What is the child health passport?
The child health passport refers to a process, as well as a document.
The child health passport process commences with the collection of a child's essential health information, when a child is placed in out-of-home care under the Child Protection Act 1999. The child health passport process incorporates:
· gathering essential health information about the child
· preparing the child’s health care file
· deciding whether a health appraisal or health assessment is required
· arranging a health appraisal or health assessment
· arranging a dental appraisal or dental assessment
· the involvement of child, parents and carer in the health assessment
· preparing the child health passport folder
· arranging health assessments
· arranging required follow up appointments and assessments, if applicable
· including information about a child’s identified health and dental needs when completing the child’s strengths and needs assessment and developing or reviewing a case plan
· collecting non-essential health information.
The child health passport is also a folder, containing a copy of relevant documents applicable to the child’s health. It is provided to the child’s carers to enable them to adequately respond to the child’s health needs for the duration of the out-of-home care placement.
What is the health care file?
The health care file is a physical client file that contains the original documents relating to the child health passport process. All original documentation associated with the child health passport process is filed on this file, due to freedom of information and audit requirements.
What is covered within the child’s health assessment?
The standard health assessment process usually undertaken by a health professional for children in the general community is acceptable. The Well Child Health Check or Healthy Kids Check for children who are four years old entail an assessment of a child’s physical health, general well-being and development, with the purpose of initiating medical interventions as appropriate. Examinations and assessments include:
· an assessment of the child’s general physical health including their height and weight
· visual and hearing screens
· an appraisal of the child’s developmental milestones.
Professionals who may undertake the health assessment
The child’s health assessment may be conducted by a range of health care professionals, including:
· general practitioners and general practice nurses
· indigenous health services
· Royal Flying Doctor Service and outreach paediatric clinics
· paediatricians
· child health nurses
Where a child is already being seen by a paediatrician or other health professional, it may be more appropriate that they undertake the assessment. If a child has a regular general practitioner and has been seen recently, a health appraisal will determine whether or not they need a full health assessment. A child may not require a full assessment if their health professional is regularly reviewing and monitoring their health.
If a child has a regular general practitioner but has not been seen recently, it may be preferable that this GP completes the assessment to ensure continuity of care.
The child’s cultural needs are an important consideration potentially informing the decision about the most appropriate health professional to undertake the health assessment. Having the health assessment completed by a culturally appropriate service can provide another link for the child to their cultural community.
If the child is Aboriginal or Torres Strait Islander, it may be more appropriate that the health assessment process is undertaken by an Aboriginal Medical Service, Indigenous health service or a culturally sensitive general practitioner.
The same considerations apply when referring a child from any cultural background for a health assessment.
The child’s case plan is also likely to influence which health professional is engaged to conduct a health assessment. For example, when a young person is transitioning from care, considerations may include:
· linking them to a health professional that could manage their health care needs after they exit care
· whether the proposed health service bulk bills so that money does not prevent the young person accessing their doctor, following their transition from care
· if the young person is living independently, engaging them with a health service that is close to public transport.
The overall goal of the case plan is another consideration potentially informing the decision about the most appropriate health professional to conduct a health assessment. For example:
· when the goal is reunification, it may be appropriate to use the parents’ health care provider or a health service located close to the parents’ residence
· when the goal is long-term out-of-home care, it may be appropriate to use the carers’ usual general practitioner.
Deciding the most appropriate health professional to undertake the health assessment ultimately requires professional judgment by the case worker, having regard to the above-mentioned considerations and the views of the child, parents and the carers.
Available health services
It is important to be aware of the local health services where a child can be referred for a health assessment, and some initial mapping and documenting of the health services in the local area may be necessary. In addition, the Child Protection Liaison Officer (CPLO) from Queensland Health may be able to provide advice about local services and processes, such as the ‘Well Child Health Check’ (WCHC).
The WCHC is a free health assessment process offered by Queensland Health to all Indigenous children in the community. The WCHC is only available in Queensland Health’s Northern Area Health Service, which covers all of the department’s Far Northern and Northern Zones and parts of Central Zone (Bowen, Whitsunday and Mackay).
Dental assessment or appraisal
The goal of a dental assessment is to maintain good oral health and prevent problems from becoming serious, by identifying and treating them as soon as possible. All Queensland resident children four years of age or older who have not completed Year10 of secondary school are eligible for publicly funded oral health care via Queensland Health's Child and Adolescent Oral Health Services (previously referred to as the School Dental Program).
