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

2. 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

4. 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.

5. 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 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.

7. 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

8. Nutrition

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

10. 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

11. MCH, childcare, playgroups

12. 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
CD – via DIBP
Pre School Field Officers
Help kids with developmental problems
Free kindergarten association
Enrolment – call kinder
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

13. 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
Ideally 12m, often 6m, balance vs missing school
Limited places in North – outpost schools
Local Government and Catholic schools
(Govt)
(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

15. 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 +)

16. 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

17. 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

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

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

21. Other practical issues
Carer allowance
Better start funding (in transition)
Continence funding (in transition, 5 yrs +)
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

23. 4% overall, <2% Vic and NSW

24. 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%)

25. 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

26. 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

30. When in doubt… It covers everything:
It covers everything:
The raising children network has fantastic online resource where you can search for local services based on locality.