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NSW Health recommends that this guidance is used by child and family health services in the review and development of their local protocols. The guidance is provided as a resource to assist districts in ensuring that the best possible child and family health services are available to support families in the context of continuing local responsiveness to the needs of the COVID-19 management process.

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Child and family health provides essential services to families

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 changing service modalities must be made taking into account the potential lifelong impacts of those decisions to children and families.

Families with a new baby must have access to child and family health services. Although provision of usual care in Child and Family Health is recommended after a risk assessment, 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.

Child and family health services provide an important universal service for mothers/carers, children 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.

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 newborn COVID-19 guidance​ document.

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Infection prevention and control risk assessments must continue to be part of routine service delivery

Irrespective of the care setting risk assessments should include assessment of COVID-19 risk in addition to an assessment of the family’s needs and level of vulnerability. Infection and Prevention Control measures should take into account the NSW Health response and escalation framework​ (CEC). The escalation framework should be checked regularly to ensure the appropriate infection prevention and control measures are in place.

Training is available and recommended via My Health Learning on the appropriate way to don and doff Personal Protective Equipment.  

The COVID-19 Infection Prevention and Control Guidance for Home Visits (CEC) provides full guidance on conducting a COVID-19 risk screening and assessment prior to offering a home visit. The COVID-19 Infection Prevention and Control: Primary, Community and Outpatient Settings (CEC) guidance provides specific information about safe practice in community services. Further information can be located on guidance from the Clinical Excellence Commission.

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Guidance for services with temporary reduced capacity

Prioritisation of service delivery may be required due to local LHD factors - e.g. as a result of staff deployment to COVID-19 management duties’, local outbreak management, or staff requiring self-isolation due to potential exposure. In this case, essential appointments should be prioritised for at risk or high needs parents/carers or children. 

An assessment of the family’s needs and vulnerability must be conducted to identify families where the level of risk warrants prioritisiation for services including face to face assessment. Examples of family needs and vulnerabilities that may warrant face to face care include:
  • Level 3 vulnerability (see PD2​010_016) including mental health issues and/or DV, and/or family known to Department of Communities and Justices including baby in out of home care.
  • at risk communities including Aboriginal and Culturally and Linguistically Diverse (CALD) women, rural and remote women, their partners, families and communities
  • loss of weight greater than 10% post birth
  • significant breastfeeding difficulties
  • NICU and special care discharge
  • babies with a birth weight under 3kgs
  • maternal birth complications
  • multiple births. 

A local service protocol (see section below on alternative modes of care) should be developed to guide this needs and vulnerability risk assessment, decision making regarding the service to be offered, and the mix of service modalities to be offered to families based on their needs, risks and preferences for service delivery.

Service delivery should continue to be sensitive to staff and family infection concerns

​​It is important to address staff and family concerns about close contact  with reasonable changes to practice, including:
  • Minimise the need for close contact, where possible. Ideally during essential face to face appointments practice physical distancing by keeping more than 1.5m apart with the exception of the provision of clinical examination.
  • Practice standard precautions at both individual and service level, including for example enhanced environmental cleaning and hand hygiene.
  • Practice transmission based precautions when providing care to patients who have suspected or confirmed COVID-19.
  • Refer to the NSW Health website and the CEC COVID-19 website​ for the most up to date infection prevention and control advice on home visits​ and outpatient, primary and community care​.

Please note that fathers/co-parents should not be excluded from attending an appointment in the home. Where the risk assessment is that both parents/carers are WITHOUT symptoms or risk factors for COVID-19, BOTH parents/carers should be encouraged to participate in the appointment as per usual practice, using standard precautions and physical distancing.

This advice is consistent with the COVID-19 Infection Prevention and Control Guidance for Home Visits (CEC).
Equally, fathers/co-parents should not be excluded from attending an appointment in the clinic. Where the risk assessment is that both parents/carers are WITHOUT symptoms or risk factors for COVID-19, BOTH parents/carers should be encouraged to participate in the appointment as per usual practice, using standard precautions and physical distancing.

Where the health worker cannot maintain physical distance of >1.5 metres from the parents/carers, a surgical face mask should be worn as per the response and escalation framework.

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Local protocols must guide clinicians in decisions about modes of care

For any intervention, clinicians may choose to use a mix of modality of service delivery and the extent to which clinicians choose to use face to face or telehealth delivery will depend on COVID-19 and clinical risk factors. 

Telehealth is an overarching term encompassing telemedicine, tele-education, tele-therapy, tele-mentoring and tele-monitoring. A range of modalities are included: the telephone, video conferencing, store and forward, remote monitoring and the use of clinical apps. The length of these telehealth consultations should reflect the needs of families.

