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3.4.8 Health care planning

Last Modified: 24-Sep-2019 Review Date: 04-Jan-2021

Purpose

To guide child protection workers in the health care planning processes for children in the CEO's care.

Note: CEO refers to the Chief Executive Officer of the Department of Communities.

Practice Requirements
  
  • When a child comes into the CEO’s care, including provisional protection and care, you must arrange for an initial medical assessment with a general practitioner (GP) or other health professional within 20 working days, unless an assessment has already occurred (for example, the Perth Children's Hospital Child Protection Unit has undertaken an examination).

  • All children in the CEO's care must have an annual health assessment to assist in developing and implementing the 'health' dimension of each child’s care plan. Where children with disability have regular health assessments as part of their therapeutic requirements, you should assess whether additional health assessments are necessary, such as dental checks, and record in Assist that the child is under the care of a health team.

  • All requests (Form 510 - Comprehensive Health Assessment - Health Care Planning for Children in Care) to WA Health for a child in care to receive a health assessment must be sent to the central statewide email address DOH.CICreferrals@health.wa.gov.au  

  • Children who come into care aged 4 years and older must have a Strengths and Difficulties Questionnaire (SDQ) completed via Viewpoint once they have been in care for six months (or earlier if they are settled in the care arrangement), and then on an annual basis. Ideally, the SDQ should be completed before a child’s care plan review. Refer to the ‘Strengths and Difficulties Questionnaire’ procedure below.  

  • Children in care who attend school must be enrolled in the School Dental Service program.

  • You must apply for a Medicare Card for all children for whom the CEO has parental responsibility.

  • You must assist carers to claim a Foster Child Health Care Card for children in the CEO’s care  placed with that carer, or have the children added to the carer’s Health Care Card (where they have one).

Process Maps

Refer to the following flowcharts available in related resources:

  • Health Care Planning Pathway for Children New to Care
  • Health Care Planning Pathway for Children Already in Care
  • Strengths and Difficulties Screening Process
  • Processing Medical Expenses from Public Providers and Private Practitioners.

 

Procedures

  • Overview
  • The Child Health Passport
  • Considerations before making a referral for a child to have an initial medical assessment and/or comprehensive health assessment
  • The initial medical assessment
  • The comprehensive health and development assessment
  • The health assessment for a young person in detention or on remand
  • Obtaining a Medicare Card
  • Obtaining a Health Care Card
  • Strengths and Difficulties Questionnaire
  • Dental health
  • Filing and recording
  • Developing the health plan
  • Overview

    You must undertake health care planning for all children in the CEO's care (s.30 of the Children and Community Services Act 2004 (the Act).  Refer to the resource In the CEO’s Care – Parental Responsibility Chart.

    The term ‘health plan’ refers to the planning decisions and steps required to meet the child’s identified health needs that are documented in the care plan (or provisional care plan).  

    Within the health care planning pathway, when a child first comes into care they must have an initial medical assessment followed by a more comprehensive health and development assessment. A health and development assessment review is then carried out on an annual basis, before the care plan (or provisional care plan) is due for review.

    Health assessments identify any problems early to reduce the potential impact later on in the child’s life. For example, if a hearing problem is not identified and treated, the child may develop difficulties with speech or experience learning problems.

    You should provide the carer and parent with a copy of the Health Care Planning for Children in Care - Information Sheet for Foster Carers.

    The Health Care Planning Tracking Sheet is a useful tool for tracking and recording the relevant health care processes completed for a child in the CEO’s care (see related resources).

    Power of the CEO to give consent on behalf of a child in care

    Section 127 of the Act gives the CEO the power to provide consent in lieu of a parent where that child is:

    • in provisional protection and care subject to an interim order - s.29(2)
    • the subject of a protection order (time limited) or protection order (until 18), or
    • the subject of a negotiated placement agreement, only if the agreement authorises the CEO to do so.

    Where a child is the subject of a negotiated placement agreement (NPA), parental responsibility essentially remains with the child’s parents, except as determined by the agreement. If agreed to and included in the NPA, you can provide consent on behalf of the CEO for the child to have any medical or dental examination, treatment or procedure required.  

    Where a young person is provided with a placement service under s.32(1)(a) of the Act, parental responsibility remains with the young person’s parents. Therefore, you will need to discuss health care planning processes with the child's parents and the young person and obtain thier consent.  Where it is assessed that the young person has sufficient understanding and maturity to make decisions, they can provide consent for services and sharing of relevant information – refer to the Gillick Principle in related resources.

