Toolbox 2: Best Practice in the Management of Children’s Medical Conditions in Outside School Hours Care- Unpacking Regulation 90 Children’s Medical Conditions.

Belinda Rouhan: Hi, I'm Belinda Rouhan. I'm the General Manager of OSHC Programs for Gowrie NSW.

Question: What is regulation 90? Why is it so important?

Belinda: Regulation 90 is about medical conditions - having a medical conditions policy and it gives really clear direction on what we must include in the policy to have robust practices and procedures in place.

Question: What information is included in the regulation?

Belinda: Information included in the regulation includes how to manage medical conditions, the documentation required, who is responsible at different touch points, so the family, the staff, the service, development of practices and procedures to minimise risk, harm, and hazards in relation to the medical condition and the requirement of medication and self-administration of medication for school-aged children. This is if your service policy allows for self-administration of medication, and it includes a record-keeping of self-administration of medication.

Question: What documents are required?

Belinda: We require an action plan for the medical condition and how to manage it or the steps to take in case of a medical incident. That needs to be done by the doctor and provided by the family. A risk minimisation form is then completed in conjunction with the service staff, preferably a nominated supervisor and the family and that looks at the risks and hazards within the service, specific to the service and specific to the child, and how to manage these and minimise these where possible. It's important to consider key times of exposure. For example, serving afternoon tea if a child has an egg allergy or when you're doing craft, and someone brings in egg cartons for the craft area. These are all things that we need to consider when creating our risk-minimisation plans. We then have the risk communication document where any updates, changes, or reviews about the child and their medical condition needs to be documented. This might include, for example, a parent calling and letting the service staff know that there's been a medical incident at home so that they can document them on our communication plan as well. It needs to also have how our information is being shared with our teams. So how do you share information about this child in particular and any changes or updates to their plans with your permanent staff, your casual staff, your agency staff, and new staff.

Question: What practices and procedures need to be considered?

Belinda: Some examples of practices and procedures to consider: is your service not aware? Do you have specific procedures in place to minimise potential risk of harm during food serving or consumption? What about allergy seasons, springtime, in winter when we see asthma flare-up? And other high-risk times too and have it listed here. It can be common for children and families not to know that their child has a medical condition, and that diagnosis happens during childhood once the child has a medical incident. So, what practices and procedures do we have in place for our service to minimise overall risk and exposure for all children? It includes things like how do we display our medical information so it's confidential but accessible to all of our staff? Some services might have little cards with the child's picture and just some basic information, especially in pack up, pack down services. Do you have folders with all of this information? And how do we update our teams on our practices, procedures, and any changes? Again, I'm going to come back to those new staff, casual staff, and agency staff. I sometimes find that we're really good at updating our permanent staff but what about agency staff who are working with us for a shift or casuals who barely work with us or don't work regular shift patterns or new staff? It might be their first day and they have a child with them. Anaphylaxis in their area. So how do we manage that?

Question: What is the process for self administration of medication?

Belinda: School-aged children usually self-administering medications such as a ventilator at home already. To continue to provide this autonomy, we need clear procedures in place such as where this medication is stored and how it's accessed by that child and no other children. How do we record self-medication when the child does self-administered medication and what are the procedures around it? So, do we still have educators? Do they assign it? All these things, how do we share this information with the parents? That also needs to be clearly documented as part of our procedures and policies.

Meray Parsons: It will just be Belinda and I. So, thank you everyone for joining us. Today's session is the first topic of toolbox 2. So, if you've been joining us over the last week, we have been looking at the toolbox one, which focused on supervision. And this week is toolbox 2, which is focusing on best practice in medical management. My name is Meray Parsons. I am the quality and compliance manager at Gowrie New South Wales. I work with nominated supervisors, educators, and staff in supporting services to be proactive with their compliance and working on embedding high quality practices through our outside of school hours care (OSHC) and early education services. On the call with me as well is Belinda Rouhan. Belinda, would you like to introduce yourself?

Belinda Rouhan: Thanks, Meray. My name is Belinda Rouhan, and I am the general manager of outside of school hours care for Gowrie New South Wales. In my role, I support our OSHC teams, families, and work closely with the OSHC managers in their daily practices within the OSHC services.

Meray: Thanks, Belinda. So today is topic 6. So, it is the first topic of toolbox 2, and we are going to be really unpacking regulation 90, which is the medical conditions policy. At this point I would like to acknowledge that this resource has been developed by Gowrie New South Wales but funded by the New South Wales Regulatory Authority as part of the best practice series for 2023. I would also like to acknowledge our First Nations people as the Traditional Custodians of our land and waterways. We also acknowledge their continued connection to the land, sea, and traditional countries across this nation. We thank Traditional Custodians for caring for Country for thousands of generations. We recognise this country was never relinquished by Traditional Custodians, and that their continued connection and commitment remains to Country. Gowrie New South Wales pays respects to Elders past, present, and emerging, and all First Nations people, including those joining us today. And I am currently joining you from the traditional lands of the Bidjigal people.

So today we are going to be looking at 5 key learning areas during this webinar. First, we are going to have a good look at what our medical condition is, what are the required key practices that are stipulated in regulation 90, and what pieces of documentation are required within this regulation. We will also have some links to the National Quality Standard and ‘My Time, Our Place’. And as we have done with our previous sessions, we are going to really unpack these and also provide some practical strategies for consideration for our OSHC services.

So, the laws and the regulations which underpin medical management, and the medical conditions policies are National Law section 167, regulation 90 and regulation 91. As you can see, there were different responsibilities for each of those requirements. So National Law section 167 is important here because it does relate specifically to every reasonable precaution that is taken to protect children from harm and hazard likely to cause injury. There is a specific regulation for medical conditions, and it really specifies that our medical conditions policy must be in place. And it talks about what those requirements are, which we will unpack today. And then obviously regulation 91 is one that is sometimes missed but it is important to provide to a requirement to provide families with a copy of medical conditions policy.

Okay, so what does regulation 90 medical conditions policy say in a nutshell? Regulation 90 states that an approved provider must ensure policies are in place for managing children's medical conditions and details what must be included in the medical conditions policy. And the next part of this webinar will unpack regulation 90 for our day-to-day practices in out of school hours care. When we think about this, medical conditions are a high-risk area that requires careful thought and really effective systems. I want to take a moment here to ask you to think about the consequences when medical conditions might not be managed properly. What if we could not find a child's Epi-Pen and they needed it? What if we could not locate the children’s contact details, their family contact details, and they had to go in an ambulance in an emergency? This is not for added drama. But often it is important to understand the why and the risk associated to some of the work that we do.

And so what we will do is really try to unpack the important aspects of the medical conditions policy that are needed to be in place if a child with a medical condition is enrolled at your service, the procedures that we will use that you will use at your service to manage those medical conditions and what are the practices for sharing information related to that. Belinda will take us through the policy for the next couple of slides. Thanks, Belinda.

Belinda: Thank you, Meray. So, you are required to have a policy for children attending with a medical condition, even if you have no children currently attending. And the reason for this is that being a child could develop a serious medical condition at any point in their childhood. It is not necessarily something that they are aware of, or parents are aware of before they start attending care. And quite often, children who attend care can have their first medical episode within a care environment. So, regulation 90 stipulates that there are key pieces of documentation that a service must have when a child with medical conditions is enrolled in the service. We are going to outline these in the following slides.

So, to be compliant with regulation 90, the medical conditions policy, there are some key requirements to have in place when a child with a diagnosed medical condition in enrols at the service. These are summarised in this diagram, and I am going to break them down in more detail now. One important aspect of the medical conditions policy is that it includes information regarding children who are diagnosed with asthma, diabetes, or a diagnosis that a child is at risk of anaphylaxis or other diagnosed medical conditions. The policy must also stipulate how the nominated supervisor, staff and volunteers at the service are informed of children's medical conditions. So, I want everyone to take a moment and think back to your own service and your own practices. How do you currently inform new educators at your service of any children with medical conditions? And are your practices aligned with your services policy? Do you know your services policy for medical conditions? We encourage you to think about your practices in relation to the information we are giving you today in this webinar because you might see ways you could improve your practices or adjust them after critically reflecting on the information. And as Meray said, it is such a high-risk area. It is important that we are constantly reflecting and improving our practices where we can.

So, your medical conditions policy should state that families must provide the medical management plan for their child created by a registered medical practitioner, such as a GP. So, it is a good opportunity to go back to your services today, check your medical management plans, to see that they are all signed or created by GPS or other medical practitioners. The medical management plan should also state the medical condition, the management of it and treatment if there were to be a medical incident, as well as what medication and dosage is used to manage this condition as well as if it were needed for a medical incident. So, an example of this would be a child with asthma and using their asthma puffer. They might use their asthma puffer as a preventative, but then they would have a different dosage if they were to have a medical episode. If there were a medical incident at your service. All staff must know the medical management plan and be in following it. So, it is a legal, legal requirement and their duty of care. Again, I want you to consider your current practices. How confident are you all your educators, that your educators are aware of the medical plans of children at your service? So, think about all your educators, your new educators, your casual, your permanent educators. How are, how confident are you that they could follow those plans in a medical incident? If you think this is an area for improvement, what steps could you put in place to support the educators to build their understanding?

