Health Foster and kinship carer handbook: Health 43 Children coming into care are often in poor health — they may have developmental and mental health issues. They may need assessments, regular visits and check-ups from doctors and other health professionals. The health plan, developed as part of the Child Health Passport assessment, identies these needs and forms part of the overall case plan. The Child Health Passport All children and young people entering out-of-home care for more than 30 days will receive their own Child Health Passport. The Child Health Passport includes: • the Child Information Form • the child’s heath plan • Medicare card details • information relating to specic health needs. An initial baseline health assessment will cover the child’s general physical health, including visual and hearing screens and progress with developmental milestones. The child’s health plan is developed from this initial assessment, ensuring more effective, coordinated health care for the child. The health plan includes: • signicant ndings from the health check • proposed health/treatment plan • recommended follow-up treatment and timeframes • actions to be taken. Health Foster and kinship carer handbook: Health44 Who can do the initial health assessment? • The child’s GP (for continuity) • Your GP (for convenience) • Indigenous health service • Royal Flying Doctors Service and outreach paediatric clinics (remote areas) • Clinic-based paediatricians (for example, the Child Advocacy Clinic at the Royal Children’s Hospital) • Paediatricians working with child health nurses • School nurses (for vision and hearing tests) How much will it cost? The initial health assessment is generally a long consultation and you may be charged for the assessment. Medicare item numbers exist for health assessments for Aboriginal and Torres Strait Islander children, regardless of whether they are in out-of-home care. These children should be bulk-billed at no cost if a bulk-billing practice or public hospital provider is used. The Health Insurance Commission is seeking a similar arrangement for all other children. In the interim, you will need to pay for the assessment and submit your doctor’s bill to Medicare to obtain a rebate. After that, any out-of-pocket expenses for baseline assessments will be reimbursed by Child Safety Services. What happens with the Child Health Passport? You will be given the Child Health Passport and Child Safety Services keeps a copy. To make sure it remains current, we ask that you forward any updates from medical, allied health or dental visits to Child Safety Services — we will do the same. The Child Health Passport folder must move with the child whenever the child moves placement. Medicare cards Children in care on Child Protection Orders are issued with their own Medicare card. Child Safety Services is responsible for organising this and providing you with the Medicare number. Children over 15 years can apply for their own card. Child Safety Services must apply for younger children who are subject to a Child Protection Order granting custody or guardianship to Child Safety Services . What do I do if the child in my care does not have a card? Your doctor or pharmacist can use an emergency Medicare card number for bulk-billing and subsidised medicines. I have received a Medicare reimbursement cheque but it is in the name of the child in my care. What can I do? Post the cheque back requesting that it be reissued in your name. Health Foster and kinship carer handbook: Health 45 When lling out the Medicare form, make sure your details are lled out in the claimant section, not the child’s. Immunisation The Queensland Government supports immunisation of children. All children in care will be vaccinated according to public health recommendations. Child Safety Services will pay for all scheduled vaccination costs. I am not sure whether the immunisation schedule for the child in my care is up-to-date. What do I do? Your Child Safety Ofcer can nd out for you. Available therapeutic support Accessing these allied health supports is dependent on the case plan — if the need is identied, Child Safety Services will cover the cost. This includes: • counselling for: - sexual assault - drug and alcohol abuse - grief and loss • speech therapy • play therapy • occupational therapy • school support • specialist medical support • youth services • family or individual counselling or therapy. Sexuality and sexual health Children in care have the right to receive information and support about sexuality, relationships and reproductive health. It is important that children receive positive messages about their sexuality, sexual development and safety. Can I talk to a child in my care about sexuality? Communicating about sexuality is an ongoing conversation with the child in your care, not just a ‘one-off’ talk. It is important to remember that children will require different pieces of information at different times as they grow up. One of the best ways to give information to a child about sexuality is to share small amounts of clear, correct and positive information. It is best for this information to come from the adults in their life that they know and trust. As a carer, you may be the person in the best position to provide assistance and respond to the needs and questions that a child or young person has. Foster and kinship carer handbook: Health46 Why is learning about sexuality important for a child in care? Children learn about sexuality all the time. Children in care may receive mixed messages about sexuality every day from TV, music, magazines, advertising and their peers. Research shows that children in care have poorer sexual health outcomes than peers not in care. Compared to other children they have: • higher rates of earlier onset of sexual activity, pregnancy, parenting and sexually transmitted infections (STIs) • higher rates of sexual abuse and sexual behaviours that cause concern. Children in care also have less access to sexual health information, education and services. Children who receive comprehensive