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    The Child Health Passport

    Each child in care must be provided with a Child Health Passport (Passport), unless a young child has a Department of Health ‘all about me’ purple folder (rather than duplicate records). However, once a child reaches school age, they must be provided with a Passport.

    Important information must be entered in the Passport before, or when the child is placed with the carer. This includes the child’s name, date of birth, emergency contact name and telephone number, Medicare number (if known), medic alerts, the child protection worker’s name and district, and information about known medications, allergies, health conditions and immunisation records. For the WA Vaccination Schedule, click here.

    The Passport provides the carer (or residential care staff) with immediate knowledge of the child’s health needs, for example, if the child uses an asthma inhaler or requires other medication. You should assist in keeping the Passport up-to-date and encourage the carer to take it along to health appointments. Taking the Passport to appointmentsprovides health professionals with information so the child receives appropriate care and treatment.

    The Passport must accompany the child if there is a change of placement, be given to the parents if the child returns home, or be given to a young person when they transition from care.

    Replacement pages for the Passports can be obtained (or via the link in related resources). For supplies of new Passports, please contact Policy and Service Design on (08) 6381 2250 or email your order with contact details to sharon.shackleton@communities.wa.gov.au

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    Considerations before making a referral for a child to have an initial medical assessment and/or comprehensive health assessment

    There may be matters to consider before making a referral for a child to have a medical assessment and/or a more comprehensive health assessment. For example, the child may wish to have someone else other than the carer present at the appointment.

    The child’s cultural needs are an important consideration, potentially informing the decision about the most appropriate health professional to undertake an assessment. 

    There are a range of factors that need to be considered in meeting the health needs of a child from a culturally and linguistically diverse (CaLD) background. This includes whether an interpreter service is required, the gender of the health assessment provider, and an understanding of the trauma experienced prior to (such as war) or since moving to Australia (for example, social isolation).

    If the child migrated to Australia under the Humanitarian Program, you should advise the health professional undertaking the assessment to consult with a community migrant health nurse, the Migrant Health Unit or the Perth Children's Hospital Refugee Health Service. This is to determine whether the child has undergone a recent health check and to obtain refugee specific health information. In some circumstances, they may be the best provider to undertake the health assessment rather than involve another health professional.

    Consideration may also be required regarding the specific needs of Aboriginal children before they are referred for a health assessment. The Aboriginal practice leader or other relevant Aboriginal officer in the district can be consulted before you make a referral. It may be more appropriate for the health assessment to be undertaken by an Aboriginal Medical Service or other Aboriginal health service.

    Where a child is already engaged with a number of health professionals or being seen by a GP on a regular basis for a health condition, further health assessments may not be warranted. This may be the case for a child with a disability. In this instance, you should discuss this with the relevant health professionals.

    Similarly, if a child has a diagnosed disability they may be engaged with disability specific services. Although a child may already be under the care of a health team, you should discuss health care planning assessments with current health providers to check that all aspects of the child’s health care are being addressed, such as immunisation or oral health care.

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    The initial medical assessment

    When a child comes into the CEO’s care, they must have an initial medical assessment as soon as practicable but within 20 working days, unless an assessment has already occurred (for example, through the Perth Children's Hospital Child Protection Unit). Consultation should occur with the carer and child, where age appropriate, before making the appointment. 

    Deciding on the most appropriate GP or other health professional to conduct the health assessment requires professional judgment, having regard to the views of the child, parent/s and carer.

    The child protection worker should book a 30 minute appointment with a GP or other health professional, and advise the carer of the day and time. When making the appointment, advise the GP/surgery/health provider that a Department form will be sent with the child that provides information about the health assessment request and includes Medical Benefit Schedule item numbers that may be used, such as the 4 year old Healthy Kids Check.

    Before the appointment, the child protection worker must:

    • complete pages 2 and 3 of the Form 513 - Initial Medical Assessment Form - Health Care Planning for Children in Care, and
    • update the Child Health Passport as required, including the child’s immunisation records. 

    Information on obtaining immunisation records can be found in Chapter 3.2: Medical or dental treatment - including immunisations. Refer also to the Australian Childhood Immunisation Register (ACIR).

    The carer should be reminded to take the Child Health Passport to the appointment if they are attending.

    The health professional is advised on Form 513 to return it (or their clinical notes) to the child protection worker at the district office once the assessment is completed. Once received, the Form 513 (or clinical notes) must be scanned to the Child History File in Objective and the original placed in the Child History Folder.

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    The comprehensive health and development assessment

    A child who is new to care must be referred for a more comprehensive health assessment once the initial medical assessment has occurred, unless he or she is already seeing a health professional for ongoing management of their health.