So, think about the start of the session, either before school care or after school care. Do you have a list of children attending that session who have medical conditions clearly highlighted for your educators? Do you give them an opportunity before the shift to familiarise themselves with the medical management plans or any triggers listed in the risk minimisation plans of the children attending? And the centre is responsible for developing a risk minimisation plan and communication plan in consultation with the family and with consideration from the medical management plan. So again, consider your current practices. Did you consult the family whilst creating the risk minimisation and communication plans for children in your care? And are they detailed and individualised to the child? Or do you kind of use a template? And if someone has asthma, you use the same template for them all. Really important to the children. We are just hearing some feedback. If someone, everyone is muted, I hope. And do you review these plans regularly? It is important that we review, staying connected and ensure these plans are current.

And finally, the policy should state that the practices and documentation for the instances in which a school-aged child self-administer medication. So, if you have a policy in your service allowing for self-administration of medication, then your medical management policy should include practices and documentation around self-administering medication.

So, if we go to the next slide, let us look at self administration in more detail. So, in regulation 90, there are 2 clauses that relate to the self-administration of medication for children over preschool age. These clauses, sorry, excuse me. These clauses are stated as the medical conditions policy of the education and care service must set out practices in relation to self-administration of medication by children over preschool age if the service permits that self administration. So, the first thing to do is check if your service policies allow for self-administration of medication in subregion. Two, the practices must include any practices related to recording the medication record for a child of notifications from the child that medication has been administered. So, what we want to do is ensure that you have stipulated whether you allow self-administration of medication in your policy and then have authorisation from the family documented. Unpacking this important consideration for the medical conditions policy for school aged care settings further through regulation 96 of the Education and Care Services National Regulations are recommended. So, I know there's a lot of heavy words right here, but basically we want you to refer to regulation 90, and then if you allow self-administration of medication refer to regulation 96. Regulation 96 states that the approved provider of an education and care service may permit a child over preschool age to self-administer medication if the authorisation for the child to self-administer medication is recorded in the medication record for the child under regulation 92. And the medical conditions policy of the service includes practices for self-administration of medication. Again, we encourage you to seek further clarification from the regulations or if you would like some further clarification or have any questions, feel free to pop them in the chat box and we will be able to come to your questions at the end of this session.

Now we are going to look at procedures for management of medical conditions. So, a medical conditions policy should be in place even if you do not have children attending the diagnosed medical condition. As we said earlier, a child could have a medical incident even if they are not diagnosed and have never had an incident previously. It is important that all staff are aware of their requirements under National Law, National Regulations, and your service policy. And how do you manage the following medical conditions, asthma, diabetes, and anaphylaxis? Before a child with a diagnosed medical condition commences attending your service. Some key questions to ask are, has the child's parent provided a medical management plan for the child from the doctor? Has a risk minimisation plan been developed in consultation with the family? And do you have a communication plan in place? Will it be necessary to adjust any of the usual practices of your program in order to be fully inclusive of the child? And do your staff need to attend further training or specialised training in relation to the medical condition? So, for example, if a child is diabetic and staff need to check their insulin levels, and finally, has all of the above been communicated to your staff? I am now going to hand over to Meray to talk through what is a medical condition and show you some example documentation.

Meray: Thanks, Belinda. Okay, so as discussed, the nature of each child's specific healthcare need, allergy or relevant medical condition can really vary from child to child. And it is important that the partnership with the family at the point of enrolment is, is really that partnership being established as essential to ensure the child's safety and inclusion. So as a starting point we need to be aware of what constitutes a medical condition. And so there is a definition that can assist us. A medical condition as defined by ACECQA is a condition that can be that has been diagnosed by a registered practitioner. So if it is a GP or an immunologist so a person registered as a health practitioner under the National Law to practice medication other than a student can diagnose a medical condition. So, we had a question earlier in the chat about what constitutes a medical condition, ADHD, or other types of neurodiverse conditions. And under ACECQA yes, that does constitute a medical condition as it is a diagnosis.

Some of the most common ones, but not all are medical conditions on the slide here that you may be aware of. But there, there will be others as discussed. Just before each child's specific health need can really vary. And enrolment procedures here as well as attunement to children can be really fundamental as we start to equip ourselves with the knowledge for each child's specific need. Also accessing relevant professional learning about specific medical conditions is important. I can see this. I am just going to add, I can see there are a few questions in the chat. I we will get to all of those questions at the end. So, if I do not answer them now, we will get to them. I know that the first question we did get to answer just now, so hopefully that has been helpful.

Now, when we do have a diagnosed medical condition, the parent or the family has to provide the program or the service with a medical management plan for the child created by a practitioner. The medical management plan must be followed in the event of an incident relating to the child's medical condition. So, the medical management plan should have information about the diagnosed medical condition, including the severity, any current medication prescribed for the child, for this specific medical condition, along with the requirements of those dosages. Any medication required to be administered for an emergency or alternatively, even if it is outside of the service hours. So, if a child's taking medication for a diagnosed medical condition, but it is at 1:00 PM we should still have a record of that and have that.

On the medical management plan, the response required if there is no if the child does not get it better after initial treatment and when to call an ambulance for assistance. It is important to note that medical management plans now do not expire, but some medical practitioners will have a review date. Consider including in your policy around medical conditions what your service considers as best practice. So, for us at Gowrie, we have a 2-year maximum review period. So, if the practitioner has put in a one-year review period, we require the families to provide us with an updated medical management plan within that review period. If there is no review period documented on the medical management plan, Gowrie New South Wales's policy is that we have, we ask families to review the medical condition within 24 months. So, think about what it is that you have in your policy. And remember, under regulation 170, all staff and volunteers must follow your policies and procedures. So, any documented review date in the policy must be followed by, by staff. And that that goes to the fact that even if there is no review date on the medical management plan, whatever is in your medical conditions policy is what you have to follow. An example that you may have seen is an anaphylaxis medical management plan that is on the slide here. Other medical conditions that we might have spoken about might not have a nationally recognised medical management plan. So, some of those different medical conditions we talked about will not have an ASCIA medical management plan or an Asthma Australia medical management plan. We need to capture the information documented in this regulation and have that provided by the medical practitioner as well as a photo of their child and their name for easy identification.

So as part of regulation 90, we are required to develop a risk minimisation plan in consultation with the family. So, if you remember, the medical management plan is provided to us by the family and is completed by the medical practitioner, by the child, by the family's doctor or immunologist. The risk of an organisation plan is something that we complete at the service in consultation with families, and this really looks at the risks associated to that child's medical condition. How do we assess those risks? And then how do we minimise them? And then we really want to record the strategies for minimising that risk. And we use this to really help identify the child to staff and to volunteers, and to know where the location of medication or what can we do to further reduce that risk, especially with regards to safe food handling or preparation or storage of food in the service. You really want to think about here, what part of your program could create a risk for children that are diagnosed with a particular medical condition. A really good thing to think about is you are not just your food, but your arts and crafts. And so if there is a wheat allergy, for example, there are some materials that you might use, paints and glues that do have a wheat ingredient in them to just really think about what are some of those broader things that could expose children to the allergen or to the trigger for that medical management.

So, this is an example of a risk minimisation plan that we use at Gowrie. It talks about the details of the child at the top and then what are the potential allergens in the service. What, where, when are the potential exposure times and what do we do to reduce that risk? And so I have seen really good ones where it does talk about changing the type of paint we use. So, it could be the allergen is wheat and the times for exposure, obviously the meal ones would be covered as well, but then the times might also include things like arts and crafts and resources, and what are the strategies to minimise the exposure. So here it is important to really dig into the details. So not using that type of paint is probably the surface level you really want to think about. Okay, have we communicated that to have we put that in our notes without ordering? Have we put it in? Have we put a notation in our art storage area to say, look, these types of paints are to be minimised or to be removed if they contain wheat. So that you are really trying to make sure that that risk if we have identified it is completely minimised. At the bottom of this, you can see that the exam we have some examples that have been shared as well. So on this example, it is the egg allergy about which we have talked. You might have come across things like dairy allergies. So, if we are offering milk to children, how do we minimise the risk of exposure there? It might not be possible to eliminate having dairy as it is part of your menu requirements. So how do we reduce that exposure? Sometimes for example, medical conditions like diabetes, what is the risk there? It might not be an allergen, but it could be if a child has skipped a meal, the risk there is that they might have to be provided with smaller snacks earlier on. Especially know in the after school care environment, what is that communication with the school and how does that help us then understand what we have to do to minimise the risk of a hypo or a hyper or for that child with that medical management plan?

