This information relates to children in kinship care, residential care, home-based care and lead tenant but is not applicable to a child in out-of-home care on a childcare agreement (voluntary placement) where parents retain their parental responsibilities and must be consulted and provide permission for medical treatment including administration of medication.
See procedure Consent for medical examination and treatment for tasks that must be undertaken to ensure appropriate consent is provided when arranging medical examinations and treatment for children involved with child protection.
Children in out-of-home care must have their medical and dental needs met.
Decision-making
Where a child is in an out-of-home care placement as a result of:
- an interim accommodation order
- a family reunification order
- a care by Secretary order
- a long-term care order, or
- a therapeutic treatment (placement order),
decisions regarding the provision of any medication rest with the Secretary (or delegate) or a person in a CSO authorised by the instrument of authorisation for community service organisation. See Authorisation for CSOs to provide medical consent - advice. Child protection is required to act in the best interests of the child and may authorise the administration of prescribed medication even where parents object, on the advice of a registered medical practitioner (s. 597(3), CYFA).
Where a parent objects to the administration of any medication, the practitioner is to discuss this with the team manager. Parents are to be advised of their right to seek a review of the decision and of complaint mechanisms.
Young people
In some circumstances, older children with sufficient maturity and understanding of their medical situation and the proposed treatment are legally able to request or decline treatment without the endorsement of parents or guardians. The powers of the Secretary or their delegates or an authorised CSO under s. 597 of the CYFA do not displace the ability of a competent child to request or refuse treatment. Where such instances involve children on protection orders and the treating doctor believes the child’s decision will place them or their health at risk, the medical practitioner should consult child protection.
Where there is concern that the child’s actions or decisions will place them or their health at risk, this must be brought to the attention of the relevant team manager in child protection. Legal advice should be sought if 'no treatment' places the child at risk.
Involving and informing parents
In relation to involving parents about medical issues for a child in out-of-home care, including medication, as always, the paramount consideration is the best interests of the child. This includes considering, and giving the child’s views and wishes such weight as is appropriate to the circumstances.
Where a child is in out-of-home care under an interim accommodation order, a family reunification order, or a therapeutic treatment (placement order), child protection has an obligation to engage any parent with whom the child is intended to be reunified, to the fullest extent possible, in case planning decisions for their child (s. 175C of the CYFA). This means parents would usually be, as soon as possible, informed, consulted and appropriately involved in any medical treatment, including administration of medication needed by their child.
For children in out-of-home care under any of the protection orders or a therapeutic treatment (placement) order (that is, not under an IAO), child protection has a responsibility to provide information to parents about the child (s. 178(1) of the CFYA).
However, as set out in s. 178(2) of the CYFA, child protection is not required to provide information to a parent about the child, including the provision of personal information if:
- a child over 12 years does not consent and their refusing consent is considered reasonable, or
- it is not in the child’s best interests to provide the information, or
- an order dispensing with service of all documents (under s. 531 of the CYFA) to that parent has been made.
The provision or disclosure of children’s health information also needs to be consistent with the health information sharing principles in the Health Records Act 2001. For further information see advice Information Sharing in child protection practice.
An important task for practitioners is to gather detailed and accurate information on the health needs and medical history of children entering out-of-home care. For kinship care placements this information is recorded on the client profile located in the Case Practice component of CRIS. For foster care or residential care placements this information is recorded on the looking after children (LAC) essential information record (EIR) located in CRISSP. See LAC processes flowchart.
Health needs and medical history information includes:
- medicare number
- immunisation record
- pre-existing conditions, including allergies
- current medications and instructions for administering this medication
- previous medications given, including reactions to previous medications
- any known medications a child must not be given
- name and contact of general practitioner, maternal and child health nurse, any other health care professional involved with the child
- abuse of prescribed medications
- parents view on administering medications.
Medication prescribed by a doctor or a dentist must be administered according to the prescription. This includes specific doses at specified times during the day, for specified periods of time.
Prescribed medications for a specific child cannot be administered to, or shared with, any other child. Each individual child requiring prescription medication must have their own prescription from a doctor.
If the prescribed medication is part of ongoing treatment, this should be reflected in the child’s case plan which is reviewed on a regular basis.
If the prescribed medication is for a single course of treatment, any medication left at the end of the course of treatment must be disposed of safely. Pharmacists will dispose of surplus medication.
If the child is on prescription medication for a pre-existing condition when they enter out-of-home care, the carer will need to bring this to the doctor’s or pharmacist’s attention if a new prescribed medication or over the counter medication is being considered, to ensure there is no adverse interaction between medications.
Over-the-counter medications such as cough medicines, cold and flu tablets, pain relief medicines (paracetamol or aspirin) may be administered as part of the routine care of a child. The administration should be discussed with the pharmacist and the dose must be given in accordance with the child’s age or weight. If the child is on prescription medication for a pre-existing condition, this must be brought to the pharmacist’s attention to ensure there is no counteraction of medications.
Levels and dosages of over-the-counter medication must be strictly adhered to. If the child does not respond to the medication and improve within a reasonable time period, they should be taken to the doctor.
If a child refuses to take prescribed medication, carers should address the situation in an age appropriate manner. At no time is a child to be forced to take medication. The carer is expected to discuss with the child the reason the medication has been prescribed and the implications of not completing a course of treatment. If this is a kinship care placement, the carers may require support from the child protection practitioner to address this with the child. This information is to be recorded on CRIS. Where refusal undermines treatment, the prescribing doctor’s advice should be sought.
Generally carers will administer and monitor the usage of prescribed and over-the-counter medication to children in out-of-home care. The use of ongoing medication must be recorded in the child’s care and placement plan (0-14 years) or care and transition plan (15years+), as per the program requirements for home-based care or residential care services in Victoria. CSOs maintain records detailing the child’s medical and dental assessments, including records of any immunisations; and pass these to the child, their family, or another relevant CSO, when a child changes placement or at the conclusion of a placement.
In the case of a kinship placement, it is the responsibility of the case practitioner to accurately record this information in the client profile (Health section) on CRIS.
Where the child is placed in foster care or residential care, information in relation to medications should be recorded where possible on the client profile in CRIS, or on the LAC EIR (health) (CRISSP).
The information recorded should include the:
- circumstances under which the medication was required
- who prescribed or advised the medication was required
- whether the medication was prescription or over-the-counter medication
- when parents were contacted and what their response was, that is, whether they agreed with the decision or not, or if they were not contacted, the basis for the decision not to contact them
- whether further medication or medical follow-up is required.