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Challenges of foster care

Experienced foster carers who have performed this dedicated role for many years will all tell you the role is full of challenges as well as rewards.

Although it’s impossible to predict every challenge you might face as a carer, many of the possible scenarios and how to deal with them are covered in preliminary and ongoing training sessions. It also helps to network with foster care team members in your area - see the support contact list.

Many of our foster carers will tell you that many of the challenges, when handled successfully, bring the greatest rewards that only foster care can create. Your foster care caseworker is trained in these very challenges, and you must always contact your caseworker if any of these problems seem overwhelming. Foster care is about team work, and you should never bear these problems alone.

Challenges in foster care can include:

Most of these challenges will bring stresses to a foster care placement no matter how caring and well-prepared foster carers may be.

It is important that you talk to your caseworker about potential problems so you have realistic, rather than idealistic, expectations of the foster child or young person when you accept the placement.

Never be afraid to contact your caseworker to discuss any concerns you have regarding your relationship with the child or young person.

As long as they are safe from harm, we may be able to provide additional support and strategies to enable the foster care placement to continue and help resolve the problems.

Supporting children who've experienced trauma

To support your role as a carer, Family and Community Services has developed 3 videos on trauma with clinical psychologist Dr Howard Bath.  Understanding trauma will help you to support the children and young people in your care to feel safe, develop healthy connections with people, and use adaptive coping mechanisms to help them deal with their past.

These videos will help you understand trauma and how to:

  • meet the additional needs of children and young people who have experienced trauma
  • support children and young people to cope with the past and have a bright future
  • provide new strategies to manage challenging behaviours that stem from trauma.

Understanding trauma series: The 3 core needs of children

1. Feeling safe

This is the first of 3 videos on the core needs of children and young people in care who have experienced trauma. This video highlights how kids who have experienced trauma are continually alert to the possibility of threat. They experience chronic stress and anxiety that impacts on their emotions and behaviour. Carers can support children and young people by creating an environment of emotional and culturally safety where their emotions and perceptions are acknowledged and respected.

2. Healthy connections

This video focusses on the importance of healthy connections for kids in care who have experienced trauma. Kids and young people in care can be acutely aware that they are different and can hunger for normality. Mixing with local kids and your community helps normalise their experience and develop healthy connections with caregivers. Carers can support healthy relationships by focussing on their connections with kids, rather than focusing on teaching them how to behave.

3. Adaptive coping

Children and young people in care who have experienced trauma can have difficulty controlling their emotions and impulses.  Research tells us that learning to manage emotions is based on the availability of support, coaching and trust from caregivers – so your role as a carer is vital. Active listening and focusing on the feelings that are driving their behaviour will assist these kids develop healthy and adaptive strategies to cope with the past.

About Dr Howard Bath

Dr Bath has more than 40 years experience working with children and young people in the child protection and youth justice systems. Trained as a clinical psychologist, he has been a houseparent, youth worker, manager, clinician and agency director. From 2008 to 2015 Howard was the inaugural Children's Commissioner of Australia's Northern Territory with responsibility for the wellbeing of vulnerable children. He currently provides a range of consultancy and training services across Australia and overseas through the Allambi Care organization. He can be contacted at howardb@allambi.org

Additional trauma resources

Our DCJ Psychology team regularly produces materials to support carers in their role. The below resources were developed by the team for Fostering Our Future, our digital magazine for foster carers. Sign up to receive the free quarterly resource.

Helping children feel safe after trauma

Much of the challenging behaviour we see in children in care comes from feeling unsafe. The more they fear you’ll abandon them, the ‘naughtier’ they may seem. This is largely because of previous experiences of being unable to trust their parents.

The human brain can only develop through experiencing love and care in infancy. When a child has not been cared for properly, they don’t learn how to soothe themselves, and their language is slow to develop. This means it’s hard for them to ask for help, and because they may be upset most of the time, they’re likely to tantrum in frustration instead. Read more about helping children feel safe after trauma in Issue 43 of Fostering Our Future.

Music heals hurt minds

Throughout human history people have understood the power of music to soothe and calm children. Rhythm helps people regulate their feelings.