As part of regulation 90, we also must have a communication plan. And this part here is an important piece of documentation. The outlines how the service will communicate to families and staff in relation to policies, and also how families and staff will be informed about the risk minimisation and emergency procedures that are to be followed. So, when a child's diagnosed with a medical condition it is important to note that we use this communication plan to document changes to the child's medical management and to really update the risk minimisation plan. We then, in that communication plan, establish how this communication will happen and we really try to make sure that it is clear who is responsible to communicate to families, who is responsible to communicate to the service, how that communication is done. So at Gowrie, we stipulate in the communication plan that changes to a medical condition have to be in writing so that we can ensure that there is that is actioned appropriately. So, we did cover lots of information around partnerships with families as part of supervision, but it absolutely will have crossed over here for our medical conditions. Also, I am just going to take a quick moment. I can see there are a few chats in a few comments in the chat. I just will say that there will be a lot of different times that we can look at those questions and get back to you. So, but please keep them coming through.

So, communication plan here is template for a communication plan. This talks about, who are the priorities that we priority family members that we would call in an emergency. We would have their contact details as part of the enrolment, but it might be that in an emergency it's grandma that lives closest to the service, or it could be that dad is the person to call because he's usually working from home and he's able to get to the service quicker. So that is why we have this secondary contact details list here. And then we stipulate who is required to communicate, for example, changes to the medical condition or do we inform families that they have to provide the medication and has to be on the premises at all times the child is in attendance. Remembering that regulation 90 does really talk about having relevant staff members and volunteers are informed of the medical conditions policy and the risk minimisation plan and that parents can communicate any changes to that medical plan and risk minimisation plan. So that is the tools in which we would communicate those changes. I am going to hand it over now to Belinda to talk us through some of those practical strategies.

Belinda: Thanks so much Meray. Now that we have gone through all the heavy information, let us look at some practical strategies. So, the policy must also stipulate how the nominated supervisor staff, including those employed by an agency. So if you use any of our agency staff to fill shifts, volunteers at the service, your casual staff, how are all of them informed of children's medical conditions? So, this means that all staff are informed of the medical conditions policy and their requirements under the National Law and Regulations. All staff are informed of any children diagnosed with a medical condition or specific healthcare need and the risk minimisation procedures in place. And all staff are informed where medication is stored and or any specific dietary restrictions relating to the child's healthcare needs or medical condition. And when all children with diagnosed medical conditions have a current risk minimisation plan and communication plan that is accessible to all staff. So, if we think about this, you've had someone call in sick, you've got an agency member, a staff member arrive at the service, they've never been to your service before, how do you ensure that they have access to all this information? So, if you have an agency or a new casual or even a new educator starts, do you schedule time before their first shift to do a service orientation? Do you include your medical conditions policy or the key points from it? In that orientation? Do you show them the children in attendance who have medical conditions? Do you talk to them about the risk minimisation plans and procedures in place? Do you show them where to access medication? Do you show them where all the risk minimisation and communication plans are stored? Like what are your practices if you think about it for that very first time they come? And then also, how do you document this? So where do you document that you have taken this new casual person or new staff member or agency staff member through all of this documentation and practices? If you do not have this currently documented or you do not currently put this into practice, maybe this is something to consider moving forward.

Now I want to take a moment to consider some questions. So, what do your current practices look like and what initial ideas do you have that you might add? So, consider adding some of the following to your current practices and some of them we talked about in the previous slide. So, including the medical conditions policy in your enrolment information or on your website for all families, including the medical conditions policy in the service induction for new staff, and include an update of children in attendance with medical conditions in the daily debrief. So, I am going to assume here that most people have a daily debrief. If you do not have a daily debrief, how do you update your staff that day on any changes to the programs or children in attendance with medical conditions? Consider updating all staff in regular staff meetings about changes to children's plans or sending email updates to staff about key changes to ensure everyone has been informed of these changes. And then how is this information documented? So, do you keep it with a communication plan? Where do you document that you have made these changes and then communicated it to all staff? So some more points to consider.

So far in this online seminar we have discussed key aspects of regulation 90. Now we want to provide some practical considerations that relate to this policy. So, these considerations are starting points. And to hear more about some day-to-day scenarios, I recommend that you take the time to view the video vignette on the topic provided in this toolbox where you can watch and listen to a real-life conversation with an OSHC professional about this topic. And I would like to preface here that the video vignettes and critical reflection packs will be provided along with a recorded webinar. I think that after the end of these sessions, these will all be sent to you.

So first, let us look at some practical strategies for medication. If children require medication for their medical condition, ensure this is stored out of reach of children, but in a location easily accessible to educators. So, for example, if you have an allergy friend bag you can purchase these online really handy and great to take with you on excursions and things as well. Which is really helpful for the next question, consider how you store medication in information on transport or on excursions. So, if you have children attending with asthma or allergies or anaphylaxis, how do you store their medication when you go on excursions? When displaying documentation? Have you considered using different colours to signify different medical conditions? To assist with easily spotting children's medical conditions? And how do you display the medical conditions? Do you have it in an easily accessible format? So, if you think about a large service you know, do you have all their medical management plans up on the wall and you might have 20 or 30 of them, that can be really overwhelming. So how do you make it easier for yourself? One really useful way that a number of services display this information within Gowrie New South Wales is having small card-sized laminated displays, which have a colour-coded border for the medical condition. So, I think, for example, green is allergy, asthma is blue, red is anaphylaxis, and it has a colour photo of the child, their medical condition, and the days they are attending. So, this is a quick reference guide. Educators then need to know and understand the medical management plans and risk minimisation plans in more detail and where to find them. But this reference guide is useful for our large services.

The staff also need to review medical management plans on a regular basis, but each daily debrief go through the children in attendance with the medical conditions and their triggers as well as strategies the service has in place to manage. So, I think consideration here is given to, we might list out the children in our attendance that day with medical conditions, but how often do you talk to your staff about the triggers for these conditions? How often do you talk to your staff about the risk mitigants you have in place so that everyone is really aware and ensuring best practice when relating when working with these children.

How do you monitor use by dates for medication and renewal dates for medical management plans? So, it is really important that you consider leaving enough time before the expiry so that the family can provide new medication and an updated medical management plan. So rather than getting to the day or the week before, perhaps sending a reminder in your calendar to send an email 3 months out, one month out, and a phone call one week out, and then regularly reminding them when you see them as well. I think it is really hard to get into doctors these days, let’s give families as much notice as possible. And for further information about medication regulations, regulations 92 to 96 detail requirements around this, which educators and staff must be aware of. And it is also relevant to note that children should not be administered medication unless the service has authorisation. However, medication may be administered to a child without authorisation if it is an anaphylaxis or asthma emergency. There are also key stipulations outlined in regulation 96 for self-administration of medication for children over preschool age, which were outlined earlier in this webinar. We also encourage you at this point to share some practical strategies in the chat box, which you utilise at your service, which might be beneficial to others. Again, we you to feel free to share throughout the session. No need to wait till the end. And I know a lot of people already have shared, which is great. Continue to share your ideas.

Okay, now we are going to look at the connections to the National Quality Standard. So, regulation 90 has direct connections to the National Quality Standard, specifically in Quality Areas 2 and Quality Area 7. With element 2.1.2 there are several direct connections to the practices in place for the management of children's medical conditions. So during the rating and assessment visit and throughout all embedded practices, the authorising officer will discuss how the service communicates information about a child's individual health requirements to staff members, how the service conveys concerns or questions about a child's health needs to their family, and how information about a child's individual health is kept confidential. So, if you think about when you are displaying this information about children, where do you display it? Is it in the office? Is it in inside the food pantry cupboard? Which only staff access, you would not display it in the main space.

Meray: And I think Belinda, Ana has asked that was just very relevant at the time. She just mentioned that. Exactly. So, for some medical conditions, they do want to have private, and we do have them either in a folder or in the inside of cupboard doors that obviously educators only would access. But to think about also how that is relevant in other places in a way that could just be everyone knows the green folder has the important medication for that day or important medical conditions listed out there. Sorry, Belinda.

Belinda: That is really helpful. It is good cause you are monitoring the chat. And in saying that you should have a sign notifying families if there are any children in attendance with asthma or anaphylaxis, like how many, but you would not identify the children. So specific reference to school aged care settings in the National Quality Standard ask services to consider the arrangements for negotiating individual procedures for the administration of medication with families and children, as well as how and is information about the child's individual health requirements is communicated with the school. So, think about when you are communicating with the school and look, they are really important because to be on the same page. You know, the child might have been administered medication at school, which will then impact their day with you. And if you have permission from the families to discuss this information. Element 2.1.3 references the requirement for services to be able to demonstrate how they meet the needs of children with special dietary requirements and to have a current service policy on dealing with medical conditions such as anaphylaxis and allergies. And finally, Quality Area 7, element 7.1.2 references the required policies and procedures available at the service, which are also available to families of which dealing with medical conditions is mandatory. So those are some really great starting points to unpack your practices and if you cross reference those with this webinar, I am sure you'll have lots of information to start with.

Now let us move on to ‘My Time, Our Place’, which also has direct connections to regulation 90. And you can see here that we are referencing ‘My Time, Our Place’, version 2. So, while there are holistic connections between many aspects of this framework and the practices outlined with the medical conditions policy, there are some specific ones that directly connect. So, we are going to discuss these now over the next 3 slides. The first speaks of partnership. So, the quotes on this slide come from ‘My Time, Our Place’ version 2. Genuine partnerships as reflected in this framework, are essential as a foundation to ensuring to children's medical conditions are managed effectively. And as Meray referenced earlier, we will be exploring partnerships more in more detail later in this webinar series.