    A child already in care must be referred for a health and development assessment on an annual basis before their care plan (or provisional care plan) is due for review, unless he or she is already seeing a health professional for ongoing management and monitoring of their health. You should discuss this with the health professional. Continuity of care should be promoted wherever possible. You should allow enough time for the assessment to be completed before the care plan review date.

    A child diagnosed with a disability is usually seen by specific services and may be under the care of a health team. In this instance, a comprehensive health assessment may not be required. However, the child may require other health checks, such as a dental checkup.  You must record that the child is under the care of a health team in the Health dimension of the Quarterly Care Review in Assist under ‘Health Assessment’.

    You must discuss the comprehensive health assessment process with the carer and child (where age appropriate), and provide a copy of the Health Care Planning for Children in Care - Information Sheet for Foster Carers.

    Deciding on the most appropriate health professional to conduct the health assessment requires professional judgment, and regard for the views of the child, parents and carer, and the specific health and medical needs of the child. Refer to the procedure above - ‘Considerations before making a referral for a child to have an initial medical assessment and/or comprehensive health assessment’.

    Complete Form 510 Comprehensive Health Assessment - Health Care Planning for Children in Care to provide information about the child and his or her family to the health provider undertaking the assessment.

    If a young person declines to have a health assessment, record this in a case note. You should continue to work with the young person to address their concerns and encourage them to have a health assessment. The young person may wish to see a youth friendly doctor who is trained in adolescent health issues. A list of medical practitioners (by suburb and regional town) who have undertaken this specific training is available on the Australian Medical Association 'Youth Friendly Doctor' website.

    Where the health assessment is to be carried out by a community health nurse

    If the decision is to have the comprehensive health assessment undertaken by a community health nurse, you must inform the carer and the child (where age appropriate) before sending the referral.

    If the assessment is for a child already in care, the referral should be made two to three months before the care plan review meeting. This will allow time for the health assessment to be completed and the report provided to you.

    You should gather relevant medical information about the child and any significant family history to complete the Form 510 Comprehensive Health Assessment - Health Care Planning for Children in Care.

    Information about the child’s previous addresses should be provided so that the nurse conducting the assessment can access the child’s previous health records where available. It is also important to indicate in the Form 510 if the child is new to care, and if you and the nurse need to discuss  anything before the health assessment.

    The completed Form 510 and supporting documents must be sent to a central state-wide email address DOH.CICreferrals@health.wa.gov.au which is managed by a central intake team.  Copy your team leader into the email and attach any other relevant information about the child’s history to the email. This may include a copy of the completed Form 513 Initial Medical Assessment Form - Health Care Planning for Children in Care (for a child new to care) or a previous health plan.  Note: Do not send multiple referrals in the one email. The more information you can provide for the nurse, the better the health assessment and identification of health needs.

    The central intake team will check the referral form and, if complete, will forward it and any attached documents to the key contact (senior manager) for the health region where the child resides or attends school. The key contact will allocate a child or school health nurse to conduct the assessment, or may refer to the Aboriginal Health Team (part of community child health in the metropolitan area) if this is more appropriate for the child.  The key contact will return the referral to you if the child is already engaged with other health services and the key contact believes it would be better for one of these services to conduct the health assessment (rather than introduce another health professional). The referral may also be returned to you if the child does not attend the appointment or declines to have the assessment.

    The nurse will schedule the appointment with the carer for children under school age, while school age children will be seen while they are at school. If a child has indicated they do not wish to have the assessment undertaken at their school, the child should attend their GP for the health assessment instead.

    The nurse will aim to schedule the assessment appointment within 30 working days from receipt of the completed referral form, with priority given to a child who is new to care.  There can be delays however, in getting an assessment appointment during school holidays for school-aged children, especially during December and January, as the school health services do not operate during these periods. In addition, the child and/or carer may not be available to attend an appointment during these times. If an assessment is required during these times, you should arrange for this to be undertaken by a GP instead.

    If the carer will be attending the assessment appointment, remind them to take the Child Health Passport to the appointment.

    The 11 Month Care Planning Guide assists in forward planning for the annual health assessment.

    WA Health has a list of key contacts for each district that may be used for local communication purposes only (in related resources). No referrals are to be sent to these email addresses.

    The nurse assessment for children under school age (0 - 4 years)

    The nurse will undertake an oral health inspection and assess the child’s emotional and developmental status using the Ages and Stages Questionnaire (ASQ) as part of the health assessment. Where the nurse considers there may be mental or emotional development issues, the Ages and Stages Questionnaire - Social and Emotional (ASQSE) may be used to assess the child and to recommend appropriate services for referral if required. However in some instances, the nurse may need to use another assessment tool with the carer such as the parent’s evaluation of developmental status (PEDS).