Different areas of the brain are affected by trauma and neglect depending on the age of the child. If a child has been mistreated as a baby then it is especially important to stimulate the pathways in the brain which can promote healthy development by music, singing and verse.

The brain is sensitive to these because they offer children a way to express their feelings, perceptions, thoughts, and memories in ways that words cannot. Read more about the benefits of music for young children in Issue 43 of Fostering Our Future.

More help

If you need further assistance in supporting children in your care who have experienced trauma, talk to your caseworker.

Maintaining ties to culture while in foster care

Children need and have the right to grow up in an environment where they are able to value their culture, religious background and language.

Carers play a crucial role in promoting and maintaining a child’s cultural connections. The need for foster carers from a broad range of backgrounds has never been more critical.

Aboriginal carers for Aboriginal kids

Aboriginal carers are especially important to help Aboriginal children in care grow up strong and proud. It is important that they help kids to maintain connections to family, land and culture to give them a strong sense of who they are, where they belong, and understand their family and community relationships.

The booklet Raising Them Strong is a good resource and covers topics such as health, education, grief and loss, family contact and navigating 'the system'. It was developed with Aboriginal foster and kinship carers, care support workers, caseworkers, and the Aboriginal Child, Family and Community Care State Secretariat (AbSec).

See also:

Caring for children from migrant or refugee backgrounds

Families from different cultural backgrounds help children to maintain their language, religion and identity while they are in care.

If you apply to become a foster carer you will be asked about your cultural and religious background, including languages spoken - this helps to match children needing care stay with carers from a similar background.

See also Culturally and linguistically diverse children and young people on the Caring for Kids website.

Caring for children from diverse cultural backgrounds

Carers will need to be supported by caseworkers to attend to the specific needs of migrant and refugee children and young people. While this applies to all carers, it is particularly important for carers looking after children and young people from a different cultural background to their own.

Caseworkers can assist carers to attend to the specific needs of culturally and linguistically diverse (CALD) children and young people by:

  • discussing carer attitudes towards the child’s cultural background and people from the cultural community
  • helping carers to identify positive attitudes and pre-conceptions, stereotyping and/or prejudice
  • working with the carer to identify practical strategies to support cultural maintenance and how to deal with discrimination, prejudice and/or racism
  • providing the carer with information about the culture, religion, language, and community of the child in Australia
  • providing contact details of relevant cultural, religious and linguistic services and networks in the local area
  • providing information about the specific needs of refugee children and contact details for specialist services and supports that can provide further information and advice.

Key attributes carers need

The following attributes are adapted from the work of Elizabeth Vonk in the United States on defining the attitudes, knowledge and skills required by non-CALD adoptive parents looking after CALD children and young people (Cultural Competence for Trans-racial Adoptive Parents, 2001). The expectation is that improvements in carers’ abilities in these key areas will contribute towards better outcomes for CALD children/young people in their care.

Cultural awareness

Cultural awareness is your ability as a carer to examine and understand the role that race, ethnicity, and culture plays in shaping your attitudes, beliefs and practices. This includes an understanding of your attitudes, beliefs and interactions with members of culturally diverse communities – particularly in relation to the cultural background of the child/young person in your care.

Responding positively to prejudice and discrimination

Experiences of discrimination, prejudice and racism may confront you and the children and young people in your care. You should be able to understand the impact of prejudice and racism on the child and young person and assist them developing positive strategies for coping with this issue.

This can be particularly challenging if you are non-CALD and have had limited personal experience of being the target of discrimination, prejudice or racism. It is important that the child/young people’s experiences in this regard are not minimised or negated.

Multicultural strategies

As a carer you should be able to identify and implement appropriate strategies to create avenues for CALD children/young people to maintain or further develop cultural, linguistic or religious ties. This includes being informed about CALD related services, supports and networks relevant to the needs of the child/young person.

The Tips for carers checklist outlines practical ways in which these attributes can be used to support CALD children.

More information about raising culturally and linguistically diverse children and young people can also be found on the Caring for Kids website.

Participating in case planning

A case plan for a child or young person in out-of-home care is not only important in terms of record keeping, but is a vital tool to ensure the best possible outcomes for the child's placement, development and future. We place a great deal of importance on ensuring the actions and decisions recorded in the case plan are put into practice.