So, the principle of collaborative leadership and teamwork also underpins how regulation 90 is met in practice. And you can see on this slide we have a quote here, collaborative leadership and teamwork are built on a collective responsibility of educators to contribute to children and young people's wellbeing, learning and development. So, consider in your service how you work within the guidelines of this principle in your management of medical conditions. Consider critically reflecting on your practices in relation to medical management and the principle of collaborative leadership and teamwork. And then documenting this, and again, pull out and explore some of the ideas we have shared within this webinar. You may have some ideas for future improvements for your service and your team, or you might see this as a strength in your service, which is an embedded practice. You might even consider using this as an example of an exceeding thing, and you might be in the space right now where you can see future improvements, but in 3 to 6 months you might be looking at this as an exceeding thing after you critically reflect, after you include all stakeholders in that process and after it becomes an embedded practice.

And finally, consider how does the principle of equity inclusion and high expectations relate to regulation 90? So again, consider your practices in your service and how you might adjust them to ensure all children are included and have an opportunity to participate regardless of their medical condition. So, a perfect example of this would be if you have a child who is Coeliac, how do you adjust the menu on the days they are attending? So, they are not the only ones eating a separate meal, but everyone is sharing the same meal. In practice, this might mean making an afternoon tea that is allergy friendly for all children. It could be regular snack breaks during vacation care for children who need it so that the child with diabetes is not sitting alone to eat all the time or to have a private space where they can check their insulin. It could be moving indoors earlier during colder months so that children with asthma are less likely to have exposure to cold air. And again, we strongly encourage you and your team to reflect on your practices in relation to how you manage medical conditions and find ways to be more inclusive of all children if possible. We want you to see this as an opportunity to improve your routines and seek feedback from different stakeholders. And really important to document this journey. Journey. I am now going to hand it over to Meray to finish our webinar today.

Meray: Thanks Belinda. So where to next? Where can you go to get more information? Next? We have a fact sheet that will be part of this topic. And then, it is a really good go-to reference that you might use as part of your service induction. We also have a vignette with some educators talking about how they have done this in their service, so how they have actually brought to life regulation 90 in their service in a really practical way. And as part of the last part of this will be a critical reflection pack that you might want to access as well. There have been some fantastic references put in the chat, but also on the screen we really do use The Guide to the National Quality Framework as the source of all truth. It has some really important suggestions, and it does pull out some OSHC specific examples as well.

But while we are before we answer some questions, we would really like to thank you for attending. We know that taking an hour out of your day might be challenging, sometimes you might have a long to-do list. So, we really do value you, and we hope that you can please you will get a feedback survey if you can just pop that in complete that so that we know how to best tailor these sessions for our team members. So, in the first couple of sessions we did, we had some information or some feedback to say, can we do a bit more of around circle type format. And so, we are hoping that by having questions going through during the session, we can facilitate that more. So, we usually try to put those put those feedback suggestions into play straight away. But I know there is a lot of questions. So, we are going to spend the next 10 to 15 minutes before the end of the session answering some questions. So, we did

Belinda: You want me to, we just have one from Julia Pati, and I know that she asked us to break down a medical condition, but something she gave as an example is an ADHD diagnosis. Do we need a medical management plan for these?

Meray: Yes. So, we have recently checked this. And because it is a diagnosed condition technically yes what that medical management plan and communication will look like, and the review date for that might be different. So, you may not need to administer any medication, but you may. I know that there are a few different medications for children with ADHD. And so, does the child need medication at school? Do we have to be aware of what an escalation of behaviour might look like? And that might be an escalation or a risk minimisation plan. So, if you think about a behaviour management plan and a risk minimisation plan for that for children that might have a diagnosed ADHD medical condition, how do they interplay together? And then how do we have the inclusion professional that might be working with us, really giving us some information around there. So, we at Gowrie do have a risk minimisation plan and a communication plan that forms part of a child's medical condition. If they are diagnosed with ADHD, some of this includes medication, but some of those children do not have medication. And the risk minimisation then links very closely with the behaviour plan.

Terry has asked a relevant question, if their child has an ADHD medication at home, do we still need to have a plan and a risk minimisation? So just remembering that that having a medical management plan may or may not require medication, medication being given is not the criteria to have a medical management plan and a risk minimisation plan in play. So as an example, some children have epilepsy that have no medication required, but there are things we need to do such as time the epileptic seizure call an ambulance. The medication part does not necessarily then trigger the medical management requirement if they are diagnosed with a medical management plan. That is the ACECQA definition.

Belinda: Okay.

Meray: Neurodevelopmental I am not sure if it is a diagnosis sorry, Julia has come back. And ASD coming back to that, it really would look at you would tailor your behaviour your inclusion plan and your medical management plan to overlap those ones. So, there maybe it might be more of an inclusion plan, but I would say that under your ACECQA definition, it is a medical diagnosis I suppose.

Belinda: Great. I have one from Kathy about look, and this is a very relevant one too. A lot of our services are on school sites and cannot have notices and displays up. So, some of the ways you can get around this is having folders. And I know Julia said it key ring, so that is something too. You can have those little examples and then go to your folders. I know that some of the OSHC programs and our early years programs have implemented is a folder with key medical management or risk minimisation plans in the afternoon tea spaces. So, where there's food being served, it is really important that we know in those spaces who has conditions. And this is included in a folder. Do you have any more examples, Meray, you would like to share?

Meray: Yes. So, there is the folders, there is caring. We have lanyards sometimes that have just a really short like little business card size for each child photo, what the allergen is and what medication they might need. So really just a photo. And it could, sometimes they do not have all the details. It is just more for your agency and your casual staff to pop that on. If they are on the oval, they can have a quick look to see if something is happening and they can check if one of the children that that is in their care is a child with a medical condition. So that is another way that we've, I have seen we have some more questions around in terms of training for type one diabetes about handovers. The best place here, and there is a few comments back and forth on this one. Absolutely. What I would do, if it were me, I would go to the family, I would ask them to contact their medical practitioner. Sometimes there's child family nurses and local community health nurses that might come out and do a bit of a session around diabetes. We have a child with a nasogastric feeding tube and the child's medical practitioner came out and showed us how to link it all up, make sure there is no air bubbles. It is best to start with the family's practitioner for their medical condition because each child is very different. So, you really want to go to the medical practitioner that knows the most about that child if possible. If not, you might then start to think about other local support networks. Usually, the school might also be a good avenue to contact to see if they have had some training and to piggyback on training they have organised for their team. So, if it is quite a complex medical condition, you might think about doing that as well.

We also have another one, this is from Julia. Johnny has ADHD and is required medication while at the service. Is self administration when Johnny punches the tablet out of the foil and gives it to himself, we take the tablet out and then give it to the child. So, what is the type of administration? So, with self administration, we are talking about where when we hold the medication, we give it to the child to administer and we then sign off. So, we are the ones documenting it. We are the ones observing it and supervising that medication. If the child takes the medication and pops it in their mouth, that's not necessarily self administration. That is, we have the sign on, we are providing the medication and we are recording it. So that would not be, just the simple act of taking it is an age-appropriate thing for a child of primary school age. Self administration is really around something like a diabetes insulin injector. So, a lot of children who do have type one diabetes might have an auto injector that they have and that administers according to what they record is what they have eaten. That is the type of self administration that is that, when you look at that, that is what we are talking about, where it is administered by the child, the child holds it. It could be an asthma puffer as well. Belinda, did you have any more to add to Julia's question there about self administration?

Belinda: No, that is pretty on form. I just do have 2 people have asked about, one asked if they can bring their Epi-Pen from school to OSHC and we sign in every day instead of leaving at the service. That is, yes, you can, Epi-Pens are expensive and for families to buy 2 or 3 when they expire within a year can be a big cost. So definitely yes, as long as they are being signed in and out. And along with that, we had another where someone asked if a child could keep an asthma puffer in their bag, and it is really important to consider as your risk minimisation or where is that child's bag kept because who has access to that asthma puffer? Yes, that child might, but then all the other children in care do as well. So yes, they can self-administer their puffer, but then what does this look like within your service practices?

Meray: Questions? Sorry, Belinda, you go?

Belinda: No, they are from up the top. So, we are covered all up the top. Now we are back to where we started at the bottom again. So, I will hand it over to you.

Meray: Yes, should we be specific on an action plan renewal date? So, this is a question that has come from Ana, if the renewal date is the 27th of June, should it be renewed before the 26th or end of June would be fine as sometimes sending reminders that there are delays. I would think about the risk here to children when making those decisions. So, the review date, if it is specific, the 27th of June, that is when the renewal date should happen before. So, you are right, families do tend to be delayed for a few days if the child's action plan is in review. So, it is a 2-year review date and we have stated that it is 2, you know we need it before 2 years, I would really start to remind families 3 months out to have that in play. If medication after several reminders at Gowrie New South Wales, if we have several reminders by email, we have let the family know that we need this. We have let them know face to face; we have sent them a text message as well. We do sometimes have to put a ‘stop care’ in place until that medication and that review date is provided. So, it is just important to know what you know, to think about that in your policy. What happens if something expires, then what is the is the consequence or what is the next step that you take? And if that is in your policy and that has been provided to the family, then we have to follow that policy.