    Where the nurse assesses that there are mental health concerns, you should consult the district psychologist to discuss the child’s mental health needs and services to which the child can be referred.

    Health Improvement Plan and recommended referrals from the health nurse

    The nurse will complete the Health Improvement Plan (on last page of Form 510), and return this and any referral documents to you within five working days of completing the health assessment.

    The Health Improvement Plan must include the significant findings from the health assessment, any recommended referrals and other actions the nurse suggests need to be taken and by whom, including if a follow-up appointment is required.

    Sexually transmitted infections (STIs)

    A community health nurse does not routinely ‘screen’ for STIs but if a need is indicated, the nurse generally refers to a GP. The Communicable Disease Control Directorate must refer any STI notification of a child less than 14 years of age to the Mandatory Reporting Service - refer to Chapter 2.2: Sexually transmitted infection notifications.

    If the nurse or a doctor also forms a belief that sexual abuse has occurred they must submit a separate mandatory report - refer to Chapter 2.2: Mandatory reports of child sexual abuse.

    As the STI notification relates to a child who is in the CEO’s care, you must commence a Duty of Care Notification. Refer to Chapter 4.2: Notification of death, serious injury or critical incident for details.

    It may be appropriate in some cases to consult with other agencies to determine the service provision and support to the child and family.

    Blood-borne viruses (BBVs)

    Blood-borne viruses include Human Immunodeficiency Virus (HIV), hepatitis B and hepatitis C.  If a child in the care of the CEO has an infection or is at risk of infection, ongoing and close consultation with medical personnel as well as the Department of Health, the Western Australian AIDS Council and/or Hepatitis WA should occur. Information relating to a child’s infection should be disclosed on a need to know basis only, preferably with consent of the child. In the case of a child, disclosure of any infection must be made to:

    • the child’s primary carer, including carer and residential care staff when the child in the CEO’s care
    • the case manager and team leader
    • the child’s parents, unless this is considered not in the best interests of the child. In this case the decision should be endorsed by the district director and documented
    • medical personnel involved in, or consulted about, the management and treatment of the infection
    • the relevant Executive Director and Assistant Director General where the child is placed in out of home or alternative care and the infected person’s behaviour constitutes a risk to others, or where a recommendation is made for testing.
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    The health assessment for a young person in detention or on remand

    A nurse will review the young person upon admission to the centre, and any urgent health needs will be addressed. If the young person requires a doctor’s review, an appointment must be made for the next available clinic. A physical assessment of the young person must be carried out by a GP within 28 days of admission.

    If you require copies of the health assessment reports for a young person, you can make a request on Department letterhead and email it to Central Medical Records – InformationRelease@justice.wa.gov.au.  

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    Obtaining a Medicare Card

    Overview

    A Medicare Card or number is usually required for claiming a Medicare benefit, visiting a GP who bulk bills, seeking treatment as a public patient in a public hospital, or having a Pharmaceutical Benefits Scheme (PBS) prescription filled.

    However, it is not necessary to provide a child in the CEO’s care Medicare Card or number to access medical treatment or to claim reimbursement for a Medicare service. The claimant (the person who incurred the expense for the service, such as the carer) can be paid a Medicare benefit for a service they paid for, even if the patient (child in care) is not enrolled on their Medicare Card.

    There is a range of Medical Benefit Schedule (MBS) services provided by GPs that are suitable at each stage of the assessment and care of children in the CEO’s care. These include general consultations, a range of health services, and chronic disease management services assessed through Chronic Disease Management Plans or Mental Health Treatment Plans. Refer to the table on the Commonwealth Department of Health website regarding MBS items available for the primary health care needs of children in out-of-home-care.

    You should also refer to the following in related resources:

    Medicare can be contacted on 1300 660 035 for any queries. You may be required to provide the Department's ID and current password.  The Commonwealth requires the password to be re-set every three months for security purposes.  To obtain the ID and password, contact the Authorised Officer via: medicare.child.protection@cpfs.wa.gov.au

    A child requires a Medicare Card

    You must apply for a Medicare Card as soon as possible for all children who enter the CEO’s care.  Refer to the related resource In the CEO's Care - Parental Responsibility Chart. Procedures to obtain a Medicare Card are outlined in the section ‘Completion of documentation’ below.

    Where the CEO does not have parental responsibility, children should be issued with a duplicate of their parent’s card if they are in a placement arrangement for longer than one month. Where access to the parent’s Medicare Card is not possible, you should apply to Medicare to obtain a duplicate of the parent’s Medicare Card. Refer to the Department of Human Services website for details on requesting a duplicate card.  