Case planning almost always requires a team effort including the child or young person in care, family, carers and other important people in their lives. Whenever appropriate and possible, all interested or responsible parties are involved in the decision-making process.

What is a case plan?

A case plan is a record of the goal or objectives for Communities and jusitce (DCJ) intervention in the lives of children, young people and their families or carers. The case plan records all the important decisions and tasks that are necessary to achieve the goal and objectives agreed on by all parties.

Case planning involves regular assessment of the issues facing a child or young person, their family and foster carers.

Case plans make it clear to all parties why DCJ is involved, what issues need to be addressed, and what the individual responsibilities of all parties are.

Participating in the case plan

Participation means that everyone gets to take part in discussions, express their views, and have their opinion considered in the case planning and decision-making process.

It also means that where DCJ makes decisions or takes action, the people whose lives are affected are given reasons for those decisions or actions, as well as the opportunity to respond.

Why participation is important

A case plan is more effective if it has been developed with the participation of all parties.

Where effective and cooperative relationships are established with families during the case planning process, better outcomes are achieved for children and young people.

Who should participate

Wherever possible, case plans are developed with the participation of the child or young person, their family and their carer, if they have one.

We recognise the need for specific strategies to ensure the participation of children and young people, women and men, people with disabilities, Aboriginal and Torres Strait Islander people and people from culturally and linguistically diverse backgrounds.

Foster carers

Where a child has been placed with a carer, it is vital that the carer participates in the case planning process. As a carer, you have responsibility for making day-to-day decisions about children or young people in your care, and you may also be delegated aspects of parental responsibility.

This gives you an important role to play in case planning, and a right to participate in decision-making about the safety, welfare and wellbeing of children or young people in your care.

We are committed to giving carers the information you need to participate, and recognise that you may also need additional resources to help you participate effectively, such as interpreters, support people or child care.

Birth parents

Whenever it’s possible and appropriate, we encourage the parents of children and young people to be involved in case planning. Your child's caseworker will talk to you about your participation in decision-making and explain that the interests of your child are of paramount importance.

As a birth parent, you can participate in decision-making by:

  • attending conferences and meetings
  • having a support person accompany you to a meeting or conference
  • contributing agenda items for a meeting.

See more on rights of parents whose child or young person is in care.

We understand that parents may need extra support to express their views, participate in decision-making and understand the outcomes. We can provide appropriate support to help you participate, such as arranging for an interpretor or Aboriginal or Torres Strait Islander support person or community representative.

See Children in out of home care for more information for parents of children or young people in foster care.

Life Story work

Life story work is a method used to record the details about a child or young person’s history and personal development. It is a record of their life in words, pictures and photos made by the child or young person with help from a trusted adult or other person having a meaningful relationship with the child or young person.

My Life Story Book has been developed to assist children and young people in out-of-home care develop a sense of self, in relation to their life experiences. It is a chronological account of the child or young person’s history, and should be started when the child enters out-of-home care and maintained throughout their time in care.

Download My Life Story book PDF, 1685.5 KB

Benefits

There are many benefits to keeping a life story book:

  • working on the book together helps build a bond and develop trust between the child or young person in care, their foster carer and caseworker
  • the child or young person develops a stronger feeling of self identity and self esteem through learning about and accepting their past
  • the book “bridges the gap” between foster carers and parents when the child returns home, especially when parents feel they have missed out while their child has been in care
  • making the book helps the child distinguish reality from fantasy
  • the book allows the child or young person to ask their caseworker questions they may not have felt safe to ask before such as what their parents are like and why they are in care
  • the book ensures that details about the child or young person’s culture and religion are recorded

It is up to the child or young person to decide who to share it with and they should be encouraged to keep the book in a safe place. The life story book stays with the child or young person when they return to their own home or go to another placement.

Aboriginal life story

The Aboriginal version of My Life Story Book supports Aboriginal children in out-of-home care in understanding more about their cultural identity and in developing a sense of connectedness to family, kinship groups and the community.

Aboriginal and Torres Strait Islander children and young people placed in care have similar needs to non-Aboriginal children. However, there are differences that are specific to Aboriginal children and young people.

