​ ​​​​​​​​​​

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.

This guidance outlines what should be used when the escalation framework is at Green, Amber or Red level. The Clinical Excellence Commission (CEC) Response and Escalation Framework in Chapter 3 of the COVID-19 Infection Prevention and Control Manual and Agency for Clinical Innovation (ACI) COVID-19 Risk Monitoring Dashboard should be checked regularly to ensure the appropriate infection prevention and control measures are in place.

 ​​​

On this page

Child and family health provides essential services to 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.

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 while considering the potential lifelong impacts of those decisions to children and families.

[back to top]

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 CEC ​Response and Escalation Framework in Chapter 3 of the COVID-19 Infection Prevention and Control Manual

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

Chapter 8: Home Visits in the COVID-19 Infection Prevention and Control Manual provides full guidance on conducting a COVID-19 risk screening and assessment prior to offering a home visit. For COVID-19 Infection Prevention and Control: Primary, Community and Outpatient Settings - see Chapter 7: Non-acute healthcare settings in the COVID-19 Infection Prevention and Control Manual for specific information about safe practice in community services. Further information can be located on guidance from the Clinical Excellence Commissionand a list of current case locations and exposure sites can be found of the NSW Health website.

[back to top]​

Guidance for services with temporary reduced capacity

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 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 Safe Start Strategic Policy PD2​010_016) including mental health issues and/or domestic violence, and/or family known to Department of Communities and Justices including baby in out of home care.
  • at risk communities including Aboriginal culturally and linguistically Diverse (CALD),  rural and remote women, their partners and  families.
  • babies with a birth weight under 3kgs
  • Loss of weight by the baby of greater than 10% post birth
  • significant breastfeeding difficulties
  • NICU and special care discharge
  • 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. 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.See Appendix A - Home Visiting Guidelines and Appendix B - Outpatient and Service Delivery Guidelines for guidance around precautions to use when working with families and staff.

[back to top]

Local protocols must guide clinicians in decisions about modes of care

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. 

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 length of these telehealth consultations should reflect the needs of families.

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
  •  telehealth is an effective way to safely include fathers/co-parents, additional clinical staff, staff from other agencies, or  whoever else may be required to be present during a face to face service.
​​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.

[back to top]

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 reso​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. 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 but if this is not possible, other 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 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. 
  • 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 - see Breastfeeding in NSW-Promotion, Protection and Support PD2018_034 .

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.

[back to top]

Immunisations

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.

[back to top]

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

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 COVID-19 Infection Prevention and Control Manual  (for primary, community and outpatient settings see Chapter 7: Non-acute healthcare settings  and for home visiting services​ see Chapter 8: Home visits)

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 to engage each family with 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 currently, 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

Ensure the full check is completed following the recommended COVID-19 infection prevention and control precautions.

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

Ensure the full check is completed following the recommended COVID-19 infection prevention and control precautions.

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

Ensure the full check is completed following the recommended COVID-19 infection prevention and control precautions.

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

Ensure the full check is completed following the recommended COVID-19 infection prevention and control precautions.

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

Ensure the full check is completed following the recommended COVID-19 infection prevention and control precautions.

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

Ensure the full check is completed following the recommended COVID-19 infection prevention and control precautions.

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. 

[back to top]

Groups and service delivery

StEPS Screening

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

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 can 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 - see section 7.4 Group community sessions and meetings of the COVID-19 IPAC Manual

In a Red Alert, all face-to-face groups should cease. 

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.

Family Care Cottage Services/Day Services

This is essential and services must continue, following the recommended infection prevention and control precautions. Telehealth services to be used as appropriate.

Allied Health Services

Services should continue where possible, following the recommended infection prevention and control precautions.

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, following the recommended infection prevention and control precautions. 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 or virtual residential care.

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.

[back to top]

Appendix A - Home Visit Guidelines: Green, Amber, Red

Adapted from Clinical Excellence Commission COVID-19 Infection Prevention and Control Manual

Refer to the  Risk Monitoring Dashboard to see current risk alert levels. A list of current case locations and exposure sites can be found on the NSW Health website.

Any service delivery must follow local advice on any additional precautions as instructed by the Local Health District e.g. Amber + masks.

