High-risk infants

Follow this procedure when working with high-risk infants.

Introduction

See High-risk infants – advice for further information.

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.

Age is not the only factor contributing to the greater risk of harm to young infants. Infants’ vulnerability can be compounded by environmental and other risk factors. If one or more risk factors are present, a clear plan needs to be in place to define and document protective factors, including demonstrated links to effective social and professional support.

A case meets the requirements of ‘high risk’ if a child is younger than two years and risk factors are present, and if the severity and cumulative impact of these risk factors affects the child’s safety and development.

The decision to close a case involving a high-risk infant, at any phase, must be endorsed by a practice leader or more senior practitioner (for example, an area manager, a principal practitioner).

Procedure

Intake case practitioner tasks

  • Obtain information where practicable about the infant’s perinatal health (from 20 weeks gestation to 28 days after birth). Consider contacting the hospital where the infant was born, the maternal and child health service or other health professionals who have access to information about the infant’s perinatal health.  
  • Contact interstate child protection services to ascertain protective history for the infant or siblings, if the infant or siblings were born interstate.
  • Consider whether to recommend to your supervisor that the infant be categorised as a high risk infant.  If so, record this on CRIS.

Case practitioner tasks

  • Consider consulting a practice leader and principal practitioner about the assessment and plan.
  • Consider referral for: 
    • placement on the high-risk infants schedule
    • Parenting Assessment and Skill Development Service (PASDS)
    • Cradle to Kinder intensive ante and postnatal support service.
  • Prior to closure, consider convening a case conference to confirm arrangements for ongoing protection and support.
  • Prior to closure, consult with your supervisor or practice leader regarding the removal of the high-risk status on CRIS.  Record the rationale on CRIS.
  • Seek endorsement for case closure decision from a practice leader or a more senior practitioner.
  • Complete CRIS requirements including mandatory screens and records of activity, decisions and rationales.

Investigation case practitioner tasks

  • See procedure First visit for tasks that must be undertaken.
  • Consider whether to recommend to your supervisor that the infant be categorised as a high-risk infant.
    • Observe the infant’s physical and emotional presentation. Observe the infant’s interaction with each parent or caregiver.
  • Where there are allegations of physical abuse or neglect, ask the parent or caregiver for consent to conduct a thorough visual examination of the infant.
  • Where the report relates to an infant who is asleep at the time of the visit, request permission to observe the child to check their immediate wellbeing and make a time for a follow up visit. If the report relates to serious abuse or neglect, request the parent wake the child for a visual examination.
  • Consult your supervisor if visual examination is denied. Record consultation and decisions in CRIS.
  • Refer the infant for forensic medical examination if visual examination indicates non-accidental injury (from physical abuse or neglect) with parental permission or via a protection application. Contact the Victorian Paediatric Medical Service or local hospital to arrange an examination. See Medical and forensic examinations - advice.
  • Refer a non-crawling baby with bruising for medical examination unless there is a compelling reason not to.
  • Complete a SIDS safe sleeping and environment assessment and provide parents/carers with information about safe sleeping. (An easy-to-read brochure can be downloaded at: www.sidsandkids.org/safe-sleeping). See SIDS and safe sleeping - advice.

The SIDS risk assessment should be repeated for all places where the child sleeps and should be revisited on a regular basis.  

Supervisor tasks

  • Endorse a decision to categorise an infant as a high-risk infant.
  • Beyond intake phase – convene and chair a case conference to develop a case plan.
  • Ensure a forensic medical examination is undertaken (either with parental consent or through a protection application) for a child under two years of age where visual examination suggests non-accidental injury. Bruising on a baby who is not yet crawling should be medically examined unless there is a compelling rationale not to.
  • For all cases, obtain the endorsement of a practice leader or principal practitioner prior to closing the case.

Practice leader or principal practitioner tasks

  • Participate in case conferences and provide consultation to assist assessment when requested.
  • Endorse decisions to close high-risk infant cases.

 

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