Talking about Covid-19

Many of the children and families we work with may experience barriers to receiving accessible information about Covid-19 and help to make sense of what this means for their daily life, their family and what they should plan for.

Why you should talk about the pandemic

In the way that this pandemic has impacted on each of our lives, as practitioners, talking about the pandemic will need to be a part of your conversations with children and families so you can:

• support them to understand the continued risks and how to keep themselves safe
• help them understand why you are wearing a mask, what the social distancing rules are and why these help to protect them and others
• understand if they are experiencing symptoms or have been diagnosed so you can protect others and yourself talk about how the pandemic may increase the existing difficulties they face that put their child at risk
• let them know about any changes in the ways you may work with them because of the pandemic
• put plans in place to support them and maintain connections with others.

How to talk about it

What you talk about with children and families will vary depending on the reason for our involvement with them. Although there are some basic aspects that are relevant to any child or family we work with.

Stay up to date on official advice.

Wherever possible call the family ahead of any visit to explore who is in the household and whether any are exhibiting COVID-19 symptoms, have been in contact with someone who has or is suspected of having COVID-19, or are required to self-isolate.

You should wear a DCJ provided face mask for visits with families.

DCJ provided masks should be used once and thrown out after it is removed. Masks can be worn across multiple sites, but should be changed every one-two hours or if touched. Make sure to use hand sanitiser before and after putting on your mask.

It is recommend that you use the face masks provided by your workplace, but it you choose to wear a cloth mask, please follow the NSW Health guidance on choosing, wearing and making cloth masks. A cloth mask needs changed every one-two hours and then washed.

Explain why you are wearing a mask and offer a mask if required to any family members over 12 years of age. If you have not met them before, show them a photo of you, so they can see what you look like without a mask. Children under 12 years of age do not need to wear a mask. Toddlers under 2 years of age and babies must not wear masks, which are a choking and suffocation risk.

Ask what they know about the pandemic. Explain key areas including:

• what the virus is and what the symptoms are
• how the virus is contracted
• how to reduce risk by keeping hands clean and not touching face
• why the government has recommended using face masks in public
• who is most at risk
• the current official advice about social distancing and other instructions
• what to do and where to go if anyone in their family gets sick.

This COVID-19 family resource by Raising Children Network provides great advice and ideas about how to talk about and support all COVID-19 related issues.

Use simple words and specific descriptions. And be conscious of words that could cause fear or distrust such as isolation, control and mandates.

Use basic words and stay away from jargon. For example:

Don’t say ‘use basic hygiene practices’.

Instead you should describe what these are ‘you need to wash your hands with soap and warm water for 30 seconds after you go to the toilet and before eating, try not to touch your face or other people’s face, cough and sneeze into your elbow or tissue and then throw that tissue in the bin.’

Don’t say ‘social distancing’

Instead describe simply the current advice.

Demonstrate hand washing wherever possible.

Give them translated information if they cannot read or understand English fluently and if they have limited English verbal skills.

Translated information

Repeat information consistently and regularly. Especially if the family member has difficulties remembering information or understanding new concepts because of disability, substance use issues or mental health issues.

Use visual aids like posters, handouts and videos.

It is important that any Covid-19 information shared with families comes from official sources.

Healthdirect have a variety of visual aids and videos

Let them know that they way you work with them will change as restrictions ease. This may mean checking in by phone for instance when health risks make visiting unsafe for anyone involved but this may not always be the case as you will visit face to face as the first option.

Let them know that our services to the community are still happening and reassure them that you will call them before a visit. However, they can still contact the office. Make sure to let them know that these changes are to help to make sure that they are kept safe so that they do not assume it is simply about worker protection.

How to talk to the child about Covid-19

It is important to include children in conversations in ways that they can understand and can learn the skills to stop the spread of germs. If they are kept in the dark this can make them worry more.

Some children who do not attend school regularly or who have parents facing problems, may not have had a caring adult talk with them about COVID-19, answer their questions or show them how to wash their hands or cough and sneeze properly.

Access helpful resources

These resources can be helpful to plan how to talk with the child but also to provide to parents, carers and supports so that they can use them too.

UNICEF has some helpful and practice tips about how to talk to children about the virus.

