Healthcare that counts: A framework for improving care for vulnerable children in Victorian health services (2017)
All Victorian health services play a vital role in the early identification and effective response to vulnerable children at risk of child abuse and neglect. The Healthcare that counts framework supports all health services including hospitals, community health services, alcohol and drug services, mental health and dental services to identify and respond to vulnerability by embedding organisational governance, systems and structures focussed on vulnerable children and families.
The framework aligns with and supports the implementation of mandatory Child Safe Standards and supports the Victorian government's reform direction to deliver effective and integrated services to vulnerable children and families at risk of or experiencing child abuse, neglect, family violence and other forms of social disadvantage. This framework replaces the previous 2006 framework for acute health services and has been broadened to include all parts of the health sector to reflect the shared responsibility across the service system for protecting and promoting the health, safety and wellbeing of children.
The framework outlines five Action areas for Health services to review as part of a continual quality and safety improvement process. Health services can undertake an annual self-assessment to measure their progress against the framework by reviewing the indicators of best practice, rating progress and identifying gaps in practice. A simple self-assessment tool to guide this process is available from this website. Useful resources and examples of best practice are available at the Children at Risk Learning under the resources tab.
Children at Risk Learning Portal
This e-learning supports health professionals in their early identification of and effective response to children at risk of child abuse and neglect. The online training is widely used across the health and welfare sectors to support the professional development of all health professionals.
The online training is free and helps all health professionals to:
- identify vulnerable children
- respond to suspected abuse or neglect
- understand legislated responsibilities and the child protection and family services system.
The portal also hosts a range of other resources and tools to help health professionals and health organisations strengthen their practice and improve their knowledge of vulnerable children and their families.
Resources and information for health professionals
Legislative responsibilities for health staff
Reporting child abuse or neglect
Any person who believes on reasonable grounds that a child has suffered or is likely to suffer significant harm as a result of abuse or neglect, and that their parent has not protected or is unlikely to protect the child from harm of that type, may make a report to Child Protection.
A reasonable belief does not require proof. Where a report is made in good faith, reporters are protected.
Mandatory reporting of suspected child physical or sexual abuse
Doctors, nurses, midwives, teachers, school principals, police officers, out-of-home care workers, early childhood workers, youth justice workers and registered psychologists must report suspected child physical or sexual abuse to Child Protection. This mandated obligation is set out in the Children, Youth and Families Act 2005.
Mandated reporters must make a report:
- when they form a belief on reasonable grounds that a child needs protection from significant harm as a result of physical injury or sexual abuse
- where they form this belief while practising their profession or carrying out duties of their office, position or employment
- each time they become aware of any further reasonable grounds for this belief.
'Forming a belief' is the process of asking whether you are more or less likely to believe the child faces significant harm based on the information available. It does not mean you have to prove the abuse has occurred or is likely to occur.
‘In need of protection’ means the child has suffered or is likely to suffer significant harm, and their parents have not protected or are unlikely to protect them from harm of that type. It can be about a single act, omission or circumstance or accumulate through a series of acts, omissions or circumstances.
‘Belief on reasonable grounds’ means if a reasonable person doing the same work would have formed the belief on those grounds.
‘Grounds’ for a belief are matters of which you have become aware and any opinions in relation to those matters.
The Children at Risk Learning provides resources for mandated reporters.
More information on mandatory is available on the Service Providers website.
Significant concerns for the wellbeing of a child or unborn child
If you have significant concern for the wellbeing of a child, but do not believe they are at risk of significant harm, and where the immediate safety of the child will not be compromised, a referral to Child FIRST or The Orange Door may be appropriate.
Child FIRST, as the access point for family services, is progressively transitioning to The Orange Door. The Orange Door is the new access point for families who need assistance with the care and wellbeing of children, including those experiencing family violence, to contact the services they need to be safe and supported.
Referring to Child FIRST or The Orange Door is appropriate where families:
- are experiencing significant parenting problems that may be affecting the child's development
- are experiencing family conflict, including family breakdown
- are under pressure due to a family member's physical or mental illness, substance abuse, disability or bereavement
- are young, isolated or unsupported
- are experiencing significant social or economic disadvantage that may adversely impact on a child's care or development.
Contact numbers to make a referral in each local government area are listed on the Child and family services information, referral and support teams (Child FIRST) on the Services website.
Failure To Disclose Sexual Offence On A Child Under 16 Years
Any adult who forms a reasonable belief that a sexual offence has been committed by an adult against a child under 16 has an obligation to report that information to police. Failure to disclose the information to police is a criminal offence.
This criminal offence, found in the Crimes Act 1958 ss. 327-330, became law in Victoria in October 2014 and includes all adults working within Victorian health settings.
Visit the Department of Justice and Community Safety website for more information and a downloadable factsheet.
