

If a child is not involved with professional service providers, consider making referrals to relevant services or consulting with them for information, resources and assistance.

Develop a medium- to long-term suicide risk management plan

Attention

Medium- to long-term suicide risk management plans are only developed for children subject to ongoing intervention. Wherever possible, develop the medium- to long-term plan with the child, their parents, carers, the safety and support network, and relevant health professionals.

The medium- to long-term suicide risk management plan is developed:

  • in ICMS within two weeks of recording the suicide risk alert and developing the immediate suicide risk management plan
  • following a review of the immediate suicide risk management plan.

It is submitted to the senior team leader for approval.

Time sensitive

The maximum duration of a medium- to long-term suicide risk management plan is 3 months.

The medium- to long-term suicide risk management plan will include the following:

  • details of interventions that have occurred since the suicide risk alert was recorded, including outcomes of interventions already undertaken as part of the immediate suicide risk management plan 
  • strategies for how and when the medium- to long-term suicide risk management plan will be monitored and reviewed and who is responsible for actions
  • any further follow-up actions to be undertaken and who is responsible for the actions
  • an assessment about the current level of risk (high, medium, low) determined with the senior team leader. (Refer to Identify the current level of risk.)

Identify the current level of risk

Consult with the senior team leader to identify whether the current level of risk (to be recorded in the child’s medium- to long-term suicide risk management plan) is high, medium or low. This will be based on:

  • the CSO’s knowledge and professional judgement about the risk factors and warning signs (including cultural considerations) specific to the particular child
  • progress and outcomes associated with any interventions that have occurred since the suicide risk alert was recorded 
  • information and assessment about the child’s current situation, behaviour, presentation and context.

Practice prompt

To determine the current level of risk for a child subject to an investigation and assessment or ongoing intervention, also consult:

  • the child’s safety and support network
  • the youth justice case worker―if the child is in contact with the youth justice system.

Inform relevant people

Inform the following people about the alert and the immediate or medium- to long-term risk management plan:

  • At intake, inform the notifier.
  • During an investigation and assessment or for a child subject to ongoing intervention, inform the child, parents and other relevant people (such as carers, health practitioners and school staff).

Critical incident reporting

If a child attempts suicide or if a child’s self-harming episodes require hospitalisation or are assessed as attempted suicide, complete a Critical incident report through the critical incident reporting management system in line with the Critical incident report management system - guidelines for users and the policy Critical incident reporting.

Respond to a child with multiple suicide risk alerts

Attention

A subsequent suicide risk alert must be completed whenever a child demonstrates or engages in a new episode of suicide risk behaviour.

If a child subject to a suicide risk alert repeatedly engages in suicide risk behaviours, consult with the senior team leader to consider if the recurring behaviour:

  • signifies an escalation or intensification in the pattern or severity of the child’s suicide risk behaviour or risk of suicide
  • is being adequately addressed by actions in the current suicide risk management plan.

When deciding whether to record a subsequent suicide risk alert, consider if the actions in the current immediate or medium- to long-term suicide risk management plan are working to address the repeated suicide risk behaviour.

If a subsequent suicide risk alert is recorded, consider if the previous suicide risk management plan contains actions, interventions and supports that are relevant to the:

  • child’s pattern of self-harming behaviour
  • current level of risk
  • child’s situation
  • progress that has been made.

The new suicide risk management plan may repeat the strategies of the previous plan if the new episode is to be responded to and managed in the same way.

Review the immediate suicide risk management plan

Time sensitive

Review the immediate suicide risk management plan within 2 weeks of the suicide risk alert and the immediate suicide risk management plan being recorded.

A suicide risk alert and the immediate suicide risk management plan created at intake or during an investigation and assessment will be closed if:

  • There is agreement by the relevant people to undertake the actions documented in the immediate suicide risk management plan.
  • All relevant information and the rationale for the decision have been documented.
  • No further ongoing intervention is warranted.

If the child is subject to ongoing intervention―or if an investigation and assessment has subsequently resulted in ongoing intervention―the review of the immediate suicide risk management plan will result in a decision to either:

  • keep the suicide risk alert open and develop a medium- to long-term suicide risk management plan
    or
  • close the suicide risk alert. (Refer to Close a suicide risk alert.)

Review the medium- to long-term suicide risk management plan

The medium- to long-term suicide risk management plan must be reviewed at least every 3 months until the alert is no longer required and is closed in ICMS.

The purpose of reviewing the plan is to ensure that interventions with the child have been implemented and are responding to the child’s needs. The review will result in either a decision to:

  • keep the suicide alert open with an updated medium- to long-term suicide risk management plan
    or
  • close the suicide risk alert―refer to Close a suicide risk alert  Close a suicide risk alert.

For a child subject to ongoing intervention, information from the review of the medium- to long-term suicide risk management plan will be used in reviewing the child’s case plan or support plan. 

