High-risk infants - advice

This advice provides additional information regarding working with children under the age of two years.

Introduction

See procedure High-risk infants for tasks that must be undertaken.

Children aged under two years are over represented in child protection reports and protection applications. The fragility and developmental dependence of young infants significantly increases the potential for harm.

Where a child is less than two years and risk factors are present and where the severity and cumulative impact on the child is affecting their safety and development, the case meets the requirements of ‘high-risk’. See Infants and their families for additional information.

Identifying high-risk infants

Age alone does not define or indicate high-risk for an infant. The vulnerability of an infant under two years old may be compounded by the presence of environmental and other established risk factors. The presence of these risk factors, or your or other’s observations of trauma indicators, increases risk and potentially compromises an infant’s safety and wellbeing.

Generally, it is the interaction of multiple risk factors which contributes to critical endangerment for an infant. For example; where a young single mother lacks access to competent and supportive extended family or other supports, where there is transience, where a parent with mental illness and/or substance use issue does not receive effective treatment and support. However, the nature of some risk factors, such as violence, untreated serious parental mental illness or serious drug use by a parent of other household member, means that even in isolation they may present significant risk to an infant, potentially calling for direct, timely intervention. Where any of those more fundamental risk factors is present in the home, safety planning must include validated evidence of protective factors, including clearly defined and demonstrated links to effective social and professional support.

Other risk factors that should be considered in assessment include:

  • prematurity and perinatal health issues
  • complex medical needs of the infant
  • unsafe sleeping environments
  • exposure to smoking in the home
  • a history of another child being removed from a parent’s care
  • the death of a child within the home
  • parental substance and alcohol abuse
  • family violence
  • parental mental illness where there is an absence of effective treatment, support and supervision
  • negative parental beliefs about this particular infant
  • parental intellectual disability
  • parent/carer under 20 years or under 20 years at birth of first child
  • parents’ lack of willingness or ability to prioritise the infant’s needs above their own
  • rejection or blaming of the infant by the parent
  • evidence of harsh, inconsistent discipline, neglect or abuse including toward other children
  • inadequate supervision of the infant or other children or parental emotional enmeshment (i.e. parent’s inability to distinguish personal emotional needs from the infant’s needs and capacities)
  • social isolation
  • indiscriminate partnering with adults who have a criminal history or other concerning behaviour - where there is evidence that a parent’s capacity to make sound decisions regarding their infant’s exposure to others is compromised, a police history check on persons having contact with the infant may be appropriate
  • inadequate antenatal care
  • a low level of education completed by the parents (below Year 9)
  • parents’ history of trauma, abuse or neglect with or without a history of being in state care.

For an infant aged under two years where these or other risk factors are present and the severity and combined impact on the infant significantly undermines their safety and development, the case may meet the definition of a high-risk infant.

The decision on whether an infant should be categorised as a high-risk infant is significant and has implications for case decisions and case planning.

Referral to the divisional high-risk schedule

Of the total cohort of children defined as high-risks infants, a smaller number may be referred for registration on the divisional high-risk schedule. The decision to register a client on the high-risk schedule is made by the chairperson of the high-risk panel (generally the area manager). Where a practitioner identifies a case which meets the criteria above and where there is inadequate safety to address the risk, they should discuss the appropriateness of referral to the high-risk schedule with their supervisor. See procedure High-risk panels and schedules for tasks that must be undertaken.

Under threes

The first three years of an infant’s life is a critical developmental period. Practitioners and managers should consider this advice in working with vulnerable infants over the age of two years.

Service responses

Initiatives to improve the quality of services delivered to infants at risk of significant harm from maltreatment include:

  • Practice leader and principal practitioner positions support and assist child protection practitioners to enhance service delivery to infants and promote networks with the wider service system. Practice leaders have specialist expertise in assessments and case practice and can provide secondary consultation, attendance at joint interviews and case conferences, and professional development.
  • Parenting Assessment and Skill Development Services (PASDS) for families who are caring for infants known to child protection and assessed as being at high-risk. These services are divisionally based and consist of:
    • a parenting capacity assessment service — the assessment informs child protection decision-making and, in many cases, allows the mother and infant to reside together, with intensive supports, while the assessment of parenting capacity is undertaken; and
    • a parenting skill development and education and support service — the results of the assessment process inform a tailored skill development program to assist the family to acquire the skills to care for the infant in a safe and nurturing manner.
  • The Cradle to Kinder intensive ante and postnatal support service to provide longer term, intensive family and early parenting support for a group of vulnerable young mothers and their children.
  • Health assessment initiative for children entering out-of-home care.

Information gathering

The Best Interests Case Practice Model guides practitioners to obtain and document a comprehensive family history and medical history. The medical history during pregnancy and in the early weeks following birth can be critically relevant to risk assessment of the infant.

Practitioners allocated a high-risk infant must take the time to read the complete client file, to gain a clear understanding of the case history, family and social networks, past crises, planning and treatment interventions and outcomes.

Contact with the child for the purpose of assessing risk

See procedure High-risk infants for tasks that must be undertaken.

Observations of the infant should include consideration of:

  • their behaviour (appropriateness of behaviour)
  • responsiveness to parents and others in the home
  • child's development against normative developmental trends
  • physical appearance
  • emotional presentation.

Meeting to develop a case plan

In cases involving a high-risk infant, a case conference involving all relevant parties should be held at substantiation to contribute to developing the child's case plan and actions table. The meeting should be chaired by a supervisor (CPP5 or above) and documented in CRIS. Practitioners should use critical reflection, and progress and outcomes should be reviewed on a regular basis and as required by legislation. See Case planning - advice for further information.

The meeting should:

  • consider the immediate and future risks to the child's safety and development
  • identify the causes of harm or risk
  • identify the strategies, support agencies and other resources to address the risks to meet the child's safety, developmental needs and provide for their care and wellbeing
  • establish information sharing arrangements, appropriate monitoring and review mechanisms, and support systems relevant to the permanency objective and goals
  • identify the roles and responsibilities of the case manager and other professionals and agree on timelines for tasks to be completed
  • establish contact and monitoring arrangements with the child and the family.

The decisions of the meeting should be recorded in CRIS in the case plan and actions table, endorsed and provided to all parties who attended the meeting and key people who were absent.

Reducing risk of sudden infant death

See advice SIDS and safe sleeping.

Case closure involving a high-risk infant

In cases involving high-risk infants, case closure in all phases is a decision of particular significance and requires attention to both the decision itself and the closure process. In high-risk infant cases which proceed to protective intervention or beyond, a case conference should be held prior to case closure to review the case plan (which can be used as the closure plan) to confirm arrangements for ongoing protection and support.

In all cases involving a high-risk infant, the case closure decision must be endorsed by a practice leader.

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