Reporting multiple deaths
A death must be reviewed by the Victorian Coroner when it is a second or subsequent death of a child under the age of 18 within the one family.
Children who are stillborn or children who lived their entire lives in hospital are not considered reviewable deaths, unless otherwise determined by a coroner. Medical practitioners must tell the Coroner when they identify a reviewable death.
For more information, please go to the Coroners Court of website.
Specialist health programs for children at risk
Victorian Forensic Paediatric Medical Service (VFPMS)
VFPMS is a statewide, coordinated specialised paediatric medical service that provides 24-hour forensic clinical examinations and assessments for children under the age of 18 when child abuse is suspected. VFPMS provides assessments for suspected physical abuse, sexual abuse and severe neglect.
Its services include:
- evaluation of injury
- specialist expertise for sexual abuse examinations
- holistic health and developmental assessments for children with complex needs
- integrated health care with coordinated referral and follow-up
- comprehensive reports and participation in legal proceedings
- statewide advice and consultation 24/7
- education, training and research.
VFPMS only works with children who are referred from Child Protection, Victoria Police or other health professionals. VFPMS provides a comprehensive forensic assessment report and expert evidence in any court proceedings relating to the child. Its service is free and can be accessed at Royal Children’s Hospital or Monash Medical Centre, or via regional hospitals.
Call 1300 66 11 42.
Children in Out of Home Care
Pathway to good health
Children residing in the statutory out of home care system have experienced a level of child abuse and neglect that has meant that they are no longer to live safely with their families. These children as well as experiencing significant trauma in their lives also have health outcomes that are much poorer than the general child population.
To ensure that these highly vulnerable children receive the best possible health care to address health deficits, a model of coordinated care and health planning has been developed and funded by the Department known as the Pathway To Good Health. This model is currently available within the North and West metropolitan areas of Melbourne and the Gippsland region. The service focusses on all children who enter out of home care for the first time and all young people residing in residential care.
Under the program, these children have access to a coordinated pathway that includes:
- an initial health check by a selected general practitioner
- a priority referral to a specialised clinic led by a paediatrician that provides a multi disciplinary assessment that includes mental health and speech pathology
- a completed health care management plan with assessments and recommendations for treatment that can be incorporated into ongoing health planning and the child’s statutory case planning process.
A child can only be referred to the Pathway To Good Health by the child protection or out of home care agency working with the child. To see more about the Pathway To Good Health please view a short 5 minute video available at the Children at Risk Learning .
Priority access to public dental services
Dental health is a vital part of overall child health and for children in out of home care their dental health is prioritised under our public dental system. All children and young people in out of home care are eligible for priority access to public dental services. This means that children can access the next available dental appointment for routine dental care at no cost.
Chief Psychiatrist guidelines - priority access for out of home care
The Chief Psychiatrist guidelines provides priority access for both children within the out-of-home care system and those responsible for caring for the children with access to either primary, secondary or service level consultations via the centralised triage process for mental health.
Child Safe Standards
In January 2016, the Child Safe Standards (the Standards) were introduced by the Victorian Government in response to the Parliamentary Inquiry into the Handling of Child Abuse by Religious and Other Non-Government Organisations (Betrayal of Trust Inquiry). The focus of the Inquiry was strengthening organisation approaches to preventing and responding to child abuse.
Under the Child Wellbeing and Safety Act 2005, the Standards are compulsory for all Victorian organisations that provide services or facilities for children, including Victorian health services, to help protect them from harm and abuse. Implementation of the Standards are intended to drive cultural change in organisations, so that protecting children from abuse is embedded in the everyday thinking and practice of leaders, staff and volunteers.
For more information about the Standards and the principles that underpin them, visit the Departments Child Safe Standards page.
Reportable Conduct Scheme
The Victorian Government introduced a reportable conduct scheme (the scheme) in phases from 1 July 2017. The scheme aims to improve oversight of how certain organisations that have a high level of responsibility for children respond to allegations of child abuse and child-related misconduct.
Allegations of reportable conduct must be notified to the Commission for Children and Young People. Allegations of suspected criminal conduct must be reported to Victoria Police as the first priority.
Since 1 July 2017, the scheme captures mental health service providers with in-patient beds and drug or alcohol providers with in-patient beds. From 1 January 2018, all public, private and denominational hospitals and public health service are in-scope. For more information about the scope of the reportable conduct scheme refer to the website of the Commission for Children and Young People.
'Reportable conduct’ is defined in the Child Wellbeing and Safety Act 2005, to capture offences and misconduct involving children, including a sexual offences; sexual misconduct; physical violence; significant emotional or psychological harm; or significant neglect.
For more information about the Scheme, visit the Department’s Reportable Conduct Scheme page or the Commission for Children and Young People’s website.