    Some doctors bulk bill patients, such as Health Care Card holders and children under 16 years of age.  If a child in care is taken to a doctor who bulk bills, the doctor can obtain the child’s Medicare Card number directly from Medicare Australia for billing purposes where it is not available.

    Alternatively, if the carer has paid for a Medicare service for a child in their care, they can be paid the Medicare benefit at a Medicare office by advising the officer that they have paid for the service. The carer will need to provide the child’s full name and date of birth so they can be identified on the database.

    A Medicare rebate cannot be claimed where you (or other child protection worker) takes a child in care to a medical practitioner that does not bulk bill and pays the patient account. You should ask the surgery if they will accept delayed payment. If the surgery allows this, refer to ‘Medical costs and processing medical accounts’ below for details.

    Children in care 15 years and older

    Once a young person in care turns 15 years of age, they can request a Medicare Card in their own right. You need to discuss this with lthe child as part of the planning for leaving care.

    Note: Once a young person has their own Medicare Card, they are liable for the account.  Advise the young person to attend a surgery that bulk bills where possible. However, if they attend a doctor that does not bulk bill or does not allow deferred payment, the carer should attend with the young person and pay the account. The carer can then claim urgent reimbursement from us as required – refer to ‘Medical costs and processing medical accounts’ below.

    The Department of Human Services website has details on transferring from one Medicare Card to another.

    Completion of documentation

    To obtain a Medicare Card, you must complete Medicare Form 045 - Enrolment or new Medicare number request for child protection agencies in related resources. The application should be sent by email to mps.eligibility@humanservices.gov.au with the following documents (if the documents are emailed, you must certify them as being true copies of the originals):

    • Form 330 Application for Medicare Card letter
    • a certified copy of the current court order in relation to the child - a copy of the s.35 warrant (provisional protection and care) issued by a magistrate can be used for this purpose
      • one proof of birth document for the child, which can include:
      • a certified copy of the birth certificate or extract
      • certified copy of a completed Newborn Child (Proof of Birth) Form - these are in the Parenting Pack given to all new parents in hospitals.  Click here for more information. 
      • certified copy of the child’s Passport or naturalised certificate
      • a document issued by the Department of Immigration and Border Protection
      • correspondence or documentation (hard copy) from Centrelink that verifies the child’s name and date of birth
      • a letter (on letterhead) from the doctor who attended the birth that verifies the mother’s full name and the child’s sex, date of birth, and place of birth
      • for a home birth, a letter from the midwife who attended the birth that lists the midwife’s name and qualifications, mother’s full name, and the child’s sex, date of birth, and place of birth
      • adoption papers – where migration status is known.

    Note the following in the application letter (Form 330) where the child has been taken into provisional protection and care under s.37 of the Act:

    “(insert child’s name) has been taken into the provisional protection and care of the Department of Communities under s.37 of the Children and Community Services Act 2004 as there was an immediate and substantial risk to (insert name)’s wellbeing".

    If a you require further information from Medicare on the enrolment process or iare unable to provide one of the above proof of birth documents, telephone 1300 660 035. For all general enquiries, telephone 132 011.

    You may again be required to provide the Department's ID and current password.  The Commonwealth requires the password to be re-set every three months for security purposes.  To obtain the ID and password, contact our Authorised Officer via: medicare.child.protection@cpfs.wa.gov.au.

    Provision of a Medicare Card to a carer

    Once received, the Medicare Card should be given to the carer for convenience of use, although the card remains the property of the Department on behalf of the child.

    The carer is authorised to make claims from Medicare on behalf of the child.

    Where a child is in the CEO’s care for less than one month, you should provide the carer with the child's Medicare number only (not a duplicate card).  This will need to be obtained from the child's parents.

    If a child requires a medicine on the PBS, it is a legislative requirement that the child’s Medicare Card number be provided to the pharmacist to determine the child’s eligibility. However, where it is not possible for the child or carer to provide Medicare Card details (for example, the card has been lost or stolen), a pharmacist can use a pharmacy only ‘Special Medicare Number’. With consent of the carer or child, the pharmacist can also telephone the Medicare Australia PBS enquiry line to obtain the child’s Medicare Card number.

    Medical costs and processing medical accounts

    The fortnightly subsidy paid to carers incudes an amount intended to cover basic general expenses for the child in the CEO's care.  These include expenses for personal hygiene items and basic general medical treatments (Panadol, Bandaids, etc.), and non-prescription medication when a child has a short term illness such as a cold - cough or cold medicine, etc.  Health assessments as part of the Health Care Planning pathway and ongoing medical treatment, diagnostic tests and specialist health services' costs are not covered by the basic subsidy payment.

