Talking about the COVID vaccine for children in OOHC

What you should know

Draw on these resources to support conversations with carers, children and their parents:

Letters and factsheets

• Vaccine letter to carers (PDF , 154.2 KB)
• Carer questions and answers information sheet about vaccinations (PDF , 258.5 KB)
• NSW Health vaccine information in diverse languages

Websites

• Health vaccine ‘Is it true?’ FAQ page
• NSW Health updated vaccine information
• NSW Health information on vaccine safety, side effects and efficacy

Videos

• NSW Health Video about vaccine safety for young people
• NSW Health Video About what to expect at a vaccine clinic

DCJ is committed to ensuring that children in out of home care (OOHC) live healthy lives and have access to the same medical care as their peers. DCJ strongly supports the vaccination of eligible children in OOHC.

All children aged 12 and above are now eligible for COVID-19 vaccines. Bookings can be made through the Vaccine Clinic Finder. For children under the parental responsibility of the Minister, make every effort to keep them safe by supporting them and those who they live with to get vaccinated.

Carers of children and young people aged 12-15 have been sent a letter and fact sheet from the DCJ Secretary encouraging them to vaccinate the children and young people in their care aged 12 and over.

Depending on where they live, vaccinations are available from local GPs, pharmacies and vaccination hubs. Even if the child in care lives interstate, they can book an appointment.

You must record the vaccinations of all children in care, their carers and household members on ChildStory Partner. If any children, carer or household members have not yet been vaccinated, you must also record their status as ‘vaccination not received’ on ChildStory Partner. You will be asked to enter the reason why and attach a medical contraindication certificate where applicable.

What if the child or their carer has already had COVID-19?

The ATAGI clinical guidance on the use of COVID-19 vaccine in Australia in 2021 recommends deferring vaccination by up to six months after being infected by COVID-19. Infection must be confirmed by a laboratory test.

However, there may be some situations when it is reasonable to be vaccinated earlier, including if you are significantly immuno-compromised. The child and carer should consult with their healthcare professional and their individual circumstances should be considered. The healthcare professional can consult with a specialist immunisation service for additional advice if needed. If a temporary exemption from vaccination is confirmed by the doctor, they will need to complete a state/territory or Commonwealth health department approved form.

If carers and children have worries about the vaccine or need further information, they are encouraged to contact their GP to discuss administration of the vaccine.

Support eligible children and their carers to book and receive their vaccination if they are experiencing any difficulty doing this themselves.

Being vaccinated significantly reduces the chance of severe COVID-19 disease and helps keep families safe. You cannot make a young person take a vaccine, but you can do your best to support them and their carer through any worries that they have.

Have a question? Please speak with your Manager or email COVID19.Support@facs.nsw.gov.au

Consent

Generally, children aged 14 and over are able to give lawful consent to their own medical treatment.

Please keep in mind, some NSW Health vaccine clinics may require people under 16 years of age to be accompanied by a carer or guardian to the appointment to provide consent. Children aged 12-15 should be accompanied by their carer when getting vaccinated.

As with any medical appointments for children, carers may be asked to confirm their identity and relationship with the child. Carers can refer to this link to prepare for their vaccination appointment.

If a young person aged 14-17 years with capacity to consent refuses to be vaccinated, carers and caseworkers should:

1. link the young person to relevant resources available from the Commonwealth Government and NSW government
2. encourage the young person to consider obtaining vaccination in accordance with medical advice (if applicable)
3. continue to talk to the young person about their choices, the continued risks presented by COVID-19 and how to keep themselves safe

If a carer refuses to get a child or young person in statutory OOHC vaccinated, the designated agency can direct a carer to make arrangements for a child to be vaccinated.

This should be assessed on the child’s best interests and in accordance with medical advice.

If a child or young person is unable to provide consent:

For children in OOHC who cannot consent to their own vaccine, carers and guardians, or the designated Principal Officers (in residential care settings, including Alternative Care Arrangements) can consent for them.

The child’s day-to-day carers who are caring for and supervising the child in an ACA or in residential care placement do not have power or authority to give consent to the child being vaccinated or to any other medical treatment.

How to talk with Carers

Check that the carer has received the letter from DCJ outlining key information about eligibility and if the child is eligible based on their age, they have discussed or shared it with the child. Make this your starting point when talking with the carer and keep in mind that they may be feeling:

• confused or overwhelmed by different information they have heard on the news, social media, from family or friends.
• worried about how safe the vaccine will be.
• unsure about how to talk with the child about the vaccine or any fears about needles.
• worried about the thoughts and views of the child’s birth family.

Choose a time and place to talk about the vaccine that will be most comfortable for the carer. In person, if COVID safe, is usually best.

Ask the carer about their thoughts and feelings:

• ‘I’m glad that you have had a chance to read the letter and factsheet about Charlotte receiving the COVID-19 vaccine. I’m keen to hear if there is anything else you want to know or talk about before booking Charlotte in to receive the vaccine?’
• ‘You have been taking great care of Charlotte’s medical needs for 10 months now, but you are worried about whether the vaccine is the best way to keep protecting her health. It is important that you feel well informed about the vaccination and how this will benefit Charlotte. I wonder if it would be helpful if we looked at the factsheet together and explored the facts and benefits?’
• ‘We know how important it is for Charlotte to be protected due to increased risk of severe disease with COVID-19. We want to encourage you to feel informed and supported about this vaccine (OR, during the time while you wait for Charlotte to become eligible for the vaccine).’