If the child’s case plan is updated because of information in the medium- to long-term suicide risk management plan, also consider whether the following documents need to be updated:

Conduct a review meeting

At the review meeting, discuss and evaluate the medium- to long-term suicide risk management plan to determine whether sufficient progress has been made (in relation to the actions) to close the suicide risk alert.

If possible, include and consider the views of the child, parents, carers, service providers, safety and support network members and other people significant to the child.

Before deciding to close a suicide risk alert make sure:

  • The child no longer meets the criteria for generating a suicide risk alert.
  • The review of the medium- to long-term suicide risk management plan has considered:
    • whether adequate assessment has occurred in relation to child and their situation
    • the effectiveness of case work actions undertaken and outcomes associated with interventions.

Do not close the suicide risk alert if it is assessed that:

To close the suicide risk alert, refer to Close a suicide risk alert.

Develop a new medium- to long-term suicide risk management plan

When the suicide risk alert remains open, develop a new medium- to long-term suicide risk management plan and:

  • Make sure the activities, interventions or supports are relevant to the child and their circumstances.
  • Record the new medium- to long-term suicide risk management plan in the suicide risk event in ICMS.
  • Record the outcome of the review meeting in the ‘comments’ section of the new plan.
  • Submit the new medium- to long-term suicide risk management plan to the senior team leader for approval.

The new medium- to long-term suicide risk management plan may include actions and interventions included in the previous plan if there is no change to the way in which the child’s suicide risk behaviour or risk is going be responded to and managed.

Close a suicide risk alert

Attention

The decision to close a suicide risk alert is an important one, and the rationale must be:

  • informed by the outcome of the review meeting
  • endorsed by the senior team leader
  • documented in ICMS.

To close the suicide risk alert, create and complete an Incident closure form in the suicide risk event in ICMS and record:

  • the date of the decision to close the alert as the end date
  • the actions undertaken and comments
  • the rationale for the decision to close the suicide risk alert
  • the senior team leader’s verbal approval of the decision in the ‘reason for closure’ field.

Tip

When the incident closure form is completed, the suicide risk event in ICMS will close and the suicide risk alert will move to the historical alerts in the alert tab. The number of suicide risk alerts will be displayed in the top right hand corner of the alert tab. Only a current alert will display as a count outside the bracket. The number of historical suicide risk alerts will be displayed inside the brackets.

This allows anyone viewing the child’s profile in ICMS to quickly ascertain the most recent information recorded about the child’s risk of suicide.

Respond to self-harming behaviour

Identify if a child is at risk of self-harm

A child will be identified at risk of self-harm when one or more of the following criteria are met:

  • The child displays self-harming behaviour such as: 
    • self-cutting
    • self-strangulation
    • jumping from a height intended to cause self-harm
    • ingesting a substance in excess of the prescribed or generally recognised therapeutic dose
    • ingesting a recreational or illicit drug (in an act the child regarded as self-harm).
  • The child threatens or expresses an intention to self-harm. 
  • The child has peers who have recently engaged in self-harming behaviour (which may have an influence on their actions).
  • The child is involved in risky or dangerous behaviour—or is involved in risk-taking behaviour (such as reckless actions endangering life or chronic or prolonged substance misuse)―that is assessed as placing them at risk of bodily harm.

Identify a child’s vulnerability and self-harm risk factors

When considering if a child is at risk of self-harm, review the child’s history on ICMS and identify vulnerability factors such as:

  • previous self-harm alerts
  • information or behaviour that indicates an escalation or intensification in the pattern or severity of the child’s self-harming behaviour
  • a history that confirms or highlights additional risk factors such as: 
    • previous deaths of a child or adult in the family
    • serious or repeated injuries
    • mental health issues
    • a change in behaviour or personality.

Further reading

If doubt exists that a child is at risk of self-harm:

  • Talk with the senior team leader or senior practitioner for advice and direction to assess the risk of self-harm.
  • Talk with relevant professionals who have knowledge either of the child or of self-harm behaviour, such as treating healthcare provider/s, 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).

Decide whether to record a self-harm alert  

When deciding to record a self-harm risk alert, consult with the senior team leader to:

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

Record a self-harm alert in ICMS

When a child discloses or displays self-harming behaviour, or when it is assessed that the child meets the criteria for self-harm risk, record a self-harm risk alert in the alert tab of the child’s person record in ICMS within 24 hours of the incident, disclosure or assessment.

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

Practice prompt

If the child is subject to ongoing intervention, make sure the CSO with case responsibility is advised and all relevant information is forwarded to that CSSC.

If the self-harming behaviour was life-threatening or required hospitalisation, consider whether a critical incident report is required, in line with the policy Critical incident reporting.

