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. The Clinical Excellence Commission (CEC) COVID-19 Infection Prevention and Control Manual Chapter 3 – Response and Escalation Framework and Agency for Clinical Innovation (ACI) ACI COVID-19 Risk Monitoring Dashboard should be checked regularly to ensure the appropriate infection prevention and control measures are in place according to risk alert level.
Families with a baby must have access to child and family health services and provision of usual care 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, fathers and co-parents, 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, especially the most vulnerable are provided with a service to meet their health, wellbeing, growth, and developmental needs.
Child and family health services are provided to a child and one or more parent/carer at each occasion of service. Both the child and the parent/carer must be present during all appointments regardless of the health system alert status for the effective delivery of the child and family health service.
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.
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. Families must have access to services for growth and development, breastfeeding/feeding and maternal/paternal mental health support. Deferring or ceasing services can have significant lifetime consequences, especially for children who are developmentally vulnerable and parents who are struggling with their mental health. Decisions about ceasing, deferring or changing service modalities must be made while considering the potential lifelong and intergenerational impacts of those decisions to children and families.
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 Prevention and Control measures should take into account the CEC COVID-19 Infection Prevention and Control Manual Chapter 3 – response and escalation framework. Also refer to Chapter 7 – Non-acute healthcare settings for specific information about safe practice in community services and Chapter 8 – Home visits for guidance on conducting a COVID-19 risk screening and assessment prior to offering a home visit. Recommendations for COVID surveillance testing in NSW Healthcare Facilities outlined in Appendix 2A of the CEC COVID-19 Infection Prevention and Control Manual should also be considered in the development of local protocols.
Training is available and recommended via My Health Learning on the appropriate way to don and doff Personal Protective Equipment.
Prioritisation of service delivery may be required due to local local health districts (LHD) factors - e.g. as a result of staff deployment to COVID-19 management duties, local outbreak management, or staff requiring self-isolation. 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 prioritisation for services including face-to-face assessment and ongoing intervention where indicated. Examples of family needs and vulnerabilities that may warrant face-to-face care include:
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.
It is important to address staff and family concerns about possible exposure to infection with reasonable changes to practice. Fathers/co-parents should not be excluded from attending an appointment in the home or at the clinic. Telehealth as a mode of service delivery to include fathers/co-parents should be considered as part of routine service delivery.
Refer to the CEC COVID-19 Infection Prevention and Control Manual Chapter 8 – Home visits for guidance around precautions to use when working with families and staff.
Any service delivery protocol must consider the local COVID-19 alert level and any Public Health Orders or restrictions in place at the time.
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.
Immunisation is an essential service which must be delivered face-to-face. Keeping up to date with immunisation schedules must continue as usual.
During the COVID-19 pandemic response, Child and Family Health Services have implemented use of telehealth service delivery and have extended their use of other forms of telehealth. The length of these telehealth consultations should reflect the needs of families. Telehealth will continue to be a component of Child and Family health clinical service delivery.
The greater use of telehealth during the pandemic includes:
If choosing to offer services through telehealth modes, clinicians must document:
Clinicians moving from traditional face-to-face service delivery of care to telehealth modalities should refer to the ACI telehealth resources.
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 resource 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.
Where families are or have been isolated during inpatient care or at home for any reason, Child and Family Health services should acknowledge that this may be a trigger for anxiety. This may be an especially difficult time for Aboriginal and/or refugee families as their support systems through their families may not have been available to them. Health workers will need to engage with appropriate local support as early as possible. This will include Aboriginal health liaison officers, Aboriginal health workers, multicultural health staff, and/or social work services to enhance care for these families.
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. The protective effects of breastfeeding are particularly important during the COVID-19 pandemic, and this is an important message for parents.
Wherever possible, face-to-face support is encouraged, particularly for high-risk infants and infants with complex feeding difficulties. If this is not possible, support through telehealth is recommended (see above section: Infection prevention and control risk assessments must continue to be part of routine service delivery).
Breastfeeding support is critical for all breastfeeding women but especially the following groups:
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.
All immunisations are essential and must be completed following the immunisation schedule. At the time of the immunisation, physical examination of the child should be undertaken if not previously completed due to mode of preceding assessment.
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.
All families with children 5 years of age and over should be informed about COVID-19 vaccine efficacy and availability. Services should develop pathways to facilitate vaccination in high-risk communities for children and their families.
The initial contact and health and development checks, 1-4 weeks, 6-8 week and 6 months, are essential and must continue. For families identified as having high needs/vulnerabilities, 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 in the CEC COVID-19 Infection Prevention and Control Manual in Chapter 7 – Non-acute healthcare settings and Chapter 8 – Home Visits.
An initial phone contact should be undertaken to engage each family with child and family health service.
Ensure the full check is completed following the recommended COVID-19 infection prevention and control precautions.
The 1–4 week development check is essential.
It is essential to:
Note: Refer to guidance for Maternity services on the SWISH screening, which remains essential.
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.
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:
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 3 Development Questionnaire (ASQ3) and Ages and Stages Social and Emotional questionnaire (ASQ:SE2).
If providing via telehealth complete:
If health and/or developmental concerns are present after review, the Child and Family Health Nurse to follow up with a secondary developmental assessment (ASQ3 and Ages ASQ:SE2).
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.
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 ASQ3 and ASQ:SE2.
If StEPS screening processes have ceased, normal services should resume as soon as possible where feasible, following the recommended COVID-19 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 should have a local catch-up strategy in place to ensure that StEPS has been offered to all children commencing school prior to the start of the relevant 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 should continue where possible, following the recommended infection prevention and control precautions and consistent with any existing Public Health Orders or restrictions. Online or virtual groups may be conducted via telehealth. Where mode of delivery of groups is face-to-face, individual risk assessments need to be undertaken prior to group activity as described in Section 7.4 of the CEC COVID-19 Infection Prevention and Control Manual.
The decision to cease offering face-to-face groups during Red Alert should be balanced with the potential impact on engagement of families with supports. Special consideration should be given to vulnerable and specific cultural groups where face-to-face contact delivers additional benefits.
Perinatal depression and anxiety risk are heightened in times of uncertainty, 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, following the recommended infection prevention and control precautions. Telehealth services to be used as appropriate.
Services should continue where possible, following the recommended infection prevention and control precautions.
Community Paediatric and Allied Health services are essential Child and Family Health Services. LHDs/SHNs should ensure that time-critical allied health treatments, therapies and allied health and community paediatric 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.
Community Paediatric and 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:
This is essential. Services must continue, following the recommended in the CEC COVID-19 Infection Prevention and Control Manual Chapter 2 – Infection prevention and control strategies for COVID-19. Where possible face-to-face is preferred for new intake. Telehealth services to be used as appropriate where there is an established relationship.
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 or virtual residential care.
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.
Health and Social Policy Branch (HSPB).
Maternity, Child and Family Health, HSPB.
Ms Deb Willcox, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.
NSW Health is recommending that this guidance is used to assist local health district child and family health services in the review and development of their local protocols.