It is especially important to provide for their cultural needs as this helps them grow up strong, knowing who they are, where they come from and how they fit into their community. It is important to include information about an Aboriginal child’s family, community and culture in their life story. This information can be found by talking with:

  • the child or young person
  • their parents or extended family
  • Aboriginal workers
  • their caseworker
  • Aboriginal leaders
  • Aboriginal organisations and community groups
  • using internet, libraries, books and videos
  • attending art exhibitions, performing arts events, concerts and cultural camps

Download My Life Story book - Aboriginal version PDF, 11884.97 KB

Life story for kids from other cultures

Children and young people from other backgrounds can explore their cultural and religious heritage and record details in their life story work. This includes:

  • where the child’s family comes from
  • what the country or city is like
  • the religious beliefs and practices of the family
  • what language or languages they speak
  • holidays, special events, national foods and dress associated with their culture and or religion
  • how the child takes part in the culture and religion of their birth families
  • what the child liked or didn’t like.

Sources of information may include the child or young person, their family, caseworker and cultural organisations.

Role of carers

The carer is generally the person who works with the child or young person to record their life story. Carers spend the most time with them and have the opportunity to collect day-to-day information such as photos and other memorabilia.

Carers need to have a clear understanding of ways to maintain the My Life Story Book. This can include:

  • taking photographs to put in the book at special events and on special occasions, such as birthdays and first day at school
  • encouraging the child or young person to keep personal mementos to put in their book such as letters, cards, drawings and paintings
  • recording the life story at the child or young person’s pace. This may be a gradual process as they become more comfortable compiling detailed information about their families and time in care
  • spending time with the child or young person at regular intervals to update the My Life Story Book
  • discussing with the child or young person that the My Life Story Book is confidential and that no-one should access it without their permission
  • keeping the book in a safe place. The carer should discuss with the child or young person where to keep their My Life Story Book so it is safe
  • ensuring that the My Life Story Book goes with the child or young person when they leave care.

Planning

People who can help with life story work include the child or young person, a caseworker, the carer, a counsellor and sometimes family members. These people can have different roles depending on the task or may work with the child or young person on certain parts of their life story.

Make it clear who will be responsible for the roles of:

  • structuring the life story work
  • preparing the child or young person for life story work
  • collecting information
  • asking the child or young person who they would like to have work with them
  • maintaining the life story work once the My Life Story Book is compiled

Preparing kids for life story work

Generally, caseworkers will prepare the child or young person for life story work together with the carer.

An important aspect of life story work is to acknowledge the child or young person’s feelings about things that have happened to him or her. They can experience a range of feelings during the life story work. Some memories may make them feel uncomfortable or sad while others may be happy. It is important that the child or young person is encouraged to talk about these feelings with a person they feel comfortable with.

Additional support such as counselling can help deal with any difficult or sensitive issues that arise during life story work. It is also important to tell the child or young person that their My Life Story Book belongs to them and that they decide who else can look at it. If someone wants to look at their My Life Story Book they must have the child or young person’s permission.

School and education

As a foster or kinship carer you play a crucial role in supporting children and young people in your care to participate and achieve the best outcomes at school.

Learning and support planning

When a child or young person enters out-of-home care (OOHC), their caseworker will tell the Department of Education and School Principal that they are in care. The school will then start the personalised learning and support planning process (formerly Education planning).

1. Identifying the child or young person’s individual needs

  • The School Principal, your caseworker, you, the student (if appropriate) and any other relevant professionals will work together to identify the child or young person’s individual learning and support needs.
  • A holistic assessment of learning and support needs is informed by analysis of data. Information from the child or young person’s Health Management Plan (where available), previous school records, as well as any previous education planning documentation will be used.

2. Developing personalised learning and support planning

  • A number of supports based on the assessed needs of the student will be developed. The supports will be documented in teacher’s plans, records of educational and social-emotional interventions for the student, plans for individual student learning, communication, behaviour, health care and transition and learning materials (if applicable).
  • The caseworker will save this documentation in place of the former Education Plan.

3. Monitoring the impact of learning and support planning

  • Supports for a student are regularly monitored, reviewed at least annually and adapted and changed where needed, to continue to meet the assessed needs of the student. Monitoring and review will be informed by student progress data, meeting records, data specific to behaviour, health care, communication, attendance and learning achievement.
  • The school will consult and work collaboratively with caseworkers, carers and students (if appropriate) to identify and respond to addition learning and support needs. This includes collaborative planning between teachers, support staff and specialist staff within and outside education where needed.

