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Health screening Development, disability and school enrolment

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

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Health screening Development, disability and school enrolment

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  1. Health screening Development, disability and school enrolment DrGeorgiePaxton 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

  3. 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!

  4. 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

  5. Clinical red flags Vit D deficiency Prolonged cough, fever, night sweats, poor growth Rickets, bone pain, muscle pain, late teeth late fontanelle closure (low dairy) TB (active vs latent) 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

  6. Nutrition

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

  8. (Private) 0-6, single problem (quicker) Older - varies (Baffling…) 0-6, multi-problem (v slow) FAHCSIA ?interpreters NDIS

  9. MCH, childcare, playgroups

  10. 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

  11. Schools • All kids should be at school • 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)

  12. 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 +)

  13. 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

  14. 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

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

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

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

  18. 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

  19. Roll out of NDIS in metro Melbourne

  20. 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

  21. 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

  22. When in doubt… http://raisingchildren.net.au/myneighbourhood/Default.aspx It covers everything:

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