Respectfully use reliable health information to support the carer to work through any ambivalence or worries about the child receiving the vaccine.

Reassure the carer that you will inform the child’s parents about the vaccination as appropriate.

Do not dismiss any worries or questions that the carer has raised. Make sure they feel heard and validated. Give as much information as the carer needs to feel reassured or to understand why it is important for the child to receive the vaccine.

You do not need to be an expert. If there are questions you are unable to answer or if the carer tells you they do not want the child to get the vaccine, consider arranging an appointment with their GP, other medical specialists or calling the National COVID-19 Helpline 1800 020 080 to talk through the worries together.

The carer and child may feel most comfortable seeking and receiving information about eligibility and administration from their on-going GP. You could suggest this with conversations like:

‘We know how important it is to seek and receive information from a trusted medical professional. That is why we are recommending that carers and eligible children, book in with their GP to discuss vaccine administration and any worries or concerns.’

Let the carer know that your agency can support the child to book and receive their vaccination. This support may include:

• assisting the child (or carer) to book the vaccination appointment
• transporting or arranging COVID safe transport for the child to and from their vaccination appointment.

Explore any additional support that the carer requires, and action as needed.

Explain to the carer that it is best to book the young person in for their vaccine as soon as possible. Vaccine supply and high booking numbers may affect wait time. Encourage the carer to keep and stick to their appointment so that they do not experience further delay.

How to talk with the child - helping children understand vaccinations

After you have spoken with the carer, discuss with the child what conversations they have had about the vaccine. Make this your starting point when you talk with them and keep in mind that they may be feeling:

• concerned that they are being singled out because of their experiences, identity or being in care.
• confused or overwhelmed by different information they have heard on the news, social media, from family or friends.
• worried about how safe the vaccine will be or fearful of needles.

Choose a time and place to talk about the vaccine that will be most comfortable for the child. In person, if COVID safe, is usually best. Be guided by the child about who will be there for the conversation and the best way for them to participate in decisions. Reassure them that all children who meet the criteria are being offered the vaccine, whether they are in OOHC or not.

Ask the child about their thoughts and feelings:

• “Simon said he talked with you about the factsheet and getting the COVID-19 vaccine, I’m keen to hear about what you know so far?”
• “Health experts told the Government about which kids need the most protection from COVID-19. I wonder how you feel about this?”
• “There are a lot of people talking about the vaccines. Some of the information is incorrect and it can be hard to know what to believe. That’s why we are giving factsheets to kids and carers to make sure you get information from health experts. I’m keen to see if there is anything else you want to know or talk about before you get the vaccine?”

Do not dismiss any worries or questions that the child has raised. Make sure they feel heard and that their feelings are valid. Give as much information as they need to feel reassured or to understand why it is important to get the vaccine:

• “You don’t want to get COVID because it could make your health condition worse, but understandably you are feeling worried because you have heard stuff about blood clots. The health information says there is a very small risk of this for the AstraZeneca vaccine. If you are under 18 years of age, you would be getting the Pfizer or Moderna vaccine because its safest for you, so shall we look at some more information about its safety and how people sometimes feel for a day or so afterwards?”
• “You are a bit unsure about taking a vaccine that has been made so quickly. Let’s look at some more information about how scientists worked together and did testing to make sure the vaccine was safe enough for people your age?”

You do not need to be an expert. If there are questions you are unable to answer or if the child tells you they do not want to get the vaccine, consider arranging an appointment with their GP, other medical specialists or calling the National COVID-19 Helpline 1800 020 080 to talk through the worries together.

There are many resources to help explain what can be a complicated topic in a simple, child-friendly way:

• Editable vaccination story (attached) designed to explain to children how vaccinations can keep them safe and healthy.
• The Children’s Hospital of Philadelphia Vaccine Education Centre has developed a vaccine activity book to explain vaccinations in an interactive and fun way.
• Kid-friendly responses for common questions that your child may have about COVID-19 vaccines.
• NSW Health has developed resources for young people and kids

Once you have booked the vaccine appointment, wherever possible, be guided by the child about who will go with them and support them afterwards.

How to talk with parents

Finding out about their child’s eligibility for a vaccine could trigger feelings of relief or worry for some parents. Sharing important health information with parents of children in out of home care should always be guided by a risk assessment. However, unless there are exceptional safety reasons, parents have a right to know as soon as possible that their child will be offered a vaccine.

After the vaccine is discussed with the child, it is likely they will want to talk with their parents about it when they next connect by phone or spend time together. Uphold parents’ dignity by making sure they know in advance, so there is an opportunity to talk through any of their worries, and they are able to respond to their child in a supportive way.

Share information and support parents through any worries or ambivalence in a similar way to how you approach these conversations with carers. Explore how parents will prepare for conversations with their child and the ways they would like to be involved in supporting them to get protected with the COVID-19 vaccine. Having a child in care can bring about difficult feelings of loss when health decisions are made by someone else. Involve parents as much as possible and use consultation to approach this in a safe and responsive way.