    Where full payment for the health assessment is required, the payment options are:

    1. The carer pays for the health assessment and then claims the Medicare Benefit.  We reimburse the carer for the 'gap fee' for the health assessment.  Carers must provide receipts to child protection workers in a timely manner to enable reimbursement of the gap. 
    2. The health professional directly invoices the carer – the health professional must agree to this before the appointment.

    A Medicare Benefit cannot be claimed when you (or another child protection worker) takes a child in care to a medical practitioner that does not bulk bill or accept deferred payment. This includes children in Residential Care younger than 15 years of age.

    All young people in care over the age of 15 years who have their own bank account and Medicare Card can claim Medicare Benefits if they cannot use a service provider that bulk bills. If the service provider has the facility they can process the Medicare Benefit at the time, and the young person pays the balance.  If the service provider can't process the Medicare benefit, the young person must pay in full and claim online.  You must assist the young person to claim the benefit online.  In both instances you must arrange for reimbursement of the gap payment into the young person's bank account.

    If the child is in a Residential group home and does not have a bank account or Medicare Card, you need to arrange payment from case support costs for the service and cannot claim a Medicare Benefit. 

    Payment processes for medical accounts

    Refer to the flowchart Processing medical expenses from public providers and private practitioners (also access via related resources).

    The five options for paying medical accounts in order of preference are:

    1. GP or service provider who bulk bills for services
    2. GP or service provider who does not bulk bill or accept deferred payment, but the carer can meet the upfront cost for the service
    3. GP or service provider has a HICAPS machine for processing private health insurance rebates for carers who have the child in care on their private health cover
    4. GP or service provider accepts deferred payment
    5. GP or service provider does not bulk bill or accept deferred payment and the carer is unable to meet upfront costs.

    Carers can claim Medicare Benefits for a child who is not listed on their Medicare Card, but claims must be submitted by mail to Medicare. Claims cannot be processed through the surgery at the time of payment, or online.

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    Obtaining a Health Care Card

    Overview

    A Health Care Card (HCC) helps with the cost of prescription medications under the PBS and Commonwealth Government funded medical services. It also provides access to various concessions from government and private organisations. These include education and public transport concessions.

    The carer’s and/or child’s HCC must be used on all occasions where available.

    Carer's and child's eligibility for a HCC

    A carer and/or child are eligible for a HHC in the following ways:

    • A carer who is in receipt of the maximum rate of Family Tax Benefit (FTB) Part A or receives a specific Centrelink payment, such as Newstart Allowance or Parenting Payment, is eligible for a HCC. The card is issued automatically. In this instance, the carer should inform the Department of Human Services of the child, and the child’s name will be added to the carer’s HCC as a dependent.
    • Carers who are not eligible for a HCC can claim a Foster Child Health Care Card (FCHCC) on behalf of the  child. The FCHCC is not means tested and is issued in the name of the child for a period of 52 weeks. The FCHCC is automatically re-issued until a notifiable event causes cessation of the card - for example, the child leaves care or receives an income support payment. The carer is able to obtain concessions and services for the child only.

    Youmust assist carers to lodge a claim to obtain a FCHCC. You must complete and sign Form 024 - Centrelink Placement Notification Letter and fax it to the Families Processing Team at the Department of Human Services (Centrelink).  A copy of the child’s birth certificate and court order (a copy of the application for a court order will be accepted) should be provided to the carer for submitting with Form SS050 Claim for a Health Care Card. Refer to the Department of Human Services website for further information on the process.

    A child's eligibility for a FCHCC upon the granting of a protection order (special guardianship)

    Under the current Guide to Social Security Law (section 3.9.1.45), a child is considered to be in care when:

    • the child is not the natural or adopted child of the carer, and 
    • the carer is responsible for the day-to-day care, welfare and development of the child. 

    Therefore, a child that is subject to a protection order (special guardianship) retains eligibility for a FCHCC.  The child protection worker must inform the child and/or the special guardian of his or her eligibility. The special guardian will need to provide a copy of the court order and the child's birth certificate when submitting a claim for a FCHCC with Centrelink. 

    You can access more information about the FCHCC here, or via the link in related resources.

    Obtaining a HCC for a child in a residential care placement

    An Approved Care Organisation (ACO) such as the Department cannot qualify for a HCC for a child in the CEO’s care. However, a child in the care of an ACO may qualify for a Low Income Health Care Card in their own right, provided they are not considered dependent on an individual. That is, an individual in respect of the child is not receiving the Family Tax Benefit (FTB).