Belinda: I think to follow up with that, Kathy asked a good question. So, the parents noted a diagnosis condition on their enrolment but did not submit any medical plans they have requested them to do, they have not done so. What do we do in these situations? And also, to accompany, that is something that we get a lot is within our services, parents will come to us and say, oh, they no longer have asthma, or they no longer have an allergy, which can happen. So, if we want to talk about what we do in those situations,

Meray: So, I would always ask them to first put it in writing that if something has, is no longer a medical condition to put it in writing and update the enrolment form. So, if we think about the enrolment form as the single source of truth, that is really important. If we then ask them to provide the updated enrolment form with no medical condition listed, that is the best way forward. If a family pops a medical condition onto the enrolment form and then does not provide something, that is a point of that is where your enrolment processes, and we will talk about this I think in topic 9, a bit more around enrolment and orientation or topic 10. It is further down because absolutely that is where you would start to have that conversation before the child started. Is this a medical condition or is this an intolerance? Is this something you just want us to be aware of and really start to unpack those threads? If it is not a medical condition, but people want us to be aware of it, that is fine. We just note that on the enrolment form and make sure that that is clear. Especially with those things around intolerances and intolerances tend to be the part that does cause a little bit of confusion as well. The other thing is sometimes children might be on a plan. I think, I cannot remember what medical condition it is, but they might be on a plan, or a ladder that they start to introduce things at different times. That is also fine. So it could be that the medical condition is quite complex and as long as we have that documentation, as long as it is part of the risk immunisation plan and the communication plan we can work with that. It is just to have that information readily available.

Any other questions at this stage or if we have not answered your question and you have put it in there, just let us know because we have just had a few come all at once. So I am just going to go through and see if there is anything we have missed. There is a question about certificates. We will not be issuing certificates, but there will be confirmation of your attendance as part of the email for feedback. So, if you are looking at having this as part of your professional development record, you can just use that email as evidence that you attended. And it will, it will only go out to people who actually did attend. Julie has popped some really fantastic resource in there is resource links as well, and I cannot see any questions that we have not addressed.

Belinda: Annie's just asked for a template for an ADHD or ASD plan. Look with those, if you get a letter from the doctor stating it is a medical condition and then you can also, it is about look and a lot of those situations. Each service has really unique ways to document this. So, I know we call ours as student support plan and we talk about the diagnosis and the triggers and ways we can support the child. And then you would do accompanying risk management plan, but there is no one size fits all template. So, and maybe this is something that you think about in your service. What, what do your children need from you to allow them to be successful in your service? So, if you look at it from a strength-based approach, if you create this plan, how can I support this child to be successful within our program? And then work backwards from there. And you get really good feedback from parents with that approach I think as well. And include the parents, ask them what they want included, ask the school what they want, include your inclusion support team and then document all that in your self assessment because it is really important that process we're documenting and we talk about that.

We have it from Tammy. So, do parents need to get doctor's certificate or statement if their child is no longer diagnosed with a medical condition? I think, look, there is 2 separate ones. So, we have those ones where families say, I have asthma, I have food intolerance, but they call it an allergy. That is just, they have put the wrong information on the enrolment form, that is fine. They can just fix that themselves. If they have had that plan and they are diagnosed as asthma, we have really clear things in procedure then I think yes, they would need a better from the doctor just stating that's no longer the case.

Meray: And that is not a regulatory requirement. It is more around the best practice. Here it is important to differentiate. What we would do is yes, ask the family to give us a clearance, just like they would give us a clearance if the child no longer had an infectious illness. Just to know that is all completed. It is also good at this stage to try to get into those conversations early on because I think sometimes where it happens is the family has already been to the doctor and then we are asking them for information. And sometimes that will happen. Sometimes that is going to happen. But where I think is really effective is we start to remind families, look, if you do go to the doctor and your child is no longer allergic, put that in your newsletter. Put that in your information upfront so the family is empowered to ask for that before they attend and before they see the doctor obviously. And then that way it is, it is more of a streamlined process. So, it is a best practice approach here to really do that. But if not at a very minimum to provide that in writing from the parent. And absolutely change the enrolment form. So, if something were to happen, we need to go back to what is in that enrolment form and if a child is diagnosed with something we have to administer, we have to go in line with that medical management plan and have those things in place.

Look, I understand is a little bit past 10:15. You are more than welcome to ask any more questions. You are more than welcome to stay on the line, but we absolutely appreciate that people might have to get on and start their day. So, thank you again. Hopefully, this has been from the questions I think has been a topic that people wanted to find out information about. Just remembering that all the topics today will look at medical management plans in different from different perspectives. So, if you want to ask any more questions or have more information you would like to find out, have a look at what the different topics are, and I think you will find it. There will be some information that you might find relevant. So, thanks everyone. I appreciate your time today and we will stay on the line for a couple more minutes till about 10:20 in case somebody has a question that they would like to ask in a smaller setting. Likewise, we ask you di a question directly to the hosts and we will keep that anonymous if you feel more comfortable as well.

Belinda: Thank you. Also, welcome to put feedback. I know we have had feedback. If there is anything you found useful or anything, any improvements for next sessions, we are always open.

Meray: Thanks, Julia, for sharing a lot of your plans. That is really, really helpful. And the links, I am sure those who have asked those questions to have found it invaluable, so thanks for that.

Belinda: I think, yeah, Julia said she's been working on it in her Quip for the last couple of months, so, and as Meray referenced earlier in this session, I think it is really important to remember how serious this, this conversation is and these policies and procedures because it's not like, oh, I don't know. It can have just such huge ramifications with children. So yes, it is really important.

Meray: We might log everyone off today. But please feel free to contact us with any other questions if you would like to go through the feedback survey as well.

Toolbox 2: Best Practice in the Management of Children’s Medical Conditions in Outside School Hours Care- Policies and Procedures that Support Best Practice Management of Children's Medical Conditions.

Narelle Howard: Hi, I'm Narelle Howard. I'm the OSHC Regional Coordinator for Gowrie New South Wales, and I support our OSHC services in the regional space. Today, we'll be discussing medical management within our OSHC setting.

Question: What policies and procedure are needed to support management of children’s medical conditions?

Narelle: We have a really comprehensive medical conditions policy in place, which is shared across all our sites and services. This is actually updated regularly to ensure that we are compliant when it comes to the management of children with medical conditions. Probably some key takeaways in regard to the management of our medical conditions is ensuring that we have current and up-to-date medical management plans for children with identified medical conditions. As part of that process, as well as having the medical management plan, we are in consultation with our family's complete risk minimisation and communication plan. So, this identifies any key risks in regard to the child's medical condition and what we need to put in place at the service to support their inclusion within our programs to ensure that we're meeting the needs in regard to that medical condition. When we have children come to our services with medical conditions, it's really key that this is communicated across our team so that all staff members on site are aware of the child, their medical condition, and what we need to do if say they were to have, say, an asthma attack or anaphylaxis whilst at the service.

Question: What are some of the practical ways that these policies are enacted as procedures in day-to-day practice?

Narelle: As part of the enrolment process during our daily debriefs prior to the session, if we've gotten new children coming on board with medical conditions, it's communicated to our teams then, or if there are any changes to the medical condition and the management. For all new team members that are actually coming into the site, we have in our office area each child who has a medical condition. We have a file that is on display, having a photo of the child, their key triggers, any medications, the days that they attend, as well as having the current and up-to-date copies of medical management plans, risk minimisation, and communication plans, so staff are able to familiarise themselves with that child and their medical condition. As in a lot of our OSHC services, we do have a high casual workforce and irregular shifts. So, ways that we have in place to support those staff is using lanyards, so having it colour coded according to children's medical conditions, as well as a clear photo of the child for easy recognition, and also having what we do in emergency situations. So, if they were to have an asthma attack or have a low with their diabetes or things like that, we're able to support them in those situations. A lot of our play spaces are quite a distance away from each other, so having that key information in regard to medical conditions is really important. Once we actually receive that documentation from our families in regard to children with medical conditions, it's really important that we have it actually documented in the service. That could be as having clipboards that are on site, in the office, or in designated places, which clearly identify the children with their medical conditions and what we need to do with those medical conditions and also having our daily debriefs because there are changes that happen with medical conditions. So, it's really important that this is communicated within the teams. It becomes innate. It's just a regular practice ensuring that we're providing high quality care to our children and families.

Belinda Rouhan: I do want to advise that we will be recording this session, however, only Meray and I will show on the screen. These recorded webinars can be accessed along with the resource packs on the Department of Education website. After these sessions are completed, we would like to mention also that we will be hosting focus groups next Monday to seek your input and feedback on how these sessions went. It's really a good opportunity to share any changes to your practices that you have taken away from these sessions. My name is Belinda Rouhan, and I'm the general manager of outside of school hours care (OSHC) for Gowrie New South Wales. I support our OSHC teams and families and work closely with the OSHC managers within their daily practices in the OSHC services. And this is Meray. I'll hand over to introduce.