Some essential services must be delivered face to face. Immunisation is one example. Keeping up to date with immunisation schedules is even more important in the current context. 

​​During the COVID-19 pandemic response, Child and Family Health Services have increased use of telephone service delivery and have extended their use of other forms of telehealth. The greater use of telehealth during the pandemic includes: 
  • Telephone: consultations with families offering history taking and advice
  • Video call: consultations where consultations where a visual observation of the child and family is required
  • Face to face: consultations where a physical examination is required and/or clinical risk assessment of vulnerabilities indicate a face to face service is essential.
​​If choosing to offer services through telehealth modes, clinicians must document:
  • COVID-19 risks (patient or household member) as this will be time limited
  • the care provided
  • aspects of the care that were not provided
  • mode of delivery
  • a plan for completing the aspects of the assessment or service that were not completed. 

Clinicians moving from traditional face to face service delivery of care to telehealth modalities should refer to the ACI telehealth resources.

NSW Local Health Districts and relevant Networks are to develop their own workflow and policy and procedures based on the recommendations in this guidance. Clinicians must document how the care was delivered (mode of delivery) and any parts of the service and assessments that were not completed.

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Essential elements need to remain part of every consultation

Development checks, breastfeeding and immunisation are evidence based interventions that must continue. Local workflow and policy and procedures based on this guidance must ensure that the mix of care modalities offered to each family ensures the essential elements of care are appropriately delivered within the critical timeframes.

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 Personal Health Record (Blue Book) continues to provide an important resource for parents tracking their child’s health and development, and a resoo​urce 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.

Breastfeeding support. Breastfeeding is important for optimal infant nutrition, growth and healthy development, and 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 protective effects of breastfeeding are particularly important during the COVID-19 pandemic, and this is an important message for parents.

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. Wherever possible, face to face support is encouraged but if this is not possible, other support through telehealth is recommended.

Breastfeeding support is critical for the following groups:
  • Mothers who have confirmed COVID-19 and who remain symptomatic on discharge from hospital. In these circumstances babies are at risk of viral transmission through the mother’s respiratory secretions. More information about reducing the risk of transmission to the baby when feeding can be found in the Guidance on infant feeding. 
  • infants being fed with breast milk
  • at risk communities including Aboriginal and Culturally and Linguistically Diverse (CALD) women, their partners, families and communities
  • women, their partners and families at risk of lower rates of breastfeeding initiation and duration. 

For some high risk infants and infants experiencing complex feeding difficulties a face to face breastfeeding consultation may be required.

For detailed advice on breastfeeding support please refer to Guidance on infant feeding.

In addition, the following elements for child and family health service provision care are considered essential in the context of local pandemic planning.

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Immunisations

All immunisations are essential and must be completed. At the time of the immunisation, physical examination of the child should be undertaken if not previously completed due to mode of preceding assessment. Refer to the immunisation schedule.

Immunisation against influenza is strongly recommended for parents/carers and is also available free for all children from 6 months to under 5 years of age. Information on how to access​ influenza vaccinations should be provided to all parents/carers.

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Essential elements of Child and Family Health scheduled checks must be delivered

The initial contact and health and development check, 1-4 weeks, 6-8 week and 6 months are essential and must continue. 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 section: ‘Infection prevention and control risk assessments must continue to be part of routine service delivery’).

When providing services, refer to the specific infection prevention and control advice for primary, community and outpatient settings and home visiting services​

Specific guidance for services where COVID-19 risk assessment and/or local protocol means services are offered using telehealth/mixed modalities

Initial contact

An initial phone contact should be undertaken with each family to commence engaging the family with the child and family health service.

1-4 week check

The 1-4 week development check is essential. It is essential to:
  • assess how the family is transitioning to going home with their new baby, and how feeding, settling and other areas of care of the newborn are progressing
  • provide new parents with a list of the services and supports that are available to them at this time, and emphasise that they are receiving services in alternative ways that maintain support while minimising risk to them and their baby
  • deal with any issues the family wish to raise
  • have a conversation regarding SUDI at a minimum.

Note: Refer to guidance for Maternity and Newborn Care guidance on the SWISH screening, which remains essential.

6-8 week check

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.

It is essential to have a conversation regarding safe sleep practices in line with the sudden unexpected death in infancy (SUDI) policy at minimum.

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.

6 month check

Continued provision of this check, which includes the SAFESTART psychosocial screening to identify perinatal depression and anxiety risk, is essential, especially during the time of high anxiety around COVID-19.