What is your role with the student’s education?

You can support the education of the child or young person in your care by:

  • telling the school and your caseworker about any issues which may impact on the child or young person’s ability to learn
  • participating in learning and support planning.
  • asking your caseworker or school for help to make sure the supports in the learning and support planning are implemented and actions are completed
  • being involved in the school community and getting to know your child or young person’s teachers and friends
  • attending parent-teacher meetings which provide a great opportunity to talk about progress
  • making sure learning and support planning documentation, school reports and any other relevant education records are provided to new carers or parents if a student moves placement or returns home.

You can also encourage the child to:

  • participate in learning and support planning
  • participate in activities which support their learning and connection to the school community
  • complete their homework and talk about what they enjoy at school and what they are having trouble with
  • understand that completing school and going to university or TAFE will give them their best possible chance of success in life

Helping children and young people reach their potential at school

Foster carers play an important role in supporting children and young people at school. Educational outcomes for children and young people in care are consistently poorer than their peers in the general population. They include:

  • poorer literacy and numeracy skills
  • higher numbers of children and young people repeating a grade at school (10–30% of children and young people in out-of-home care in NSW)
  • higher incidences of learning difficulties, behavioural problems and intellectual disabilities
  • higher numbers of young people leaving school at an early age.

Children and young people in care often come from backgrounds where education is not a priority. They may suffer from poor self-esteem and have gaps in their learning because they have missed school or had a number of school changes. As a result they may have difficulty settling into school.

Involving children in learning from a young age is vital for them to have the best start in life. High quality preschool programs give children the opportunity to learn problem-solving, communication and social skills that they need for future educational success when they start school.

In 2008, public schools introduced the Best Start test in kindergarten and the National Assessment Program for Literacy and Numeracy with tests in years 3, 5, 7 and 9. Schools will give the child’s test results to their parents or carers.

Why education is important

Attendance at preschools through to year 12 and beyond gives children and young people greater employment opportunities and a broader set of social skills. Apart from intellectual stimulation, children benefit from education in a number of ways. They learn:

  • how to build relationships and become part of a community
  • how to work together with their classmates to achieve goals
  • how to accept success and disappointment
  • about diversity, tolerance and acceptance.

Education prepares children for life after school and helps them make decisions for their future.

Listening to children and young people

Children and young people need to be encouraged to think and talk about what goals they want to achieve and any support needed to achieve them. They also need to find out the things they enjoy and are good at and get support to do these activities.

Additional stress factors

Children and young people in care need a caring and safe environment where they feel accepted and protected. This helps them to confidently interact with and become part of their school community.

It is important to remember that moving to a new placement may also mean going to a different school. This can create extra stress for the child or young person. Other stressful periods can include starting school, moving from primary to high school or changing schools.

Carers need to be sensitive to these times and aware of possible issues that may arise. Carers can help children adjust to these changes by talking about what will happen and letting them decide what they want to tell other children at the school about their circumstances. If carers are concerned they should talk to the child or young person’s caseworker or teacher.

What carers can do at home

There are many things that carers can do to help children and young people achieve better educational outcomes, such as:

  • reading together
  • going to the library
  • talking to them about what happened at school in an open way to encourage them to discuss issues
  • giving them a regular structured time and a place for homework
  • providing opportunities for the child to study with their friends
  • showing interest in what they do
  • balancing homework with recreation, play and sporting activities
  • acknowledging and giving praise for achievements, big and small
  • taking them on trips that link to school work, for example, museums and art galleries – many of which are free

What carers can do at school

Carers can support children at school by getting involved in the school and being familiar with the staff.

Carers can also:

  • talk with the school and make sure the child gets the educational or social support they need
  • attend parent–teacher meetings which are an opportunity to talk about how the child or young person is progressing
  • discuss with the caseworker the child’s education history, what support they have had in the past, current concerns and types of support the child may need.

If you have concerns about a child or young person’s educational progress, contact your caseworker.

Useful websites

Information on the support available to a child in a state school can be found on the Department of Education website.