    Child protection workers must assist a child in residential care to complete Form SS050 Claim for a Health Care Card (in related resources or from the Department of Human Services website).  Steps to follow are:

    1. Answer questions from the perspective of the child - the child is the applicant
    2. Where the claim form asks if the applicant wants another person or organisation to act on his or her behalf when dealing with Centrelink, answer ‘Yes’
    3. Complete and attach Form SS313 Authorising a person or organisation to act or enquire on your behalf
    4. Where the claim form asks if a parent or guardian, or any other person is financially supporting the applicant, answer ‘No’.  Centrelink will check whether FTB is being claimed on behalf of the applicant and, if it is, will liaise with relevant parties on the most appropriate course of action (this may depend on the expected length of placement in the residential care facility)
    5. Attach to the Form SS050 Claim Form, a copy of the child’s birth certificate and the standard Department letter stating that the child is in the CEO’s care.  Submit the form to a Centrelink Customer Service Centre (link below or in related resources).
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    Strengths and Difficulties Questionnaire

    The Strengths and Difficulties Questionnaire (SDQ) is an important tool for assessing children's psycho-social needs and targeting interventions to address them.  The process involves collecting information from an adult who knows the child, such as a carer or teacher, or by young people themselves if they're 11 years of age or older (depending on their understanding).

    A SDQ must be completed once a child (aged 4 years and older) has been in care for six months (or earlier if they are settled in their care arrangement), and then on an annual basis. It is preferable to have the SDQ completed before the child's care plan review. Ideally, the annual SDQ should be completed at the time of conducting the annual health assessment review to get a better picture of the child's health and wellbeing for the development of the health plan (i.e. the information documented in the 'health' dimension of the child's care plan/provisional care plan).

    You should consult with a psychologist for children with disability to determine if this screening is appropriate. If it's not recommended, you must record this in the Child Information Portal (CIP) in Assist – refer to 'Recording' below.

    The preferred option for completion of the SDQ is through Viewpoint (see below). The carer/guardian, teacher or young person (if relevant) can complete the SDQ at any location with an internet connection using their mobile phone, other personal device or computer. 

    SDQ process via Viewpoint

    Refer to the Strengths and Difficulties Questionnaires Flowchart in related resources.

    Where the district has a Viewpoint Technical Officer (VTO), child protection workers must complete a Viewpoint Request for SDQ Form (also in related resources)

    The VTO or child protection worker setting up the Viewpoint SDQ must first obtain a unique 'Manager login' from the Assist Mentor or by emailing the Advocate for Children in Care -  judith.garsed@communities.wa.gov.au. Once the login is obtained, follow the steps outlined in the SDQ flowchart (in related resources).

    An email notification will be received once the SDQ is completed. A report on the scores can then be generated in Viewpoint. The results will provide a picture of the child's strengths and areas of difficulty. If the overall score is above 13/40, it indicates the need to consult with a psychologist.

    The SDQ report must be saved as a PDF and filed in Objective.

    Process when the SDQ cannot be completed through Viewpoint

    In some instances it may not be possible to have the SDQ completed through Viewpoint. For example, the carer does not have access to a mobile phone or computer with internet access.

    If it's not possible to have the SDQ completed through Viewpoint, you can arrange for the carer or guardian, teacher or young person (where appropriate) to complete a paper based SDQ.  You must print the relevant Viewpoint SDQ available under 'forms' in related resources:

    • Main Carer for YP 4 to 17 years
    • Teacher for YP 4 to 17 years, or
    • Young Person 11 to 17 years.

    Note: The child's name and name of the person who will be completing the SDQ needs to be printed clearly on the form.

    When completed, the responses provided on the SDQ form must be entered into Viewpoint by the child protection worker or Viewpoint/SDQ Technical Officer (VTO). An email notification will be received once the SDQ is completed in Viewpoint.  A report can then be generated in Viewpoint of the results. Log into Viewpoint to create the report (via Analysis). If the overall score is above 13/40, it indicates the need to consult with a psychologist.

    The SDQ report must be saved as a PDF and filed in Objective.

    Recording

    Whether the SDQ is completed through Viewpoint or on a paper-based form, you must record in Assist that the SDQ is completed. Under the health dimension of the CIP, record the 'Requirement Type' value as SDQ with the status of 'completed', and link to the document in Objective.

    Where a child has disability and the psychologist has not recommended the use of the SDQ, child protection workers should note this information in the health dimension of the CIP.

