Health screening Development, disability and school enrolment Dr Georgie Paxton Immigrant Health Jan 2017

Pre-departure health screen (offshore) Immigration Medical Exam - all (Compulsory, 3–12 m prior to travel) Hx/Exam TB screen 2-10y CXR ≥ 11y HIV ≥ 15y FWTU ≥ 5 yrs HBsAg (preg/URM/HCW) HCV (HCW) Syphilis (Humanitarian) ly) DHC - Humanitarian (Voluntary – 3 d prior to travel) Exam, parasite check Malaria RDT and Rx if positive (location) CXR and HIV if PHx TB Albendazole ≥ 1 y MMR 9m – 54y +/- YF vaccine +/- Polio vaccine Ax local conditions +/- Repeat IME Syrian cohorts Combined IME and DHC Hx/Exam TB screen 2-10 y CXR ≥ 11 y HIV ≥ 15 y HBsAg FWTU ≥ 5 y Albendazole Full 1st dose catch-up immunisations Mental health screen Development screen (<5 y) Character requirement AUSCO Outcomes +/- Visa Alert (Red. General) Health Undertaking +/- delay travel Outcomes Fitness to fly assessment Alert (Red, General) +/- Health Undertaking Australia Post arrival health screening Voluntary

Maximising referral value Make sure country, language, DOB documented Include current address, caseworker details Copy of e-medical paperwork Offshore immunisations – AIR – all ages Health undertakings Any screening completed Test results Immunisations Progress/reviews/medications Never give original paperwork to health providers! There are many different areas that clinical information will be kept and families may have all or none of those listed. The availability of clinical details, as well as language and caseworker details facilitate a much more effective consultation with the doctor. Correspondence which outlines a reason for referral improves efficiency.

Has my patient had a refugee health check? 3 sets immunisations (~3-4 needles in each) Screening blood tests Faecal specimen Mantoux test (children <5y) Check results (i.e. 2 visits) Treatment of problems On-shore, these are the minimum investigations a child will require: please see http://www.rch.org.au/immigranthealth/clinical/Initial assessment/ ACIR (Australian Childhood Immunisation Register) all immunisation records, even detention Generally these investigations will yield at least 1 (often more) issues that require follow up. Together with catch-up immunisations, several appointments are often needed to complete the initial health assessment and refugee check.

Clinical red flags Vit D deficiency TB (active vs latent) Anaemia Rickets, bone pain, muscle pain, late teeth late fontanelle closure (low dairy) TB (active vs latent) Prolonged cough, fever, night sweats, poor growth Anaemia Irritability, lethargy, developmental delay (prolonged BF, high dairy, low meat) Gastrointestinal and nutrition Low weight/poor growth, diarrhoea, abdominal pain, epigastric pain, vomiting, poor appetite Developmental concerns Parent concern, different to siblings, sentences > 3 years, detention, family stress/MH Mental health concerns Behavioural disturbance: sleep, eating, play, somatisation

Nutrition

Development and disability Developmental delay/disability Language, motor, social/play, global Vision and hearing Disability Physical Intellectual Sensory impairments (vision/hearing) Function/equipment/supports

0-6, single problem (quicker) Childcare Kindergarten Community based/CHC (Hospital) Early intervention School 0-6, single problem (quicker) Older - varies (Baffling…) 0-6, multi-problem (v slow) FAHCSIA ?interpreters (Private) NDIS

MCH, childcare, playgroups

4 yr old kindergarten Important! - play based, preparation for school Free - kindergarten fee subsidy Refugees/SHP visa 200–217, AS on BV A–F , TPVs 447, 451, 785, RoS visa http://www.education.vic.gov.au/childhood/parents/kindergarten/pages/fees.aspx CD – via DIBP Pre School Field Officers Help kids with developmental problems Free kindergarten association Enrolment – call kinder http://www.education.vic.gov.au/findaservice/Home.aspx Kindergarten is essential for children’s development and to prepare them for school. The child’s local kindergarten can be found online through the education department’s website. There is a fee subsidy available (to specific visa classes). Pre-School Field Officers (PSFOs) are available to help children with developmental problems who are attending kindergarten. Kindergartens make referrals to the PSFO. Children in community detention require approval by the Department of Immigration and Border Protection in order to attend kindergarten