 

  Green Amber Red
For patients/clients and household members WITHOUT symptoms or risk factors for COVID-19

No change to routine care, treatment or assessment.

 

Incorporate COVID-19 precautions such as physical distance of >1.5m and use of standard precautions.

 

BOTH parents/carers should be encouraged to participate in the appointment as per usual practice, using standard precautions and physical distancing.

Surgical mask within 1.5m of patient/client use.

 

Patients to wear surgical or own approved cloth mask at their own discretion.

 

BOTH parents/carers should be encouraged to participate in the appointment as per usual practice, using standard precautions and physical distancing.

Universal surgical mask use for staff.

 

Patients receiving care, as well as any present family members, are recommended to wear a surgical or own approved cloth mask during visit.

BOTH parents/carers should be encouraged to participate in the appointment as per usual practice, using standard precautions and physical distancing.

Where risk assessment identifies a patient, client or household member WITH suspected or confirmed COVID-19 OR they are a close contact and have been notified by NSW Health to get tested and self-isolate.

Surgical mask recommended for staff and parents/carers

For staff a P2/N95 respirator and eye protection recommended in an area of increased testing.

Surgical mask for both parents/carers

Staff to wear a P2/N95 respirator and eye protection

 

 

Surgical mask for both parents/carers

Staff to wear a P2/N95 respirator and eye protection.

          

Adapted from Clinical Excellence Commission COVID-19 Infection Prevention and Control Manual, Version 1.5 - 28 July 2021, Pages 52, 54, 62, 70, 82 of 217.


Appendix B - Outpatient and Service Delivery Guidelines: Green, Amber, Red

Adapted from Clinical Excellence Commission COVID-19 Infection Prevention and Control Manual 

Refer to the  Risk Monitoring Dashboard to see current risk alert levels.  A list of current case locations and exposure sites can be found on the NSW Health website.

 

  . Green            Amber                  Red           
Staff

Standard Precautions: Physical distancing to apply at all staff breaks/meetings where ossible

Droplet Precautions (surgical mask and eye protection) if within 1.5m of patients with Acute Respiratory Infection (ARI)

Contact and Airborne Precautions (P2/N95 respirator) and eye protection are required when providing direct care for:

  • patients with suspected or confirmed COVID-19
  • close contact of a COVID-19case as determined by PHU.

Staff to wear surgical mask within clinical area.

 

Droplet Precautions (surgical mask and eye protection) if within 1.5m of patients with ARI.

Physical distancing to apply at all staff breaks/meetings where possible.

Contact and Airborne Precautions (P2/N95 respirator) and eye protection are required when providing direct care for:

  • patients with suspected or confirmed COVID-19
  • close contact of a COVID-19 case as determined by PHU.

Universal surgical mask use by all staff when in the facility

Droplet Precautions (surgical mask and eye protection) if within 1.5m of patients with ARI

Physical distancing to apply at all staff breaks where possible

Contact and Airborne Precautions (P2/N95 respirator) and eye protection are required when providing direct care for:

  • patients with suspected or confirmed COVID-19
  • close contact of a COVID-19 case as determined by PHU.
Patients

Standard Precautions: hand hygiene, physical distancing, cough etiquette, respiratory hygiene and personal hygiene.

Both parents/carers should be encouraged to participate in the appointment as per usual practice, using standard precautions and physical distancing.

Mother and baby to stay together Children 12 years and under are not required to wear a mask.

Both parents/carers should be encouraged to wear mask and participate in the appointment where possible, using standard precautions and physical distancing. Alternatively, telehealth may be used to include both parents/carers. Follow Public health order. 

Mother and baby to stay together.

All adult patients to wear a mask during presentation and transit if possible

Children 12 years and under are not required to wear a mask

Both parents/carers should be encouraged to wear mask and participate in the appointment where possible, using standard precautions and physical distancing. Alternatively, telehealth may be used to include both parents/carers. Follow Public health order.

 

Adapted from Clinical Excellence Commission COVID-19 Infection Prevention and Control Manual, Version 1.5 - 28 July 2021, Pages 52-53 of 217)

   

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: Monday 2 August 2021
Contact page owner: Health Protection NSW