    Access to a private practitioner

    If a child requires ongoing treatment and the waiting time for access to our Psychology Services is considered too great given the presenting issues, it is possible to access services via a private practitioner. Child protection workers should follow the guidelines outlined in Chapter 4.2: Engaging with private practitioners for treatment/therapeutic services.

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    Dental health

    Children under school age (0 – 4 years)

    If the child has a comprehensive health assessment completed by a child health nurse, the assessment will include an oral health inspection.

    If the nurse finds that the child has oral health issues, she/he will complete a ‘Lift the Lip’ referral form. The referral form will be sent to you along with the completed Health Improvement Plan. Once received, the you must make an appointment for the child at the local public dental clinic for a dental check and treatment to be completed – refer below for details on this process.

    If another health professional conducted the comprehensive health assessment, you should make an appointment at the child’s local public dental clinic for a dental check – refer below for details on this process.

    Children of school age

    All children from kindergarten to Year 11 (that is, children who turn 5 in the first year of enrolment at school and until they turn 17 years old) are eligible for enrolment in the School Dental Service (SDS). Children in care attending Education Support Schools are also eligible for enrolment in the SDS until they reach 18 years old.

    All children in care who are school age and attend a school or facility recognised by the Department of Education should be enrolled in the SDS.

    You must complete Form 500 - Dental Treatment Notification and Consent (which includes the child’s medical history information) and forward to the General Manager, Dental Health Services (address details are provided on the form). Dental Health Services will then forward the Form 500 to the appropriate dental therapy centre to follow up. You must advise the carer (and parents if appropriate) of the child’s enrolment in the SDS program. 

    Dental Health Services will check the child’s clinical records and enrolment status, and will contact the carer and you to advise where the child is going to be seen for the dental check and any treatment required.

    Dental checks and treatment via a public dental clinic

    If a child requires a dental check or treatment, you can call Dental Health Services on (08) 9313 0555 for information on the closest public dental clinic to the child or refer to the Dental Health Services website (www.dental.wa.gov.au) under the Adult Dental Service heading and choose clinic locations.

    Dental Health Services will prioritise a child in care and apply the full subsidy rate. The following forms need to be completed and provided at the appointment:

    • Application for Dental Treatment (DS3) - available in 'Forms' in related resources
    • Form 500 Dental Treatment Notification and Consent (Note: do not post this form to Dental Health Services - it must be provided to the dental clinic).

    If the carer is attending the appointment with the child, they should be reminded to take the Child Health Passport.

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    Filing and recording

    You should place health assessment reports and other relevant documentation from the health checks in the Child History Folder, after they have been scanned to Objective by the Business Administration Team at their district.  The scanned documents are added to the Child History File in Objective by the Records Management Quality Assurance Team (refer to Chapter 4.1 Recording Obligations).  Note: forensic health reports, psychology assessment reports and any context pertaining to neglect or abuse are not placed in the Child History Folders or Files (refer to Chapter 3.4 Child history folder and child history file and Administration Manual 6.1 Storage, retention and disposal of source documents – day files).

    You must update the health dimension in the child’s Child Information Portal (CIP) in Assist to record the status of each relevant health care planning process being undertaken or completed. The ‘Requirement Type’ values and corresponding status in the CIP are: 

    • Initial Medical Assessment – completed before the child enters care; in process; completed; or unable to complete.
    • Health and Development Assessment – under the care of a health team; in process; completed; or unable to complete (if recorded as ‘under the care of a health team’ or ‘unable to complete’, the child’s health needs must be reviewed quarterly).
    • SDQ – in process; sent to psychology services; or completed.
    • Mental Health Practitioner involvement – active involvement; or inactive.
    • Oral Health – enrolled in SDS; or attending public dental.

    You must note the reason in the CIP for any ‘Requirement Type’ with a status of ‘unable to complete’. In addition, details of the child’s overall health and any referrals that need to be actioned must also be recorded. The latest health assessment reports in Objective must be linked to the CIP in Assist.

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    Developing the health plan

    The health plan will be based on the findings and recommendations outlined in the relevant health assessment reports. 

    The health plan should list the identified health needs of the child and the planning decisions and steps to meet those needs for the next 12 months. If required, you should consult with relevant health professionals when developing the health plan. Where the child has a number of health needs, a discussion may help prioritise which issues need to be addressed first.

    You may use a 'file note' to document the health plan for the child, and this can be taken to the care plan meeting for discussion with all parties. The health care planning decisions and actions must be documented in the health dimension in the child’s CIP.  These will auto-populate into the provisional care plan or care plan - these may be edited and amended as required before approval.  

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