Children younger than four years of age and those who have completed Year 10 of secondary school are also eligible for publicly funded oral health care if they are dependents of current concession cardholders or hold a current concession card themselves.
Australia's National Oral Health Plan 2004 - 2013 recommends children and adolescents receive at lease one course of general oral health care every two years.
Sources of ‘essential’ health information
When a child first enters out-of-home care, departmental officers will, at times, collect the child’s essential health information, that is, information that:
· assists the child’s carers in responding to the child’s immediate health needs
· informs the conduct of a health assessment, if required.
Sources of essential health information include:
· the child’s parents
· the child’s relatives, where parents are not available to provide information or the information provided by parents is minimal
· the child's Queensland Health ‘Personal Health Record Book’ (red book), given to a mother upon discharge, following the birth of a baby.
If the parents and relatives are unable to provide the required information, a formal request of the child and family’s health history can be made of the local Queensland Health CPLO.
If it is identified that a child or parent has an infectious or communicable disease, consider any risk to the child, parents and carer (including the carer household) and implement strategies to mitigate identified risks.
Details of the child’s immunisation status may be obtained through either:
· Medicare Australia, Australian Childhood Immunisation Register (only holds records of vaccinations given to children under seven years of age)
· Vaccination Information Vaccination Administration System (VIVAS) which also provides details of the National Immunisation Program Schedule, or
· the child’s current health professional.
An Immunisation History Statement from Medicare Australia, can be obtained by sending a request by fax to the Immunisation Register on agency letterhead with either of the following:
· a copy of the current order showing the child is in the care of the chief executive
· a statement in the request letter advising that the chief executive has custody or guardianship of the child.
Medicare Australia will require a copy of the child’s birth certificate if available, Medicare card number if known, and any aliases, together with anything else to assist to identify the child on the Immunisation Register database. The request should be faxed to (02) 6124 6672.
Circumstances prompting the collection of ‘non-essential’ health information
Following the initial health assessment, departmental officers gather additional, non-essential health history on the child and their family.
Circumstances prompting the collection of non-essential health information may include:
· the health professional requests specific information in order to make a diagnosis
· the child is having a medical procedure and a detailed health history is required
· the child is going away on a school camp or excursion
· a young person is transitioning from care and a complete health history is not recorded on departmental files
· the completion of referrals to support services, for example Evolve
· preparation for a family group meeting.
Medicare items
The child health passport process recognises that completion of an assessment may take more than one visit to a practitioner and cannot be equated to a single contact. A large number of Medicare items are appropriate for various aspects of the health care of children and young people in out-of-home care and suitable at each stage of the child health passport assessment process.
A list of items, as guidance only, is located as Appendix C in the National Clinical Assessment Framework for Children and Young People in Out-of-Home Care located: National Clinical Assessment Framework for Children and Young People in Out-of-Home Care (OOHC) - March 2011.
As the list of items is for guidance only, full eligibility criteria can be found at MBS online (http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Medicare-Benefits-Schedule-MBS-1).300
Bulk billing available for an Aboriginal or Torres Strait Islander child
When assessment is for an Aboriginal or Torres Strait Islander child, the health professional may use either of the enhanced primary care items for Indigenous children when billing for this assessment:
· item No 708 for indigenous children 0-14 yrs
· item No 710 for indigenous young people 15 yrs and over.
Key linkages based on the outcome of the child’s health assessment
Where appropriate and relevant, the outcome of the child’s health assessment informs the development of:
· the child’s strengths and needs assessment
· the child’s case plan, including reviews
· the placement agreement, including reviews
· the Education Support Plan, if applicable, including reviews
· a referral to Evolve, if applicable
· a submission for a transitional placement or flexible funding, if applicable.
Use of medical assessment tools
The health professional undertaking the health assessment is able to use any available tool to inform the health assessment. Some examples of the tools available to health professionals include the ‘Well Child Health Check’ or an ‘Age Appropriate Assessment’ tool. For mental health screenings, health professionals also have a choice of tools and these might include the ‘Strengths and Difficulties Questionnaire’, ‘Ages and Stages Questionnaire’ and the ‘Kessels 10’ tool.
The health assessment may be referred to in various ways including baseline health assessment, child health check, health screen, universal child health check or Well Child Health Check. Despite the differing terminology used by health professionals, the assessed domains are consistent.
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