Meray Parsons: Hi everyone. My name is Meray Parsons. I'm the quality and compliance manager at Gowrie New South Wales. So, I work alongside Belinda, and I work with nominated supervisors, educators, and staff in supporting services to be proactively compliant and also working with services to embed high quality practices throughout that OSHC and also the early years learning programs we operate. Thanks, Belinda.

Belinda: Thank you. The second topic is part of toolbox 2. topic 7 is policies and procedures supporting best management of children's medical conditions. And it's important at this juncture to note that the resource is developed by Gowrie New South Wales and funded by the New South Wales Regulatory Authority. Before we get started, Gowrie New South Wales acknowledges our First Nations people as the Traditional Custodians of our land and waterways. We also acknowledge their continued connection to the land, sea, and traditional countries across this nation. We thank Traditional Custodians for caring for the Country for thousands of generations. We recognise this country was never relinquished by Traditional Custodians, and that their continued connection and commitment remains to Country. Gowrie New South Wales pays respect to Elders past, present, and emerging, and all First Nations people, including those joining us today. And I'm currently joining you from the traditional lands of the Wangal people. Now I am going to hand it over to Meray now to take us through the learning outcomes for this webinar.

Meray: Thanks, Belinda. So, with topic 7, we will be looking at having an understanding of what policies and procedures need to be in place for best practice medical management of medical conditions in outside of school hours care. We'll also look at how to develop these policies so that they meet the National Quality Framework, including the National Regulations and the National Law. We'll also look at some key considerations for implementing a procedure and a policy effectively and the documentation requirements that must be in place to meet these responsibilities under regulation 90. So just with that, I might just mention that there will be some overlap between our session today and yesterday, because obviously regulation 90 is one of the main regulations that deals with medical conditions the most. But today's topic is going to really be unpacking the policy and procedure side of that topic.

So, in terms of why do we need these policies and procedures for management of children's medical conditions? So, a good starting point for anything that we are doing is to look at the reasons and look at the why for key policies and procedures for, for the management of medical conditions. Ultimately these policies and procedures are about keeping children safe. I did mention this yesterday, but what if you were an educator and you started your first week at a service and you were not, or even as a nominated supervisor and you were not across which children that had medical conditions and you were serving afternoon tea or helping children serve themselves, and you had cheese sandwiches and a child accidentally had a cheese sandwich and that child was anaphylactic to dairy. So, what do we have in place to prevent that from happening? And then what if we couldn't find their medication? So, that's the why, and that's why we find this really important and why these series of sessions are quite important.

So, on this slide, we have a responsibility to help children to stay safe and healthy. And the National Quality Standard really picks that in element 2.1.2. So, on page 144 of the guide to the National Quality Framework, there are some really clear guidelines on how to manage children's illnesses and medical conditions which I encourage you to explore that also pull out some information about the OSHC setting as well. So, the guide is a really fantastic resource, but we've also got some regulations that specify that we need to have a policy in place. So, we talked about that yesterday and that policy must cover how to manage medical conditions. It's also part of, from yesterday's webinar, is to really that regulation 90 has been unpacked in what is required, but to be really consistent with that in, when we look at what key guidelines help us to determine what's important that we refer back to that regulation 190. Regulation 168 requires that there are policies and procedures in place. And really importantly hear that section 167 of the National Law is about taking reasonable steps. So, the approved provider and the nominated supervisor must take reasonable steps, or every reasonable precaution there is taken to protect children from harm or hazard. So, there are offenses and penalties that result in the failure to do so. For individuals like the nominated supervisor, it's about $10,000. And for the approved provider it is $50,000. So that gives it weight as to why it's so important to be across this information.

So, in terms of regulation, we are going to recap what is required. So, we must have a policy that details how does the service manage medical conditions. And it's also important that we have that policy in place, even if we have no children that are diagnosed with a medical condition. We know this because children's medical conditions can emerge for the first time and they can be not diagnosed when we that can happen, have their first incident at the service. So, it's important that we as educators know and as educators are trained about what policies and procedures to undertake.

So, over the next few slides, what we're going to do is unpack a step-by-step process of how to develop a policy around medical management. And we'll also be looking at the tips that will be best used alongside this information provided so far, as well as the other contents of this toolbox. So, we understand some of you may not be responsible for developing a policy in your organisation. Some of might find this very useful. But even if you don't develop policies in your setting, you might provide feedback on how these policies are implemented, as you may be the educators implementing those policies and procedures. And you might use this information in this session to provide feedback to you to the organisation or to the person who does develop the procedures and the policies. But also, you might use this opportunity to go back into your policy after this session and see if there are any gaps after you've attended the session and see if you could provide any suggestions based on what we talk about today. So, step one, so developing a policy, there's some really key steps here.

So, step one think about a policy title that the practice relates to. So, we've provided some examples here, but remember the title must be direct, clear, and concise. So, you can easily find it. If you're using an intranet, if you're using if you've put them in a policy folder or if they're saved on your desktop, you need to be able to search and find those policy the policy that you need pretty quickly. So have it as clear and concise as possible. Most policies or medical management are really clear, dealing with medical conditions is the policy name that we use at Gowrie. But then we have to think about a policy statement. So, think about your policy statement should be reflective of your service philosophy and what your service commitment is to children. So, at Gowrie we support all children too. And then we have the statement, or it could be at our service. At Gowrie New South Wales, we recognise that children who attend may have a medical condition that requires ongoing management, and then it has a bit of a sentence there or a policy statement that relates back to your philosophy.

We also want to include some background information about why the policy is in place. The statement could begin with our responsibilities under the Early Education and Care National Law and Regulations include and list out those requirements. You could also link those legislative requirements directly to the policy. So, it could refer to other relevant regulations for medical management. And we've discussed these during this webinar, but also topic 6, which was yesterday. So, some links would be regulation 91 as well as regulation 92 and regulation 96, which provide guidance on administration of medication

So there's a fantastic ACECQA fact sheet called ‘Dealing with Medical Conditions’. It's noted that all decision making should be carried out in accordance with the principles of your policy. So, when you are developing this policy, think about what principles need to be included. So, you might include things and those principles will help guide the decision making. So, for example, all staff are informed that all children of any children are diagnosed with medical conditions or specific healthcare needs and the risk minimisations in place. So that then that principle then tells the nominated supervisor, educators volunteers and start casual agency staff what the requirements. So that principle then gives us the decision making that we need to take. Based on that you might include a principle around all staff are informed where medication is stored or if there are any dietary requirements or restrictions relating to children's medical conditions. Another principle that you might include in your policy is that all children with diagnosed medical conditions have a current risk minimalisation plan and communication plan that's accessible to staff. So, by detailing that, it really gives us the information we need to then go ahead and make decisions based on that information.

We would then use, and something that I have found really, really helpful. So, I do develop and consult with educators’ policies at Gowrie. And something that's been really helpful is linking other policies that are relevant to the topic in that policy. So, there should be a reference to other policies that are closely linked with medical management. The ones on the slide here are a starting point for consideration but consider your service context and the community you work within. In addition to including maybe a link or you could do an actual link that people within it takes you to that policy or just referencing what those policies are. So, the related policies, if you are using a hard copy system as well, so that as an educator, when you are looking at that policy relating to medical management, you do know that you actually have to look at what the administration of first aid says, or administration of medication says. You might also include what forms or procedures are linked. So, when we are thinking about medical management, you might want to also include that there are medical management plans, that there is a risk minimisation and communication plan and encourage those reading the policy to then go and seek out that information so that we as comprehensive as possible. It is always a bit of a balance to ensure policies aren't too long and too wordy so that the information does get across. But also by having those links in place, you are then ensuring that by an educator reading that policy that they are aware of a risk minimisation, that they are aware to go and seek out a communication plan, and that they know that there's a special form that need to complete if there is a medical incident such as the serious incident illness, trauma form depending on what you call it at your service. So that's a really key factor that we find really helpful.

And so, the next part here, step 4, this is possibly one of the biggest steps that sometimes culture eats our policy for breakfast. So, if we are making sure that our policies are becoming part of our culture, how do we do that? So, it's around, I'm thinking about induction creation and evaluation of those policies and ongoing training. So, it's important to document the date of the policy was reviewed and was endorsed and the dates of review so people know when that policy might be coming up for a renewal. It also helps with version control, which is a big problem if you've gone from Word and hard copy to digital copies. To have that version control is really important. And so, educators know that the policy that they're reading is the current and accurate policy. Also, if it's part of your continuous improvement as part of your self assessment or your Quip, how are your policies reviewed and by whom? So, do you involve families, and do you ensure that there are multiple voices that have been considered? And where do you source your most up-to-date information for incorporating into the policy? So, are you referencing the Department of Education website? ACECQA fact sheet are fantastic to reference as well as reputable recognised authorities. So, ASCIA is one of them as well as Asthma Australia and Diabetes Australia, would be some reputable authorised bodies on those topics and monitoring evaluation and review. So, there should be a review of this policy. The regulations don't specify how often a policy should be reviewed, but that that must be a review schedule where policies are prioritised and according to any changes in regulation or any changes in your procedures they should be then updated as well. So, for example, if there are changes in legislation you need to update that policy even if you've just reviewed it a month ago. And that if there is an incident that then triggers a critical reflection at the service, which then as a team you think actually, we need to update our practices as and our procedures. You would probably also want to update your policy as well to reflect that change.

