National Clinical Assessment Framework for Children and Young People in Out-of-Home Care (OOHC) - March 2011

2 National Clinical Assessment Framework

Page last updated: 05 December 2011

The Framework outlines an approach to improving responses that address the health needs of children and young people in OOHC. Effective implementation of the Framework is likely to contribute to health outcomes for individuals in this population.

A detailed literature review and an examination of practice in a range of national and international jurisdictions were undertaken and the key learnings have been considered in the development of the Framework.

The Framework has been informed by available information to identify best practice and balances the practicalities of what is possible against what is necessary to address the health needs of this vulnerable population. Consideration has been given to the need for the Framework to be able to be implemented in States and Territories and be applicable across a broad range of settings (e.g. metropolitan, rural and remote).

Overall the Framework provides guidance on:

  • A structure for the provision of the necessary health assessments and pathways to clinical services that will contribute to the best quality care for children and young people
  • a variety of measures that are cost efficient, evidence-based, age-appropriate and sensitive to the potential impact on children and young people in OOHC
  • how assessments might complement existing universal services provided in each jurisdiction.

Core Elements

The Framework proposes a tiered approach to age-appropriate assessments that cover the key domains of physical health, developmental and psychosocial and mental health.

It includes the following core elements:
  1. A Preliminary Health Check that should be commenced as soon as possible and ideally no later than 30 days after entry to OOHC to determine areas of immediate concern.13
  2. A Comprehensive Health and Developmental Assessment that should be completed within 3 months of placement.
  3. Further specific assessments and management, following the Preliminary Health Check and/or the Comprehensive Health and Developmental Assessment, in accordance with the needs of the individual child or young person on a case by case basis.
  4. Development of a Health Management Plan including a personal health record. The Health Management Plan should be integrated with other management plans (e.g. educational plans) into a single management plan for the child or young person.
  5. Follow-up monitoring in accordance with the clinical needs of individuals to ensure that existing issues are being appropriately addressed and new and emerging issues are identified and addressed.
  6. There will be a nominated officer/position with the role of Care Coordinator Health (CCH) This role could be provided by the statutory case officer or a health case manager and should be responsible for ensuring required health and development assessments occur, referrals to specialist services are made and that there is continuity of information and services following placement change.14
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A diagrammatic representation of the Framework is outlined in Figure 2 below.

Diagram representing the core elements of the National Clinical Assessment Framework

Figure 2 - Core elements of the National Clinical Assessment Framework

The target group for the Framework are policy makers developing responses and clinicians and service providers managing the care of children and young people in OOHC.

Key principles

The development of the Framework has been informed by the following key principles:
  1. Children and young people in OOHC and their carers will benefit from structured processes that engage primary health care and specialist services in the identification, service provision, planning, coordination and management of their health needs.
  2. The Framework should have universal application to all children and young people in OOHC whilst maintaining sensitivity to the diversity and potentially complex needs of different populations.
  3. Children and young people in OOHC should have their health information recorded and accessible to them, along with health providers and carers. In addition, the views of a child or young person concerning their own health and wellbeing and their desired health outcomes must be invited and taken into account. The outcomes of each assessment should be shared with the child, inform future assessments, and where appropriate, inform placement decisions.
  4. Implementation in States and Territories will be informed by the relevant legislation and service system in the jurisdiction.

When States and Territories develop guidelines for the implementation of the Framework, seven additional principles are suggested. These are:
  1. Initial assessments should establish continuity of care that is able to be maintained through subsequent interactions with the health system.
  2. Practitioners should consolidate each individual’s health information upon entry and continually capture and transfer health information.
  3. Practitioners should have clinical and cultural competency to complete assessments. Care should be taken to avoid stereotyping or stigmatising the child or young person because of their background (e.g. ethnic, geographic or socio-economic).Top of page
  4. Practitioners should have an awareness of particular risk factors relevant to the individual and focus on the circumstances under which the child or young person entered OOHC (e.g. family situation, history of abuse and neglect etc).
  5. Practitioners should be mindful of the diversity and potentially complex needs of the following different populations:
  • children and young people in either home-based care (e.g. kinship or foster care); residential care (previously referred to as institutional) or custodial care
  • Aboriginal and Torres Strait Islander children and young people
  • children and young people from culturally and linguistically diverse backgrounds
  • children and young people that have a disability
  • children and young people of parents that have a disability
  • children and young people of parents that have a history of alcohol or substance abuse
  • children and young people living in rural and remote settings
  • children and young people with refugee status
  • otherwise vulnerable children and young people.
6. Children/young people and their parents/carers/teachers should be consulted wherever possible and participate in decision-making processes
7. Practitioners should pay additional attention to care coordination following change of placement, re unification or other transition from care.15

13 American Academy of Pediatrics (2000) Developmental issues of Young Children in Foster Care. Pediatrics, 106:1145-9
14 Placement change includes restoration/reunification or transition to independent living.
15 CREATE Foundation. (2005). Indigenous children and young people in care: Experiences of care and connections with culture. Perth, WA: Author