​​Child Health Check: this check should include as a minimum:
  • discussion on introduction to family foods
  • conversation regarding safe sleep practices (in line with SUDI policy) at a minimum
  • parents encouraged to complete Learn the Signs. Act Early and additional parent questions prior to appointment
  • families and infants with risk factors and concerns for hearing and vision to be referred to GP.

If health and/or developmental concerns are present after review, then the Child and Family Health Nurse should follow up with a secondary developmental assessment (Ages and Stages Development Questionnaire and Ages and Stages Social and Emotional questionnaire).

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.

12 month check

If providing via telehealth complete:
  • hearing surveillance
  • vision surveillance
  • oral health surveillance
  • developmental surveillance - parents encouraged to complete Learn the Signs. Act Early and additional parent questions prior to appointment
  • evaluation of gait to be completed via telehealth
  • Family Foods feeding discussion to be completed
  • lift the lip assessment. 

If health and/or developmental concerns are present after review, the Child and Family Health Nurse to follow up with a secondary developmental assessment (Ages and Stages 3 Development Questionnaire (ASQ 3) and Ages and Stages Social and Emotional questionnaire (ASQ:SE 2)).

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.​ 

18 month check

If providing via telehealth complete:
  • hearing surveillance
  • vision surveillance
  • oral health surveillance. 

Developmental surveillance - parents encouraged to complete Learn the Signs. Act Early and additional parent questions prior to appointment. If any concerns are identified consider offering ASQ 3 and ASQ:SE 2 as above.

2 year check

If providing via telehealth complete:
  • hearing surveillance
  • vision surveillance
  • oral health surveillance. 

Developmental surveillance - parents encouraged to complete Learn the Signs. Act Early and additional parent questions prior to appointment. If any concerns are identified consider offering ASQ 3 and ASQ:SE 2 as above.

3 year check

If providing via telehealth complete:
  • hearing surveillance
  • vision surveillance
  • oral health surveillance 

Developmental surveillance - parents encouraged to complete Learn the Signs. Act Early and additional parent questions prior to appointment. If any concerns are identified consider offering ASQ 3 and ASQ:SE 2 as above.

4 year check

If providing via telehealth complete:
  • hearing surveillance
  • vision surveillance
  • oral health surveillance
  • developmental surveillance - parents encouraged to complete Learn the Signs. Act Early and additional parent questions prior to appointment. If any concerns are identified consider offering ASQ 3 and ASQ:SE 2 as above
  • school readiness check. 

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Groups and service delivery

StEPS Screening

Usual StEPS screening processes must resume as soon as possible, following the recommended infection prevention and control precautions. 

Records must be kept of early childhood education and care centres that have not participated in StEPS screening due to the COVID-19 pandemic response.

Each district must have a local catch up strategy in place to ensure that StEPS has been offered to all children commencing school in 2021 prior to the start of the 2021 school year.

For children who have not yet been screened, or if any vision concerns are identified by parents, early childhood education and care centres or other health professionals, they should be recommended to attend a catch up StEPS screening clinic (if available) as soon as possible. If a catch up clinic is not available, the family should be advised to attend their GP or optometrist for further investigation as soon as possible.

Parent groups

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, social isolation, and threats to health and wellbeing. Ongoing support offered by this contact is an essential service.

Family Care Cottage Services/Day Services

This is essential and services must continue. Telehealth services to be used as appropriate.

Allied Health Services

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.

Infection prevention and control risk assessments should continue to be part of routine service delivery.

It is essential that face to face appointments for some assessments and treatments continue.  

The use of telehealth continues to be an important modality of care for maintaining and improving access to allied health services. 

Allied Health disciplines should collaborate to develop and share resources to support clinical interventions.

​​​For all patients, an assessment of the child’s clinical needs, the family circumstances and vulnerabilities should be used to determine their suitability for:
  1. a home program, and/or
  2. Telehealth services by telephone or videoconferencing. Families unable to utilise telehealth will be provided equitable access to services.  

Sustained HHV Services / Additional Health Home Visiting

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.

Residential services

Self referrals and referrals from health professionals for residential service admissions will be accepted pending appropriate triaging. 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.

Out of Home Care Health Pathway Program

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 (primary) assessments and 2b (comprehensive) assessments if indicated, 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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Document information

Developed by

Health and Social Policy Branch (HSPB).

Consultation

Maternity, Child and Family Health, HSPB.

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.

Reviewed by

For use by

NSW Health is recommending that this guidance is used to assist LHD child and family health services in the review and development of their local protocols.​​​​​​​​​​​​​​​​​

Current as at: Sunday 29 November 2020
Contact page owner: Health Protection NSW