age-appropriate sexuality education from early childhood are more likely to make informed and responsible sexual decisions later in life and are less vulnerable to sexual abuse. Tips for discussing sexuality issues with a child in your care • Be brief, factual, honest and positive when answering questions. - Give enough information to adequately answer their question. If the child wants more information they will ask another question. • Use correct terminology — we call an arm an arm and a nose a nose, so it makes sense to call a penis, vulva, vagina or breast by its correct name as well. - By doing this, you ‘normalise’ these words and won’t single out these parts of the body as being different. You will also assist to provide a child with the language to communicate about these parts of the body. • Discuss sexuality issues in a private place. - Sometimes children ask questions at awkward times or places, such as the supermarket, sitting in a crowded bus, or when you are just too busy. - When this happens, tell them their question or comment is very interesting and important and that it is one that is better discussed in a more private place, when you are alone together or when you are not so rushed. - Always make sure you do follow up when the time is more appropriate. • Use ‘teachable moments’ to raise the subject — it could be a friend or relative who is pregnant; a pet may have babies; an issue may be raised on television or in the newspaper; or an older child in the home going through puberty. • Be open, approachable and inclusive, particularly when talking about relationships. - For example you might say: “Some people might want a boyfriend or a girlfriend, some people might be attracted to both males and females at different times in their lives”. • Be aware of yourself as a role model as children learn by example. - For example, they will learn respect for each other’s personal space, privacy and respectful interactions by observing this behaviour in others. Health Foster and kinship carer handbook: Health 47 What topics can you talk about? Sexuality education includes learning about sexual development, reproductive health, interpersonal relationships, self-esteem, feelings and emotions, body image and gender roles. Key topics areas can include: • public and private body parts and behaviours • puberty (including periods and wet dreams) • types of touch • relationships • sexual relationships • decision-making • safe sex • protective behaviours. Where can I get help? When it comes to talking about sexuality, people are often embarrassed. If you feel embarrassed or uncomfortable, talk about this with the child in your care. You could say something like “I’m nding this a little difcult because no one ever spoke openly to me about sexuality when I was growing up, but this is an important subject so I really want to talk to you.” This way the child will not think this subject is an inappropriate or rude one to ask about. It is important that they know you care and can be approached. They will respect you for your honesty. Your Child Safety Ofcer can provide you with support and sexuality education may even be a part of a child’s case plan. For further information and resources to assist in talking about sexuality issues with a child in your care, visit Family Planning Queensland‘s website at www.fpq.com.au Money matters and health You may be provided nancial support for medical and other health related matters for the child in your care, in accordance with an approved case plan, by pre-approved child related cost reimbursement. To nd out more, talk to your Child Safety Ofcer. General practitioner If it is available, choose a bulk-billing practice to minimise out-of-pocket expenses. If your preferred doctor does not bulk-bill, submit your doctor’s bill to Medicare for the Medicare rebate. Then you will only pay the difference between the scheduled fee and the Medicare rebate. For an after-hours service, and when options are limited, call the Child Safety After-Hours Service Centre (formerly known as Crisis Care) on (07) 3235 9901 (for carers only) and get verbal approval to use whatever service is available. Then Child Safety Services will pay. Foster and kinship carer handbook: Health48 Register your household for the Medicare Safety Net (see the section titled ‘Commonwealth Government benets’). For more information, call Medicare on 132 011 or visit their website on www.medicareaustralia.gov.au Specialist If you are referred to a specialist, ask whether bulk-billing is available. Some specialists do bulk-bill. You pay for the initial specialist consultation. Child Safety Services pays for ongoing visits and follow-up treatments. If the rst specialist refers you to another specialist, this is not considered as another rst consultation — this is a follow-up consultation and Child Safety Services will cover the cost. Dental The initial dental consultation and regular dental check-ups are paid out of your fortnightly caring allowance. Child Safety Services will cover the costs for ongoing treatment related to the initial problem. Child Safety Services will also cover the cost for orthodontics. If you are caring for a young person aged 12–17 years, they may be eligible for the Medicare Teen Dental Plan, which helps with the cost of an annual dental preventative check. See the section titled ‘Commonwealth Government benets’ for further information. Optical If it is available, choose a bulk-billing optometrist to avoid out-of-pocket expenses. Children coming into care from 2007 will have their eye-sight screened as part of the child health passport process. If glasses are needed, Child Safety Services will cover the cost. For children in care before 2007, an initial visit to an optometrist is paid out of your fortnightly caring allowance. Any needs that are identied during that check need to be included in an updated case plan. Once in the case plan, Child Safety Services will cover ongoing costs. Pharmaceuticals If you have a Health Care Card, or the child in your care does, your prescription medicines