Schools All kids should be at school Language schools Check age and level – no rush Think: prep age 6, cut off is 1 May Language schools Within 18 m arrival http://www.education.vic.gov.au/Documents/school/parents/translations/engldet.pdf Ideally 12m, often 6m, balance vs missing school Limited places in North – outpost schools Local Government and Catholic schools http://www.education.vic.gov.au/findaservice/Home.aspx (Govt) http://raisingchildren.net.au/myneighbourhood/Default.aspx (all) New arrival students from refugee backgrounds (arrival within 18 months) can access intensive English language programs in Victorian Government English language schools or centres. Asylum seekers can attend schools to the end of the school year in which they turn 18.  All Schools (including English language schools) can access additional support for students with disabilities. Children in Community detention can attend either Government or Catholic schools. Support systems are available for children with disability – refer early to a paediatrician

Categories (similar in Catholic education) Physical disability Visual impairment (6/60) Hearing impairment (moderate or greater) Severe behaviour disorder Intellectual disability Autism (Severe language disorder) Paed letter, Physio or OT letter RVEEH Education vision clinic Audiology report x Difficult, psychology/paed letter IQ test (<70), Vineland Diagnosis, Vineland, STx (<70) (STx < 3SD on 2 tests, AND not due to hearing, AND non verbal IQ 85+, AND signif difference b/n VCI and VSI/PRI AND ENQ = level 3 +)

Basic principles ASAP! Annual round applications (extra for preps) Need full PSD assessment to Get support in mainstream Get into specialist education So: Urgent paed assessment Hearing Language assessment IQ ASD assessment if relevant Physio/OT if relevant

Types of school Language school + PSD Mainstream + PSD Specialist education – zoned (bus) Special school – IQ 55 – 70 (mild ID) Special developmental schools – IQ < 55 (moderate –severe) Physical disability (multiple disability) Hearing impaired Blind (Berwick) ASD – usually transition to mainstream ~ grade 3

http://acd.org.au/government-specialist-schools-units/

http://www. australianschoolsdirectory. com. au/search-specialneeds http://www.australianschoolsdirectory.com.au/search-specialneeds.php

https://imvc.com.au/youthservices/broaden-your-horizons/education/government/

Other practical issues Carer allowance Better start funding (in transition) Continence funding (in transition, 5 yrs +) http://www.continence.org.au/pages/continence-aids-payments-scheme.html SWEP program (in transition) Wheelchairs, hoists, beds, bathroom equipment Lengthy wait, ?equipment hire in interim Housing issues Transport related Companion card Taxi Vehicle modifications Disabled parking

4% overall, <2% Vic and NSW

Roll out of NDIS in metro Melbourne NE Melbourne = Clifton Hill and North Yarra Darebin Nillumkik Whittlesea Banyule Oct 2018 – Next Metro = Brimbank Melton + Western Melbourne ( 50%)

Funding and eligibility Early Intervention (0-6) Developmental delay (<6yo) (List diagnoses) Impairment likely to be permanent Evidence that getting supports now will help Disability (6 – 65yo) Need diagnosis Impairment likely to be permanent/lifelong Substantially reduces ability to participate effectively

How to apply Self-referral by client/family Barwon trial - suggested NDIA accept referrals from professionals Not taken up Local area coordinator/access partner assist developing support plan and funding Family/client assisted to identify appropriate service providers Funding held by agency usually, can be client managed ‘Professionals report section’ - Part F access form

When in doubt… It covers everything: http://raisingchildren.net.au/myneighbourhood/Default.aspx It covers everything: The raising children network has fantastic online resource where you can search for local services based on locality.