Behind the News on the ABC has some helpful videos that talk about the virus, hand washing and answers children’s questions.

The Australian Childhood Foundation has set out some thoughtful advice about how parents and carers can emotionally support children during the pandemic.

Ask about their worries

All children are likely to experience worries at the moment but children we work with may have additional or unique worries. For instance if their parent is not well because of problematic use of substances or mental health issues the child might be particularly worried how they will cope. Children in care may worry about family members who live away from them.

Some children may worry about Elders in their community or migrant children may be concerned about family and friends from their country of origin.

Be reassuring, curious, warm and ask them what you can do to help them feel less worried.

Understand their role in the family

Learn about the role that siblings may have in keeping each other safe. We do not want to take this role away from them, but nor do we want them to feel the pressure of burdens. It is important to understand what additional strains and pressures they may be experiencing in the context of the pandemic.

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:

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

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 administration of COVID vaccines to eligible children in OOHC.

Some young people aged 16 and 17 are eligible for a COVID-19 vaccine and can now confirm their eligibly, and book an appointment using the Australian Government eligibility checker.

The Australian Government has indicated that some 12-15 year olds that are also eligible for a Pfizer COVID vaccination. Eligible children aged 12-15 include those who:

• experience chronic complex medical conditions that increase their risk of severe COVID-19, including severe asthma; diabetes; obesity; cardiac and circulatory congenital anomalies; neuro developmental disorders; epilepsy; immuno-compromised and trisomy 21.
• those on the National Disability Insurance Scheme (NDIS) and/or living with disability requiring frequent assistance with activities of daily living, including down syndrome, muscular dystrophy, traumatic brain and spinal cord injury, and severe intellectual disability.
• Aboriginal and Torres Strait Islander children

all children aged 12–15 years in remote communities, as part of broader community outreach vaccination programs that provide vaccines for all ages (≥12 years).

Caseworkers and carers of children aged 12-15 years will receive more information about the vaccinations and how to book an appointment once the NSW Health roll out has commenced. In the meantime, the vaccine is only available through limited Australian Government rollouts.

Keep your Manager informed and record all vaccine related casework clearly on ChildStory. This should be recorded under the Person Properties – Immunisation tab. Refer to the ChildStory Recording Tool and the Meeting the Health Needs of Children in OOHC practice mandate.

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

You should 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

Consent

Generally children aged 14 and over are able to give lawful consent to their own medical treatment. However, a child’s capacity to consent to their own medical treatment needs to be assessed on a case by case basis. A child will have capacity to consent to their own medical treatment, including a vaccination, if they understand the nature of the treatment including any risks associated with the 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. There is work being done to arrange other ways to consent. In the meantime, carers may attend appointments with children to assist in providing consent. Carers and caseworkers must respect the wishes of children with the capacity to consent.

If a child is in a foster or relative care placement:

For children in OOHC who cannot consent to their own vaccine, carers and guardians can consent for them.

If a child/young person is in a residential placement:

Where a child does not have capacity to consent to a vaccination or other medical treatment (e.g. where the child is under 14 and is legally unable to give consent, or the child is over 14 and lacks capacity to consent and this has been confirmed by a medical practitioner), the Principal Officer of the designated agency providing residential care for the child is able to give consent to the child’s vaccination under s.157 of the Care Act.

If a child/young person is in an ACA:

In relation to Alternate Care Arrangements (ACA) and children who lack capacity to consent, the Principal Officer of the designated agency who placed the child in the ACA can give consent to the child’s vaccination on medical advice under s.157 of the Care Act.

The child’s day to day carers who are caring for and supervising the child in an ACA or in residential care 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

Once the NSW Health vaccine roll-out commences all carers of children aged 12-15 years under the parental responsibility of the Minister will receive a letter from DCJ outlining key information about eligibility for the Pfizer vaccination.

Check that the carer has received this letter and if the child is eligible, 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 Pfizer 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).’

Use motivational interviewing skills along with 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. Draw on the resource links in the ‘What you should know’ section to find answers together.

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 DCJ 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

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:

• unsure about why they are being offered a vaccine before other children their age.
• 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 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?”

Again, you do not need to be an expert. Draw on the resource links in the ‘What you should know’ section to find answers together.

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.

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 an up to date S149B-K 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.