are much cheaper. Ask your doctor or pharmacist if a generic brand is suitable — it can save you dollars. Register your household for the Pharmaceutical Benets Scheme Safety Net (see the section titled ‘Commonwealth Government benets’). When you reach a certain threshold during a calendar year, you will be charged much less for your medicines (free if you are on a concession). For more information, call Medicare on 132 011 or visit www.medicareaustralia.gov.au Smoking around children Passive smoking is a health hazard. For young children, it can cause middle ear infections, bronchitis, pneumonia, asthma and other chest infections. It has also been linked to Sudden Infant Death Syndrome (SIDS). For more information about the health impacts of smoking, visit www.health.qld.gov.au/healthieryou Health Foster and kinship carer handbook: Health 49 Children coming into care are more likely to have health problems and need healthy and safe environments to thrive. From 1 January 2010, smoking in cars carrying children under the age of 16 years in Queensland is banned. Police enforce this law and anyone caught smoking in a vehicle where a child is present will be issued with an on-the-spot ne of $200. The levels of tobacco smoke in a vehicle can be very high. Young children involuntarily exposed to tobacco smoke in a very conned environment such as cars have signicantly increased health risks. For these reasons, foster and kinship carers are asked not to smoke inside the home, within conned spaces, or generally in the presence of children. Your concern of others by not smoking around children will be considered during re-approval assessment. Smoking in the presence of children in care may also be considered a breach of the Standards of Care. For more information, refer to the sections ‘Our commitment to providing care’ and ‘Matters of concern’. Quitting smoking can be tough, but it is worth it and there are services that can help you. Call the Quitline on 13 78 48. Smoking behaviour in children If the child placed with you smokes, contact your Child Safety Ofcer to discuss what strategies you may use to respond to this behaviour. A carer cannot be seen to be actively supporting a child’s smoking, for example by supplying cigarettes or setting aside an area specically set up for children in which they can smoke. This would include enabling or advising a parent to supply the cigarettes to the child for the period of their placement. Whilst you may not be able to physically stop the child from smoking, you should make every effort to actively discourage the child from smoking. When a child presents with a nicotine addiction, medical advice must be sought before giving the child nicotine replacement products or medications to manage nicotine addictions, for example nicotine patches or any similar treatments. Child Safety Services’ approval of the proposed treatment must be sought, and will be based on medical advice. Water safety Child drownings in Queensland swimming pools account for one quarter of all childhood injury deaths and is the most common cause of traumatic death for children aged one to four years. Many of these incidents could be prevented by providing and maintaining adequate pool fencing. As part of the assessment and approval process to become a foster or kinship carer, you would have met the mandatory water safety requirements as part of the Household Safety Study. As a carer, you are responsible on a day-to-day basis for looking for signs of wear and tear and damage to pool fencing and gates, to ensure that children in your care are safe and that legislated water safety requirements continue to be met. For further information regarding pool fencing and pool safety, visit www.dip.qld.gov.au Be ‘sun safe’ Skin cancer is a major risk in Queensland and it is important to protect children from Foster and kinship carer handbook: Health50 the sun’s harmful rays. Some tips include: • applying ‘slip, slop, slap’ — make sure children are well protected with a t-shirt, sunscreen (at least 30+) and a hat • avoiding being in the sun during the hottest part of the day (10am to 3pm) • being a role model by showing ‘sun safe’ behaviour to your child. Useful contacts Our General Practitioner (GP) is: Our specialists are: Other contacts: 13 HEALTH (13 43 25 84) This is a Queensland Health service that provides qualied health advice in non- emergency situations 24-hours a day, 7 days a week. Alcohol and Drug Information Service The Alcohol and Drug Information Service operates 24-hours a day, seven days a week. Call 1800 177 833 Children’s Community Health Services Child health nurses staff this service 24-hours a day, seven days a week. Call (07) 3862 2333 SIDS and Kids SIDS and Kids is dedicated to saving babies’ lives through the elimination of sudden andunexpected infant deaths, and supporting bereaved families. Call (07) 3849 7122 or visit www.sidsandkids.org Child and Youth Mental Health Service Child and Youth Mental Health Service (CYMHS) is a service of Queensland Health and provides free consultation, assessment and treatment of children and young people experiencing serious mental health disorders and problems. Conditions treated may include anxiety, depression, suicidal or self-harming behaviours, eating disorders, psychosis, trauma or mental health problems signicantly impacting on relationships with family, friends and others. For general inquiries call (07) 3310 9444 or visit www.health.qld.gov.au/rch/families/cymhs.asp Queensland Poisons Information Centre Pharmacists answer all calls 24-hours a day, 7 days a week. Call 13 11 26 Safety resources for carers For additional information on carer safety resources, visit www.communities.qld.gov.au/childsafety for links to other useful websites. . than 30 days will receive their own Child Health Passport. The Child Health Passport includes: • the Child Information Form • the child s heath plan • Medicare. allied health or dental visits to Child Safety Services — we will do the same. The Child Health Passport folder must move with the child whenever the child