There is also more information about supporting education of children and young people in care in the Education and Training section of the Caring for kids website.

Raising tweens and teens: a guide for foster carers

Life with tweens and teenagers can have its ups and downs as they face those growing years! Caring for a teen can be tough at times and there’s always room for new ideas.

The ChildStory: Caring for kids website has lots of informative articles and advice for carers, including:

Raising Tweens and Teens: A Guide for Carers and Caseworkers is a helpful, downloadable and printable resource for foster and kinship carers of pre-teens and teenagers in out-of-home care. It provides useful tips and ideas to support carers with the day to day and the more challenging issues. It also includes a Help directory and a carer toolkit.

You can find printable sections dedicated to each stage of the teenage years:

Health Pathway

As a foster or kinship carer you play a crucial role in the health of the children in your care. The Health Pathway ensures that every child entering out-of home care (OOHC) receives timely and appropriate health screening, assessment, intervention, monitoring and review of their health needs.

Step 1: Initiating a health assessment

  • DCJ will make a health referral for a child entering OOHC within 14 days of the Children’s Court order allocating interim parental responsibility to the Minister.
  • You and your caseworker can help by providing any relevant information for the referral.

Step 2a: Primary health screening assessment

  • A primary health screening assessment is commenced within 30 days of the child entering OOHC. It is usually conducted by a GP, child and family health nurse or Aboriginal Medical Services.
  • The health service provider will contact you to arrange a suitable time and date for the assessment.

Step 2b: Comprehensive assessment

  • If there is need for further assessment, a child will receive a comprehensive health assessment. This may involve a range of clinicians and may occur over several appointments.
  • You can help by taking the child to the appointments.

Step 3: Development of a Health Management Plan

  • The Health Management Plan outlines health needs identified in step 2 and how these will be addressed. The plan is developed by a nominated health professional in consultation with you, your caseworker and the child. You will get a copy of the plan.

Step 4: Targeted service intervention

  • The child will receive health services outlined in their health management plan. Where possible, these services should be provided through a publicly funded health care service.

Step 5: Periodic review and assessment

  • Regular health reviews are required and should occur as indicated in the plan. At a minimum, reviews must occur every six months for a child under 5 and annually for a child aged 5 and older.

What is the Health Management Plan?

The Health Management Plan is developed by a health professional, for example, a paediatrician, OOHC coordinator (health), health case manager.

The plan includes information provided by you, your caseworker, the health care provider and other relevant professionals during the assessment and review stages of the OOHC Health Pathway.

The plan covers all relevant information relating to the health and developmental needs of the child.

What is your role?

To help meet the health needs of a child or young person in your care:

  • encourage the child to participate in any decisions relating to their health, where possible
  • make sure the immediate health needs of the child are met
  • take the child to health appointments and provide support
  • tell the caseworker about any health, development or wellbeing issues concerning the child
  • participate in the development of the Health Management Plan
  • take the child’s blue book and the plan to all health appointments
  • do the best you can to make sure the plan is being followed
  • participate when necessary in the child’s therapy
  • talk to the caseworker about the outcomes of any health assessments and reviews
  • make sure the plan and any other relevant health records are given to new carers or parents if a child moves placement or moves back home
  • encourage young people transitioning from OOHC to keep their copy of the plan in a safe place.

The OOHC Health Pathway is a joint initiative of DCJ and NSW Health. The content on this web page is from OOHC Health Pathway: carer's guide PDF, 98.73 KB

Consent for medical and dental treatment

This is an overview of who has authority to provide consent for medical and dental treatments on behalf of children and young people in out-of-home care (OOHC), for whom the Minister for Communities and Justice (DCJ) holds parental responsibility and who are being cared for by an authorised carer.

It is relevant to children and young people in family based placements supervised by either non-government organisations (NGO’s) or DCJ and is based on Consent for medical and dental treatment of children and young people in out-of-home care.

Can a child aged 14 or older give consent to their own medical or dental treatment?

Yes, so long as the child has the maturity and capacity to understand what is being proposed by the medical or dental practitioner.

Can DCJ or NGO authorised carers provide consent to treatment for children in their care?

