Transcript 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)
DHC - Humanitarian
Hx/Exam
(Voluntary – 3 d prior to travel)
Syrian cohorts
TB screen 2-10y
Exam, parasite check
Combined IME and DHC
CXR ≥ 11y
Malaria RDT and Rx if positive (location)
Hx/Exam
HIV ≥ 15y
CXR and HIV if PHx TB
TB screen 2-10 y
FWTU ≥ 5 yrs
Albendazole ≥ 1 y
CXR ≥ 11 y
HBsAg (preg/URM/HCW)
MMR 9m – 54y
HIV ≥ 15 y
HCV (HCW)
+/- YF vaccine
HBsAg
Syphilis (Humanitarian) ly) Character
+/- Polio vaccine
FWTU ≥ 5 y
requirement
Ax local conditions
Albendazole
+/- Repeat IME
Full 1st dose
catch-up immunisations
AUSCO
Mental health screen
Development screen (<5 y)
Outcomes
+/- Visa
Outcomes
Alert (Red. General)
Fitness to fly assessment
Health Undertaking +/- delay travel
Alert (Red, General)
+/- Health Undertaking
Australia
Post arrival health screening
Voluntary
Maximising referral value
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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!
Has my patient had a refugee health check?
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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
Clinical red flags
Vit D deficiency
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
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Physical
Intellectual
Sensory impairments (vision/hearing)
Function/equipment/supports
0-6, single
problem
(quicker)
Older - varies
0-6, multiproblem
(v slow)
Childcare
Kindergarten
Community
based/CHC
(Hospital)
Early
intervention
School
NDIS
FAHCSIA
?interpreters
(Baffling…)
(Private)
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
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http://www.education.vic.gov.au/childhood/parents/kindergarten/pages/fees.aspx
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CD – via DIBP
Pre School Field Officers
Help kids with developmental problems
Free kindergarten association
• Enrolment – call kinder
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http://www.education.vic.gov.au/findaservice/Home.aspx
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
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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
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http://www.education.vic.gov.au/findaservice/Home.aspx (Govt)
http://raisingchildren.net.au/myneighbourhood/Default.aspx (all)
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
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• 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
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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)
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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/governmentspecialist-schools-units/
http://www.australianschoo
lsdirectory.com.au/searchspecialneeds.php
https://imvc.com.au/youthservices/broade
n-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
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Companion card
Taxi
Vehicle modifications
Disabled parking
Roll out of NDIS in metro Melbourne
Funding and eligibility
• Early Intervention (0-6)
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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…
http://raisingchildren.net.au/myneighbourhood/Default.aspx
It covers everything: