NSW Health recommends that this guidance is used by child and family health services. NSW local health districts and relevant networks are to develop their own workflow and policy and procedures based on the below recommendations. When using alternative modes of care clinicians must document how the care was delivered and any parts of the service and assessments that were not completed.
This guidance builds on an expectation that a comprehensive newborn assessment has been undertaken prior to discharge from the maternity service as outlined in the maternity and neonatal COVID-19 guidance.
The First 2000 Days Framework provides the evidence about critical developmental windows in early life. These windows continue to close regardless of events such as pandemics, and opportunities to support development are dramatically reduced once developmental windows pass. This means child and family health services are time dependent services. Deferring or ceasing services can have significant consequences, especially for children who are developmentally vulnerable. Decisions about ceasing, deferring or doing services differently must be made taking into account the potential lifelong impacts of those decisions to children and families.
Child and family health services provide an important universal service for mothers/carers, babies and families at a critical time. For many families the service may be their only contact with the health service system so it is important to ensure that all families, and especially the most vulnerable are provided with a service to meet their needs.
A risk assessment is to be conducted to reduce close contact wherever possible while maintaining essential face to face appointments. Risk assessments should include assessment of COVID-19 risk as well as assessment of the family’s needs and level of vulnerability. Essential face to face appointments should be prioritised for at risk or high needs parents/carers or children.
NSW Health recommends that all children known to the Department of Communities and Justice (DCJ) including those in out of home care, those with level 3 vulnerabilities (for example mental health, domestic violence), and children with health or developmental concerns (e.g. genetic issues, premature birth, discharged after Neonatal Intensive Care Unit or Special Care Nursery admission, children with diagnosed development or health issues) are sighted regularly and receive a service as close to business as usual as the current circumstances allow. For children in out of home care, note that as a minimum, children entering the Out of Home Care Health Pathway Program must receive their 2a assessments.
Staff and family concerns about close contact have been raised since the new legislative restrictions on social contact were released on 31 March 2020. It is important to address these concerns with reasonable changes to practice, including:
Families with a new baby must have access to child and family health services. During a pandemic, health services will be required to review their usual service provision and modes of care to respond to their local disaster planning. For families without an elevated risk profile, clinicians may offer appointments by using telephone or telehealth consultations, where appropriate and possible. The length of these telehealth consultations should reflect the needs of families.
Some essential services such as immunisation must be delivered face to face. Keeping up to date with immunisations is even more important in the current context. Recommended alternative modes of care for Child and Family Health service delivery include telehealth options of telephone and video calls or face to face sessions at a health clinic or in the family’s home. The principles of each are:
For any intervention, clinicians may choose to use any mix of modality of service delivery and the extent to which clinicians choose to use telephone, video call and face to face will depend on COVID-19 and clinical risk factors. Clinicians need to document:
Clinicians moving from face to face care to telehealth modalities should refer to the ACI telehealth resources.
For families with members who have suspected or confirmed COVID-19, continued access to child-centred, respectful skilled care remains essential.
This includes mental health and psychosocial support as well as clinical care to support early parenting and child and brain development and growth. The table below provides guidance about the services that may be considered appropriate for telehealth delivery, and those that cannot.
The Blue Book continues to provide an important resource for parents tracking their child’s health and development, and a good tool to assist clinicians when providing services by telehealth. The developmental tools and other information in the book should be heavily promoted to parents. If a development assessment is not completed this needs to be documented and completed as soon as practical.
Continuity of care from antenatal and birthing care to community child and family health care is always important, but even more important for families in high stress and difficult times. Continuity of health care is particularly essential, and possibly lifesaving, for babies where there is high vulnerability to poor outcomes including risk of harm. Local Health Districts should develop protocols to ensure continuity of care is maintained despite the disruptions to usual service delivery caused by the COVID-19 pandemic response.
All areas for discussion and support that child and family health nurses usually cover in the child health and development checks remain important.
Breast feeding support. Breastfeeding is important for optimal infant nutrition, growth and healthy development, protection against infection and chronic disease. Breastfeeding provides short-term and long-term health, economic and environmental advantages to children, women, families and society.
The World Health Organisation has noted that breastfeeding counselling, basic psychosocial support and practical feeding support should be provided to all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19. Wherever possible, face to face support is encouraged but if not, other support through phone or telehealth is recommended.
During the pandemic, wherever possible, breast feeding support delivered by phone and/or telehealth consultations are recommended for:
For some high risk infants and infants experiencing complex feeding difficulties a face to face breast feeding consultation may be required.
For detailed advice on breastfeeding support please refer to Guidance for parents concerning infants and COVID-19.
In addition, the following elements for child and family health service provision care are considered essential in the context of local pandemic planning.
An initial phone contact should be undertaken with each family to commence engaging the family with the child and family health service.
A risk assessment of the family’s needs and vulnerability must be conducted to identify families where the level of risk warrants a home visit. Examples of risks that warrant face to face care include for example:
In line with NSW Public Health Orders, face to face services should also be considered for specific groups considered to have elevated risk including Aboriginal families and some CALD communities.
A local telehealth protocol should be developed to guide this assessment, decision making regarding the service to be offered, and the service mix to be offered to families based on their needs, risks and preferences for service delivery.