So, in terms of thinking about how do we implement this? So, like I said, it's all well and good to have a beautiful policy that has a fantastic background and has fantastic links. But then if we are not implementing that policy, it really does just gather dust on a shelf. So, thinking about procedures as being the how to of the policy. So, it provides more detail. Your procedures should be about the practical practices that's a mouthful at the service that you and your team will implement. So, think about the procedures as the how to of dealing with medical conditions and provide as many step-by-step procedures in writing, add them clear in very plain English and make them easy to read. Something we've had some really fantastic feedback on is using colours and fonts to highlight really important parts of the procedure or to highlight things that people should take note of. So, when you take the steps that you document, your procedures will not only guide your practice and your team's practice, but also inform the Regulatory Authority of the roles and responsibilities at your service. So, procedures will also give families assurance and other stakeholders, so the schools and other stakeholders about what measures we have in place to effectively manage medical conditions and minimise risk to children.

Also, when you are developing procedures for dealing with medical conditions, it's really important to be as practical and attainable as possible. So, for example, we did mention this yesterday, if you say that all medical management plans have to be reviewed every 12 months, is that going to happen for families? Are families able to do it? Is it attainable? Because if we are saying that medical management plans have to be reviewed every 12 months and the regulatory requirement isn't, so we actually have to still meet that policy even if, if the regulatory requirement doesn't specify 12 months, we do need to then have systems and processes in place to ensure that we are following our own policies and procedures. At Gowrie what we do is we say if there is a review date, we will have the medical management plans reviewed, but if there is no review date, we require families to review these things every 24 months. So that's what we do at Gowrie, that's been feedback based on families' ability to get into GPs, to have immunology appointments, but also as children are in that middle school age, middle childhood and primary school age allergies and asthma often don't change as quickly and the changes aren't as quick as when they are in those early you know, under 5 years as well. But whatever you say is in your policy, what systems do you have in place? So how do you monitor that? Who's responsible, who's that key person that is responsible for undertaking those tasks? We have some fantastic conversations and practical tips that we talk about here in more detail in the vignettes. So those resources will be available to everyone at the end of the series. But I am going to hand over now to Belinda to take us through the next few slides. Thanks, Belinda.

Belinda: Thank you, Meray. So, it is important to remember that it's the legal responsibility of approved providers to ensure systems are in place to minimise risk and ensure health and safety procedures are implemented by the responsible p people in services. So, if you are the nominated supervisor at your service, what procedures do you have in place to ensure this? Do you train your responsible persons on medical management prior to putting them in the role? Do you document this training? Do you check or revisit their understanding at any stage? Remember too, for those responsible persons who don't step up to the role daily, these are not embedded practices, and this can be where things slip, or mistakes happen. So how do you minimise this risk? At the end of the day, ultimate responsibility lies with the approved provider to ensure their service is meeting the requirements under the Education and Care Services National Law. With this said, the specific health and safety measures in place as stipulated by the service policies and procedures have attached to them specific responsibilities for specific roles in the service team. We're now going to unpack who is responsible for different elements using the guide to the National Quality Framework as a reference over the following slides, it is important to have an understanding these responsibilities as they can also be included in the development of your policy.

So, you can see on this slide, these are some of the laws and regulations which relate to medical management and the accompanying policies and procedures along with the responsibilities assigned to different roles. So first, if we look at National Law section 167, we must ensure that every reasonable precaution is taken to protect children being educated and cared for by the service from harm and from any hazard likely to cause injury. So, this is a responsibility of the approved provider and nominated supervisor. And an example of this in relation to medical management would be having in date medication on site for the children in care with medical conditions, including Epi-Pens and asthma puffers. National Regulation 90 is a medical conditions policy that is required, and under regulation 90 are examples of what must be included in this policy. And you can see here there are different sections of this regulation, which are the responsibility of all in the service from the approved provider and nominated supervisor through to staff and volunteers as they must follow and enact the policy and National Regulation 91. The requirement for the service to provide families with a copy of the medical conditions policy that is a responsibility of the approved provider.

So, on the next slide, we'll first look at the responsibilities of the nominated supervisor. So, the nominated supervisor is responsible for implementing the medical policy and ensuring that all medical management plans are in place and that they're carried out in line with the stipulations within. So, the nominated supervisor must ensure any changes to the policy and procedures, or individual child's medical condition or specific healthcare needs and medical management plan are updated in your risk minimisation plan and communicated for all families, educators, and staff. So again, at this point I'm going to encourage you to consider your current practices. How do you share any changes and update to updates to the medical management plan and risk minimisation plan with everyone in your service. And do you do this in a timely manner? So, do you have a set time each you do it or do you update your staff as changes arise? It is the responsibility of the nominated supervisor to no notify the approved provider if there are any issues with implementing the policy and procedures. So, in your service, how do you do this? And is it documented? And it might be a perfect time to go back to your approved provider after this session and see what should be in the policy and cross checking against yours. Is there anything maybe that needs to be in there that isn't or something that's in there that you are not following in practice? And as Meray mentioned earlier, if there is a service policy and it has a higher expectation than the laws and regulations, then you must follow the policy as per the regulatory requirements.

So, the nominated supervisor is responsible for ensuring that all educators and staff are aware of and follow the medical management and risk minimisation plans for each child. Again, how do you ensure that all staff follow the plans, including casual and agency staff as well as new staff? The nominated supervisor must ensure communication is ongoing with families and there are regular updates as to the management of the child's medical condition or specific healthcare need. Is this communication documented? And how do you manage these rhythms so that they aren’t forgotten? Do you schedule time to have review dates with families throughout the year or do you speak to them informally on collection and then make notes on the communication plan? The responsible supervisor is responsible for making sure that all educators and staff have the appropriate training needed to deal with the medical conditions or specific healthcare needs of the children enrolled in the service. So, this responsible person must be first aid qualified, but are there any of your other staff that need to be first aid qualified in your policy? And if not, how do you manage the movement of children between areas and spaces if only your responsible person is first aid qualified? Do you also need to consider additional training prior to a child starting if they have a complex medical condition such as epilepsy, diabetes, or they might even need a feeding tube? And have you considered reaching out to the different organisations such as Diabetes Australia to seek further support?

The nominated supervisor must focus on ensuring that all children experience an inclusive experience at the service. So, consider the medical conditions of children in your service right now, what changes could be made to the program routines and environment so that it is more inclusive and have you completed a critical reflection on this? So perhaps in your next team meeting, you could do so together, and document then add to your self-assessment tool. So, you might see this either as a strength or areas for improvement. And the nominated supervisor makes sure that all educators and staff are aware of and follow the risk minimisation procedures for the children, including emergency procedures for using Epi-Pens. So, we have covered this extensively, but I strongly encourage you to have regular reminders and check ins with your team as when there is a medical incident. It can have catastrophic outcomes if staff don't follow the correct procedures and administration of medication.

Now let's unpack the educator and staff responsibilities. So, educators are guided by the nominated supervisor and in their absence, the responsible person educators are responsible for ensuring all the action plans are carried out in line with the medical conditions policy. So as an educator, how do you take ownership of this and be proactive in seeking out the medical management plans and medical conditions? Policy educators are responsible for monitoring the child's health closely and are aware of any symptoms and signs of ill health. So, are you confident that you can identify what the triggers and symptoms are for all children in your care with medical conditions? And if you are not feeling confident right now, then what resources or support do you need to be confident? So, what do you need from your nominated supervisor?

Educators must ensure that 2 people are present anytime medication is administered to children as per their policy. And it is a responsibility of all educators to familiarise themselves with and understand the individual needs of a medical management plans for the children attending the service with a specific medical condition. So again, consider the previous examples. How do you proactively do this in your role currently? And if you aren't proactively doing it, what support do you need to be able to do it? So, educators are responsible for ensuring that all child children's health and medical needs are taken into consideration on excursions. So, the first aid kit, any personal medication management plans, et cetera, et cetera. This this point is especially timely as we come up to the vacation care period. So, have you given any thought to this in your current practices? And do you know how you manage medical conditions and how you manage your medication and things on your risk assessments for excursions? Educators must also maintain current approved, a current approved first aid, CPR, asthma, and anaphylaxis training as per the service policy. So, what is your service policy? Is it all staff or just permanent staff? Do you actively manage this yourself and then provide the updated certificate to your work?