Yes, in certain circumstances. Authorised carers can consent to most day-to-day medical or dental treatment for a child or young person in their care (section 157, Children and Young Persons (Care and Protection) Act 1998) (the Care Act) including:

  • Medical or dental treatment of a child or young person, not involving surgery (except for minor dental surgery), on the advice of a medical practitioner or dentist
  • Medical or dental treatment involving emergency surgery, if certified (ideally in writing) by a medical practitioner or dentist as being urgent and in best interests of a child or young person. The urgency of the treatment is determined by the circumstances and the consequences for the child. It might include circumstances where the child’s life is not in immediate danger but a delay in treatment is causing the child significant distress or severe pain.

It is important to note that the law requires authorised carers to immediately notify their designated agency (the agency or NGO which supervises the placement) if a child or young person in their care suffers a serious accident, illness or injury (clause 40 (2)(c), Children and Young Persons (Care and Protection) Regulation 2012).

To ensure children and young people in care are provided with timely and managed medical and dental treatment, it is important that authorised carers are fully informed of the range of circumstances for which they can (and cannot) give consent. Informing carers about the requirements for consent occurs through initial and ongoing carer training and through communications with their caseworkers. The child’s Health Management Plan can support this cooperation between caseworker and carer to meet the health needs of the child.

When is DCJ consent required for medical or dental treatment?

Where an authorised carer does not have the authority to consent (as set out above), generally DCJ must provide consent. This includes:

  • Medical and dental treatment involving surgery (non-urgent)
  • Medical interventions involving drug and alcohol programs
  • Admission to and treatment within a psychiatric hospital
  • Contraception for under 14 year olds
  • Specialised invasive medical testing advised by a medical practitioner.

DCJ may also become involved in the medical or dental care of a child or young person under the parental responsibility of the Minister in other circumstances, including:

  • Where there is disagreement between the designated agency and the carer regarding the medical approach or a negative outcome from the medical approach, and there has been no resolution through normal processes set out under the Case Management Policy
  • Where there is an allegation that the medical procedure was done without lawful authority and was therefore an assault on the child or young person. This should be immediately reported to DCJ.

Wherever possible, consent should be obtained from DCJ during normal business hours to avoid the need to contact the Child Protection Helpline. When after hours consent from DCJis sought by a health practitioner, it is important for DCJ to obtain details about the proposed treatment, including the need for and the details of the proposed treatment and consequences if treatment is not provided. This information is critical for DCJ to provide informed consent.

Are there circumstances where neither DCJ nor an NGO authorised carer is able to consent to medical or dental treatment?

Yes, there are some circumstances where medical treatment can only occur with the approval of the court, including “special medical treatment” within the meaning of section 175 of the Care Act and a “special medical procedure” under the Family Law Act 1975.

Who consents if the treatment is considered to be a medical emergency and necessary to save the child or young person’s life, or to prevent serious damage to his or her health?

Consent is not required where a medical practitioner is of the opinion, that the treatment on the child or young person is necessary to save his or her life, or to prevent serious damage to his or her health.

Can designated agencies give consent to medical and dental treatment?

No, designated agencies (with the exception of Barnardos) are not authorised to consent to medical and dental treatment for children and young people in OOHC on the Minister’s behalf.

Under section 140 of the Care Act, all designated agencies have responsibility to supervise the placements of children and young people in the care of the agency’s authorised carers. In this way the Care Act makes a distinction between carers who have responsibility for dayto-day care decisions and designated agencies responsibility for supervising, directing and supporting carers as appropriate and required.

For example, designated agencies may have policies and procedures in place that require authorised carers to seek advice and endorsement of any medical and dental treatment, as outlined above, before consenting to certain treatments. Any policy decisions related to consent for medical and dental consent developed by the designated agency should be shared with authorised carers.

When can Barnardos give consent to medical and dental treatment?

Barnardos has a delegation for certain aspects of parental responsibility (including a delegation to consent to a broader range of medical and dental treatments) from the Minster for certain children and young people, for whom that agency has case management. These decision making functions are set out in a formal Instrument of Delegation and Deed of Agreement with Barnardos.

For more information

Please refer to the Medical and Dental Consent Tool  PDF, 169.03 KB. This tool outlines who has authority to give consent for a range of medical and dental treatments for children and young people in OOHC.

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Last updated: 24 Sep 2019