The 1-4 week development check is essential.
For low vulnerability families, telehealth appointment is strongly recommended. For high vulnerability families or those identified from a risk assessment of the family’s needs/vulnerability as having high need, consider providing a home visit where possible (see above).
When providing face to face services, use strategies that minimise contact and risk (see above).
If providing telehealth, if there are risk factors requiring further clinical investigation, refer to general practice to arrange referrals (eg for ultrasound if there are significant risk factors for hips, cardiovascular referrals) or Level 2 service for complex parenting issues it is essential to:
Note: Refer to guidance for Maternity Services for guidance on the SWISH screening, which remains essential
This is essential and must be completed. At the time of the immunisation the following physical examinations should be undertaken if not previously completed due to mode of preceding assessment:
if abnormalities are detected, refer to the appropriate service for further investigation / treatment.
The 6-8 week child health and development check is essential. If issues are identified, follow up and referral is required.
Encourage parents to complete Learn the Signs. Act Early and additional parent questions.
Telehealth delivery (video call) is strongly recommended and preferred over telephone only Face-to-face should be considered where risk assessment of the family’s needs and vulnerability includes:
If providing telehealth, if there are risk factors, refer to general practice to arrange referrals (eg cardiovascular and hips test) or Level 2 service for complex parenting issues, it is essential to have a conversation regarding SUDI at minimum via telehealth or phone.
The 6-8 week psychosocial assessment for the mother is essential including maternal infant attachment to be observed.
NSW Health services providing Domestic Violence Routine Screening should continue to adhere to the current policy requirement that routine screening only be conducted through face to face interactions. Practitioners should contact Police if they have reasonable grounds to believe the person or others are at serious and imminent threat. This must be noted in the file.
This is essential and must be completed. At the time of the immunisation the following physical examination should be undertaken if not previously completed due to mode of preceding assessment: growth assessment.
Continued provision of this check, which includes the SAFESTART psychosocial screening to identify perinatal depression and anxiety risk, is highly recommended where possible especially during the time of high anxiety around COVID-19.
Where possible this check should be performed by telehealth (video) or face to face for higher risk families and children.
If face to face is not possible, then the following should be completed via telehealth:
If health and/or developmental concerns are present after review, then Child and Family Health Nurse to follow up with a secondary developmental assessment (Ages and Stages Development Questionnaire and Ages and Stages Social and Emotional questionnaire). This may be emailed/mailed to parents for completion with telehealth follow up.
If providing via telehealth complete:
If health and/or developmental concerns are present after review, then Child and Family Health Nurse to follow up with a secondary developmental assessment (Ages and Stages 3 Development Questionnaire and Ages and Stages Social and Emotional questionnaire). This may be emailed/mailed to parents for completion with telehealth follow up and referral as required.
Families identified with familial risk factors or concerns for hearing and vision as indicated in the Blue Book are to be referred for follow up. If any concerns relating to vision refer to optometrist.
This is essential and must be completed. If the developmental check has been completed at the time of the immunisation the clinician conducting the check should follow up on any referral or development concerns.
This is essential and must be completed.
Note: StEPS Visual Acuity Screening has been deferred in a number of sites as child care centres have ceased accepting visiting services.
Defer to after 30 June 2020 and review whether further extension is required.
Records must be kept of centres that have not had screening completed.
If any vision concerns are identified by centres or in developmental checks offered by telehealth, it should be recommended that the family attend their GP or optometrist.
Parent groups should continue where possible online or virtual groups to be conducted via telehealth. Perinatal depression and anxiety risk is heightened in times of uncertainty and social isolation, and threats to health and wellbeing. Ongoing support offered by this contact is an essential service.
This is essential and services must continue. Telehealth services to be used as appropriate.
Allied Health services are essential Child and Family Health Services. LHDs/SHNs should ensure that time-critical allied health treatments, therapies and assessments, which if not provided will impact the child’s health and development, are maintained. Prior to seeing patients, a telephone screening risk assessment (see above) should be conducted as per this guide to reduce face to face modality of care wherever possible.
It is essential that face to face appointments for some assessments and treatments continue, for example infants at risk of aspiration or dysplastic hips. Some services can be delayed, such as for fussy feeders. The use of virtual telehealth by phone or video conferencing should be increased and used where appropriate.
Allied Health disciplines should collaborate to develop and share resources to support clinical interventions. For all patients, an assessment of the child’s clinical need and the family circumstances and vulnerabilities should be used determines family’s suitability for:
This is essential. Services must continue. Where possible face to face is preferred for new intake. Telehealth services to be used as appropriate where there is an established relationship.
Referrals for residential service admissions will be accepted pending appropriate screening. Should screening preclude a residential admission, and the admission cannot be safely deferred, alternate modes of service delivery to provide intensive support as required will be offered, including telehealth.
For children and young people in out of home care, note that as a minimum, children and young people entering the Out of Home Care Health Pathway Program must receive their 2a assessments, and development of a Health Management Plan.
Reviews of Health Management Plans should continue as usual. Telehealth may be used as appropriate.
Leaving care assessments should continue as usual. Telehealth may be used as appropriate.
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For use by: NSW Health is recommending that this guidance is used by child and family health services.