Develop a self-harm risk management plan

Develop a self-harm risk management plan with the child, their parents, carers and other significant people, if possible. The complexity, number and extent of actions in the self-harm risk management plan can vary and will depend on:

  • the point at which the plan is instigated: 
    • at intake―the notifier may be the only person responsible for implementing the self-harm risk management plan actions (for example, removing available means of self-harm, not leaving the child alone, and seeking help from a general practitioner)
    • during an investigation and assessment―the parent may be the only person responsible for implementing the self-harm risk management plan actions
    • during ongoing intervention―a range of people may be undertaking actions with the child in the self-harm risk management plan (for example, child protection and youth justice staff, carers, and health workers)
  • the nature and significance of the information prompting the self-harm alert. If a child is physically injured or hospitalised as a result of self-harming and/or risk of self-harm, the self-harm risk management plan actions may be undertaken by a range of people relevant to the child’s current situation. For example, a general practitioner or other healthcare provider, parent, youth worker or other identified support people may be involved
  • the child’s circumstances. The number and extent of people responsible for implementing the self-harm risk management plan actions will depend on: 
    • the child’s characteristics and individual circumstances, for example, the child’s ethnicity, behaviour, health or special needs, and relationships with others
    • the people able and willing to undertake actions to protect and support the child. For example, an Aboriginal or Torres Strait islander child involved with Child Safety and the youth justice system may have child safety and youth justice staff responsible for certain actions within the self-harm risk management plan).

Record a self-harm risk management plan

After the self-harm risk alert is recorded, record a self-harm risk management plan in a case discussion/decision case note titled Self-harm risk management plan in the relevant event in ICMS. Record the senior team leader’s verbal approval of the decision to record the alert, and the rationale.

The purpose of the self-harm risk management plan is to document the immediate and ongoing actions and interventions aimed at preventing or reducing the future risk of self-harm to the child. These may include:

  • strategies to increase the knowledge and understanding of all parties about self-harm and suicide risk
  • practical strategies that can be put into action, such as: 
    • not leaving the child alone
    • removing or safely securing any available means of self-harm or suicide, for example, weapons, medications, alcohol and other drugs, and access to a car
    • encouraging the child to talk with and seek help from a general practitioner or other provider
  • information and advice about alternative sources of support that may assist the child and their family, including community based health (such as a general practitioner) and/or mental health services such as Queensland Health’s Child and Youth Mental Health Services, the child’s safety and support network, and local community resources
  • referrals to a support or intervention service
  • strategies for how and when the self-harm risk management plan will be monitored and reviewed
  • any other matters discussed or actions to be taken, and the response of all parties.

Self-harm risk management plan for a child at intake or during an investigation and assessment

When a self-harm alert is recorded at intake (as part of an intake enquiry or child concern report) or during an investigation and assessment, and the child is not subject to ongoing intervention, record the actions the notifier or parent agrees to undertake in the self-harm risk management plan.

If the notifier or parent does not agree to undertake actions:

  • Record the notifier’s or parent’s response and the rationale for their decision.
  • Consider whether a notification (or additional notified concerns) needs to be recorded, for example, because:
    • without the notifier agreeing to act, there is no one taking necessary actions for the child’s safety
      or
    • a parent’s lack of commitment to the actions in the plan requires assessment.

Child Safety does not monitor or have an ongoing involvement with a child unless they are subject to an ongoing intervention case. This means it is critical that, during the intake or investigation and assessment response, all available options for securing the child’s immediate physical safety are clearly explored with relevant people and agencies, including (where applicable) the notifier.

If there is doubt about the level of risk and necessary action, refer to Identify the child's vulnerability and self-harm risk factors

Practice prompt

If necessary, take action to ensure the child’s safety. (Refer to Procedure 1 Decide if a notification response is appropriate and Procedure 2 Respond if a parent will not consent to actions required―temporary assessment order.)

Consider referrals to services

Children who display self-harming behaviour or who are at risk of self-harm may already have involvement with other services that have expertise to offer in addressing or reducing such behaviours.

If a child is not involved with professional service providers, consider making referrals to relevant services or consulting with them for information, resources and assistance.

Inform relevant people

After recording a self-harm alert and completing a self-harm risk management plan, inform relevant people about the alert and associated risk plan, as follows:

  • At intake, inform the notifier.  
  • During an investigation and assessment or for a child subject to ongoing intervention, inform the child, parents and other relevant people (such as carers, health practitioners and school staff).
  • If the child is in contact with the youth justice system, inform the youth justice case worker or detention centre staff―as relevant.

Record the information sharing in the self-harm risk management plan case note in ICMS.

Report a critical incident

If a child’s self-harming episode is life-threatening or requires hospitalisation, complete a Critical incident report through the critical incident reporting management system in line with the Critical incident report management system - guidelines for users and the policy Critical incident reporting.

Respond to a child with multiple self-harm alerts

Attention

A subsequent self-harm risk alert must be completed whenever a child demonstrates or engages in a new episode of self-harming behaviour.

If a child subject to a self-harm risk alert repeatedly engages in self-harming behaviour, consult with the senior team leader to consider if the recurring self-harming behaviour:

  • signifies an escalation or intensification in the pattern or severity of the child’s self-harming behaviour or risk of self-harm
  • is being adequately addressed by actions in the self-harm risk management plan.

When deciding whether to record a subsequent self-harm alert, consider if the actions in the current self-harm risk management plan are working to addressing the repeated self-harming behaviour.

If a subsequent self-harm alert is recorded for a child, consider if the previous self-harm risk management plan contains actions, interventions and supports that are relevant to the:

  • child’s pattern of self-harming behaviour
  • current level of risk
  • child’s situation
  • progress that has been made.

The new self-harm risk management plan may repeat the strategies of the previous plan if the new episode is to be responded to and managed in the same way.

Consider if a suicide risk alert is required

If a new self-harm alert is being considered for a child subject to multiple current or previous self-harm alerts, consult with the senior team leader about whether a suicide risk alert is required. Consider:

Review the self-harm risk management plan

Review the self-harm risk management plan to ensure the planned interventions with the child have been implemented and have been effective in meeting or resolving the child’s risk of self-harm.

Time sensitive

For ongoing intervention cases, the self-harm risk management plan must be reviewed at least every 3 months, until the alert is no longer required and is closed in ICMS.

For a child subject to ongoing intervention, information from the review of the self-harm risk management plan will be used in reviewing the child’s case plan or support plan. In addition, consider if:

  • the placement agreement reflects the carer’s responsibilities as outlined in the self-harm risk management plan
  • an update to the child health passport is necessary. (Refer to Develop a child health passport.)

Note

The self-harm risk management plan is not reviewed for a child who is not subject to ongoing intervention.

If a child who has an open self-harm alert and self-harm risk management plan created at intake or during an investigation and assessment subsequently becomes subject to ongoing intervention case, review the open alert. (Refer to Conduct a meeting to review a self-harm risk management plan.)

Conduct a meeting to review a self-harm risk management plan

At the review meeting, discuss and decide if sufficient progress has been made in relation to the self-harm risk management plan actions to close the self-harm alert.

If possible, include and consider the views of the child, parents, carers, service providers, safety and support network members and other people important to the child.

The review of the self-harm risk management plan will result in a decision to:

  • keep the self-harm alert open and review and update the self-harm risk management plan
    or
  • close the self-harm alert.

Record the outcome of the review in ICMS

Keep the self-harm alert open

The self-harm alert cannot be closed if it is assessed that either:

  • the self-harm risk management plan actions have not sufficiently resolved the child’s risk of self-harm
    or
  • the child still meets any of the criteria for a self-harm alert.

Practice prompt

If the self-harm alert remains open, review and update the self-harm risk management plan to ensure the activities, interventions or supports included are relevant to the child and will meet their safety and support needs.

Update the self-harm risk management plan in ICMS

When the self-harm risk alert remains open, develop a new self-harm risk management plan in a new case discussion/decision case note in ICMS, titled Self-harm risk management plan and:

  • Make sure the activities, interventions or supports are relevant to the child and their circumstances.
  • Record the outcome of the review meeting.  
  • Record the senior team leader’s verbal approval of the decision to keep the self-harm alert open.

The updated self-harm risk management plan may include the details of the previous plan if there is no change to the way in which the child’s self-harming behaviour or risk is going be responded to and managed.

Close a self-harm alert

Attention

The decision and rationale to close a self-harm risk alert must be:

  • informed by the outcome of the review meeting
  • documented in a case discussion/decision case note in ICMS
  • endorsed by the senior team leader.

Before closing a self-harm alert, make sure:

  • The child no longer meets the criteria for a self-harm alert.
  • The review of the self-harm risk management plan has considered:
    • whether a thorough assessment has occurred in relation to the child and their situation
    • the effectiveness of case work actions undertaken and a review of the outcomes of the interventions
    • the views of the child, parents, carers, safety and support network members and other involved people.

To close the self-harm alert, edit the self-harm risk alert in the alert tab in ICMS, and record:

  • the date of the decision to close the alert as the alert end date
  • the actions undertaken
  • the rationale and decision to close the alert
  • the senior team leader’s verbal approval of the decision.

Tip

When the self-harm alert in ICMS is closed, the self-harm risk alert will be moved to other CP alerts in the historical alerts in the alert tab. The number of closed self-harm alerts will be displayed in the top right hand corner of the alert tab under other alerts.

Only a current other alert will display as a count outside the bracket. The number of historical other alerts will be displayed inside the brackets.

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