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3.2.8 Medical or dental treatment - including immunisations

Last Modified: 07-Aug-2019 Review Date: 29-Oct-2010

Purpose

To inform child protection workers of the delegations and procedures for giving consent for children who are under the parental responsibility of the Chief Executive Officer (CEO) requiring medical or dental examinations and treatment including immunisations.

The guidelines also provide information on how to obtain immunisation records for children subject to a protection order (supervision) or where the CEO has parental responsibility.

Practice Requirements

  • You must determine who has parental responsibility for the child and thus holds the authority to consent on behalf of the child.  Refer to the related resource In the CEO’s Care - Parental Responsibility Chart.

  • Each negotiated placement agreements (NPA) must be checked to ascertain if it expressly authorises the CEO to consent to medical or dental treatment and immunisations in lieu of the parents.

  • In the two following circumstances, written consent for the relevant treatment or immunisation must be obtained from the parents:

    • If the NPA does not authorise the CEO to consent to medical or dental treatment and immunisations, and

    • where the child has been provided with a placement service under s.32(1)(a) and is therefore in the CEO’s care but the parents retain parental responsibility and approval cannot be provided by the CEO.  

Process Maps

Not applicable

Procedures

  • Authority and delegations for consent
  • Overview
  • Parental involvement
  • Medical checks and emergency treatment
  • Dental treatment at a public dental clinic
  • Immunisation
  • Obtaining a child's immunisation records from the Australian Childhood Immunisation Register (ACIR) - Medicare
  • Authority and delegations for consent

    Section 127 of the Children and Community Services Act 2004 (the Act) authorises the CEO to give consent (in lieu of a parent) for a child to undergo medical or dental treatment, including immunisations, where that child is:

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

    The CEO has delegated the authority to child protection workers to approve medical/dental treatment and examinations (including immunisations), where anaesthetic consent and/or an operative procedure is not required for a child for whom the CEO has parental responsibility.

    In situations where a child requires surgery or anaesthetic (other than local anaesthetic for dental treatment), child protection workers should follow the procedures set out in Chapter 3.2: Operative procedures and anaesthetic consent.

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    Overview

    Medical and dental examination and treatment includes:

    • any dental examination and treatment (including dental fillings) that includes local anaesthetic only
    • a medical examination and/or treatment that does not include an anaesthetic or operative procedure
    • an immunisation.

    Medical and dental practitioners seek parental consent as necessary. If ongoing examination or treatment is required, consent is usually be sought at the initial visit. The practitioner will request additional consent as required.

    You must advise practitioners of the child’s known medical history, including any medications being taken, prior to the child receiving treatment.

    Medical and dental reports provided to child protection workers, including immunisation records, must be placed on the Child History Folder and a copy scanned to the Child History File. A copy of medical reports or information from reports may be provided to relevant parties (for example, a copy may be provided to parents and/or foster carers if appropriate).  

    You must update the Quarterly Care Review (QCR) in Assist and the Child Health Passport to include any new health information. 

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    Parental involvement

    Where it is possible and appropriate, parents should be advised when it is known that a child needs to have a medical or dental examination and/or treatment, including immunisation.

    If the parents disagree and the matter is contentious, you must discuss this with your team leader. The best interests of the child should be the determining factor.

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    Medical checks and emergency treatment

    As part of the health care planning process, when a child first comes into care they will have a general medical examination followed by a health and development assessment. The child will then have a health and development assessment on an annual basis before the care plan review. Child protection workers arrange and provide consent for the medical check and health assessment. For details, refer to Chapter 3.4: Health care planning

    A carer can take a child to see a medical practitioner for a medical check, short-term illness (such as influenza) or emergency treatment (for example, a broken bone), without the consent of the child protection worker, but the carer must inform the child protection worker as soon as possible afterwards. 
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    Dental treatment at a public dental clinic

    If a child needs a dental check and/or treatment (and it cannot be provided through the School Dental Service for school age children), they can be seen at a public dental clinic.

    Dental Health Services prioritise referrals for children in care and apply the 100% subsidy rate.  

    1.  Call Dental Health Services on (09) 9313 0555 for information on the closest public dental clinic or view the Dental Health website under the Adult Dental Service heading and choose clinic locations.

    2.  Complete the following forms and provide at the appointment:

    If a child requires a dental procedure that involves a general anaesthetic, then a submission for anaesthetic consent is required. Refer to Chapter 3.2 Operative procedures and anaesthetic consent.

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    Immunisation

     

    All children in the CEO's care must have all necessary vaccinations according to the WA Health Childhood Immunisation Schedule, unless there are contraindications on medical advice.

    The Department's policy is in line with WA Health and the National Immunisation Program, which aims to reduce the number of cases of diseases that are preventable by vaccination in Australia.

    Immunisation is a simple, safe and effective way of protecting children against harmful diseases that can cause serious health problems in the community.

    Vaccines, like other medicines, can have side effects. However, the vaccines currently used in Australia provide benefits that greatly outweigh their risks. Most side effects after vaccination are minor and serious reactions are extremely rare.  Having children immunised offers protection against the most serious childhood infections.

    The Department's policy is to ensure that all children in care where the CEO has parental responsibility, i.e. children in provisional protection and care, children on a protection order (until 18) and protection order (time limited), have the necessary vaccinations according to the WA Health Childhood Immunisation Schedule, unless there are contraindications on medical advice. 

     

    Children and young people in the CEO's care must meet immunisation requirements for carers to receive child care fee assistance and Family Tax Benefit Part A.

     

    This can affect a carer's eligibility for these payments where they receive the payment for a child in care and that child is not fully immunised, unless there are contraindications on medical advice.

    Child protection workers must make sure that children in the CEO's care are immunised (unless there is an exemption for medical reasons from a doctor or immunisation provider).

    Vaccines recommended by the National Health and Medical Research Council (NHMRC) for children are funded by the Australian Government and provided free of charge. Immunisations can be obtained from Community Health Clinics, general practitioners (GPs), Regional Public Health Units, some Local Government Councils and Aboriginal Community Health Services. Note that GPs may charge a consultation fee.

    School-based vaccination program 

    The Year 7 school-based vaccination program is provided free of charge. GPs can offer this vaccination for students who did not or could not access it through the school program.

    Immunisation providers will seek consent for immunisations as required. If an immunisation provider requests written consent, you can complete Form 589 Immunisation Consent Form. The form must be signed and forwarded to the immunisation provider directly, or given to the carer or support person who will attend the appointment with the child. 

    If the carer is taking the child to the appointment, you should remind them to take the Child Health Passport so it can be updated by the immunisation provider.

    The Childhood Immunisation Schedule (funded by the National Immunisation Program) lists the vaccines recommended for all children from birth to 5 years of age.  For information about immunisation providers and/or for appointment bookings:

    • visit the WA Department of Health website - Where can I get immunised? 

    • call the Central Immunisation Clinic in West Perth on (08) 9321 1312

    • call the local Public Health Unit in your region.

    Flu vaccinations

    Influenza, commonly known as flu, is a highly contagious disease caused by the influenza virus. The influenza virus changes each year and protection provided by the previous year's vaccine diminishes over time.

    Children are at higher risk of serious complications from the flu. Children who become infected can develop serious illnesses, including convulsions (seizures or fits) and diarrhoea.

    Advice from the Commonwealth Government's Chief Medical Officer and the WA Health is that annual flu vaccination is recommended for all people 6 months of age and older.

    Unless there are contraindications on medical advice, child protection workers must make sure that all children in provisional protection and care and children under a protection order (until 18) and protection order (time limited) receive the flu vaccine each year.

    WA Health advice is that the only reason for a child not to have the flu vaccine is following a severe (anaphylaxis) reaction to a previous dose of flu vaccine, or to any component of any vaccine. Allergic reactions to the flu vaccine are rare. If unsure, child protection workers should seek advice from the child's GP.

    As influenza usually occurs from June, with the peak around August, vaccinating from mid-April will allow children to develop immunity before flu transmission is at its peak.

    The following groups are eligible to receive free government funded flu vaccinations:

    • Children aged 6 months to less than 5 years
    • Aboriginal people 6 months and older
    • Children 6 months and older with certain medical conditions that put them at risk of severe flu, including:
      • heart and kidney disease
      • chronic respiratory conditions
      • chronic illnesses that required regular medical attention or hospitalisation in the previous year
      • chronic neurological conditions
      • impaired immunity
      • children aged 6 months to 10 years receiving long-term aspirin therapy.

    Further information about the flu vaccine for children can be found on the website Healthy WA.

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    Obtaining a child's immunisation records from the Australian Childhood Immunisation Register (ACIR) - Medicare

    The Australian Immunisation Register (AIR) records details of vaccinations given to people of all ages who live in Australia. Immunisation providers use the AIR to check and update the immunisation status of a child.  Parents and guardians can obtain a copy of the child’s immunisation details at any time (AIR history statement).

    Child protection workers can also telephone the Austrial Immunisation Register Wards of State enquiry line 1800 037 723 for information.

    Once a child has been issued with a Medicare card, you can access the child's immunisation records from AIR. If access is required before the Medicare card is issued, complete Form 595 – Letter of Authorisation to Obtain Immunisation Records and send to WA Health. For more advice, contact AIR Skill Group WOS on 1800 037 723.

    Obtaining an immunisation history statement for a child where the CEO has parental responsibility

    Evidence of care for a child under the parental responsibility of the CEO (for example, a Children’s Court order) is not required to obtain an immunisation history statement when the child's Medicare card has been amended to show the child's current address details as that of the Department. In this instance, child protection workers must complete Form 593 Authority to Obtain Immunisation Records and fax it to AIR on (08) 9214 8222.

    If evidence of care is required to obtain an immunisation history statement for a child under the parental responsibility of the CEO, you must complete Form 595 Letter of Authorisation to Obtain Immunisation Records and fax it to AIR - (08) 9214 8222 - with a copy of the current court order.

    If a current court order cannot be provided, complete Form 595 to advise that the Department is the responsible guardian for the child.  You must also send a copy of the child's birth certificate (if available), Medicare number (if known), any other name the child may be known as, and any other information that may help Medicare to identify the child on the AIR database.

    You must update the Child Health Passport once the immunisation history statement is received, and scan and save a copy to the Child History File in Objective and place the original document in the child's Child History Folder.

    Obtaining an immunisation history statement for a child who is the subject of a protection order (supervision)

    If the child is under a protection order (supervision), you can request the child's immunisation records from AIR on behalf of the parents. you must obtain the parent's written authorisation. The parents must complete and sign a Form 594 Authority to Obtain Immunisation Records (Parental) and fax it to AIR - (08) 9214 8222 with a copy of the current court order.

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