So, this is something that can quite often get left to the nominated supervisor, however, it is everyone's responsibility to maintain their own qualifications. So as an educator, you should be maintaining your qualifications and providing updates to your nominated supervisor. Educators must undertake specific training and keep it updated if required, to ensure appropriate management of a child's specific medical condition. So again, we come back to the feeding tube, epilepsy, diabetes. And educators are responsible for ensuring that practices and procedures in relation to the safe handling preparation can consumption and service of food are adhered to along with any changes to a child's medical management plan or risk minimisation plan. And these are implemented immediately within the menu preparation. So, consider your own practices, how do you incorporate any last-minute bookings into the menu for the session? And how do you communicate with staff, families, and children the ingredients in the menu, and ensure that there are practices and procedures in place to minimise risk for food allergies and anaphylaxis.

And finally, we are going to talk about the family's responsibilities. So, in partnership with the service, it is the responsibility of families to advise the service of the child's medical condition and their specific needs as part of this condition. This includes but is not limited to the provision of regular updates to the service on the child's medical condition, including any changes to ensure all information required is up to date and current. They're responsible for rep providing a medical management plan from a medical professional on enrolment or diagnosis of the medical condition, and providing an updated plan as required by service policies. Families are also responsible for collaborating with the service to develop risk minimisation and communication plans. So, considering these 3 points, how do you set these expectations with families in your service? Are there responsibilities clearly outlined in the policy you provide them with? And do you discuss their responsibilities to ensure that they are aware of what this means? Do you give them reminders or proactively open discussion about the above? For some families, your service might be the first experience with managing the medical condition. So how do you engage them so that they are confident in the process, but also understand the expectations we have of them? So, I'm going to hand you back to Meray now to talk you through procedures.

Meray: Oh, thanks Belinda. So, we're going to use the next few slides to unpack some procedures in regard to best practices. So, this is where the really practical areas come up. What we found yesterday in, in the session is that you guys also are the experts in your services. So, you might also have some fantastic suggestions you might want to share in the chat. I think yesterday really it was, it was great to see that collaboration between the participants. So, as we are chatting and as we are going through some of these procedures, please feel free to ask questions. You don't have to wait till the end. But also, please feel free to share if you are doing something that we haven't covered that you think would be, it would be nice to, to share with the rest of the participants.

But essentially to minimise risks here in the environment, we need to be taking actions right up at up at enrolment or at diagnosis. So, the child might already be enrolled, as we've said many times, that all of the medical condition information should be collected at that stage. And then we really need to consider this alongside the contextual information at the surface and the risks identified in the care environment. So it could be that the child is anaphylactic to bee sting, and so what then do we have to do? It might be very different. The risk minimisation form is then created with that family, and it will be very different to if a child had anaphylaxis to dairy as the, as the scenario I used earlier. So, to think about minimising those risks, they are really going to be very specific to your service and you will be the experts in your service and the family is the expert of their child. So, it's those 2 levels of expertise, I usually think about them in that way that come together to have the best possible risk realisation plan as well. And then once we have that, it goes back to this saying it's all and good that it's been really robust and it's comprehensive, but then how do we communicate this? And we always have to remember our casual and our agency educators that we might use. And educators who might not be part of your services are the core team. They could be educators that only work vacation care. So how, how does that information get passed to those educators? You might think of different styles of communication for different cohorts of teams. So, in previous roles I've had with OSHC, we used to have a vacation care debrief and it was almost like a 4 or 5 page document that we had to for at the beginning of every vacation care because there are different children, then you might have your daily debrief for your before and after school care sessions. You might send things in a weekly email so that you know everyone has it in writing, and then look back individually to make sure people understand it. So, think about the different cohorts within your team and think about what type of communication style will work for them, the different groups of people.

We then want to think about these procedures in a bit more detail. So, I'll go through some of these in a bit more detail here. And it would, first of all to consider some of these things on the slide, but there are also some practical measures that must be in place to really understand and put in place best practice management for medical conditions. So, these are a few, they are not in extensive, and you might have additional suggestions, but really review for emergency evacuation and emergency procedures. So, whether it be evacuation and lockdown procedures or any emergency procedures to see if there are any adjustments that need to be made relevant to medical conditions and relevant to children's health and safety if they have a medical condition. So, if we are evacuating and the evacuation point is off the school premises or even within the school premises, if we're evacuating, do we have medication that we take with us? Because with those scenarios we could then have some cross contamination and then children need their medication. Do we then develop a risk assessment based on that and really practice it? So, when we have our lockdown and evacuation or emergency management drills practice, really specific scenarios are a really great way to see if there are anything, any pieces of the puzzle that are missing. And then what happens, what changes have to happen to our procedures if our service is single staffed?

So, I know in our previous topic session we did, there were a few people on, one of the participants that were single staffed. So, what needs to change then for these processes? When we are talking about some of the most common medical management conditions or the medical conditions that are most common. So, things like asthma, diabetes, anaphylaxis allergies these should, the procedures around these should all be specified in our policy because while we might have somebody having their medical episode for the first time at the service, we might not have a medical management plan for that child if it's the first incident. But we need to know how to respond. And if we think about section 167, every reasonable precaution is taken, this is an example of how we would take every reasonable precaution. So, we know children can have their first episodes in services and not have a medical management plan. And if we then understand what that what that what that the procedures are for that, and it's included in the me medical conditions policy, we are then making sure we're in line with that section of the law and having systems in place. I mean, we've talked about these fair few times, but we know that some of the most breached things are, are medication expiry dates or medical condition management plans that are outside of their review time. So, what needs to happen so that we have the right medication supplied and where new medications are required? Families are aware of this and ahead of this and having a look at reviewing risk assessments for the risk immunisation risk assessment. So, for example it might be that you are introducing, or you are going for an excursion to the botanical gardens. What does that mean for the child that has anaphylaxis allergy to bees? What does that mean in terms of the excursion? How do we ensure they are still included? And how do we ensure that their health and safety is still prioritised? And having that really open communication with families then helps families really remember to let us know if there are changes related to their child's medical conditions. And once you know the educator at the signing area receives that information, how do we ensure all families will sign in and all educators know that that information has changed. So, do we request it in writing, and do we share it as part of a newsletter or a debrief if the risk minimalisation needs to be updated, how is that reshared again?

So, one procedure I really want to unpack here is around having all educators working with children, being able to identify children who have a medical condition and being able to be, have the training of administering that medication. So, for example, an Epi-Pen or if it is an insulin injector, understanding how to administer that medication and knowing who the children are. This procedure here is really important and I'm just going to highlight a few areas here that all educators and staff should be provided with general information about the children involved. So, if you have an educator who's an agency educator that's just arrived, how do we give that a, that that individual some general information so that they are aware? Do we have some signage around family areas or signing guests, identifying that there are medical conditions around anaphylaxis and perhaps what that ana what the triggers are so that families are aware what back or what not to pack in, in children's bags as well. And so, while we do want to consider children's right to privacy and their right to dignity, we also have to make sure that that information is communicated with families.

So, we did have a question earlier. Some families might not want the medical management plans and quite rightly displayed in an area where everyone can see them. So how do we display in areas that ensure all educators have that information, but that not every single person utilising the service can look at that? So are there folders, we had a suggestion where I think one of the participants mentioned the green folder is the folder that's in every play space and that has all the information about children's medical management plans, their triggers, and their communication plans, as well as their risk minimisation plans. We do have at Gowrie you can actually purchase them online, but we use allergy buddies because they're very compact, they're easily transferable and movable when you're going on excursions and they're just like little toiletry bags, if I put them that way, with a zipper and they've got a clear sleeve in the front, you can put the child's photo with without all the identifying details, but in that bag, you can have all the children's medications. So, we have one that sits near usually like storage room or the office area for the nominated supervisor. And we have one sometimes near a fridge because there might be medication that needs to be in the fridge as well.

One thing that sometimes is really important to think about is handover procedures. So, a scenario I like to use is of a little boy I once worked with who I was working for in the afternoon session, and we knew he was a child with asthma, and we could see that he was starting to have some of those mild asthma symptoms. So, if we think about that medical management plan from asthma Australia, it was very mild. He wasn't wheezing, he was just a little bit out of breath. And so, he took, he followed, we followed the medical management plan and he was administered 4 puffs of his Ventolin puffer. And then I had to go to another service. So, I did do the handover, and that handover was to the rest of the educators because that little boy actually then started to have more moderate and severe asthma symptoms. So had I not provided that handover, there might, it might not have been clear what medication he's already had, has this come on suddenly. And for anyone who's managed asthma in an emergency, those key pieces of information are important for both the paramedics, the families, and for that child's ongoing care as well. So how quickly the episode came on, what was provided in terms of medication, what was, what was the response and how did we administer first aid in that? So really ensuring that that handover procedure, what tools do we have? Is it a bit of a sign on desk that we quickly scan through and go, okay, there's nothing here to handover, or I do want to mention that 2 of the children that we know who have medical conditions are a little bit tired this afternoon.

So, to watch out for that in case it becomes anything more. So really thinking about these things and thinking about them in really a contextualised way for your service. Thinking about them in, simple, they don't have to be complex systems. They can be simple using things like colour coordinate, like colour keys and using different, for example, red for anaphylaxis. We use the ACEQUA colours, and we just replicate that for all our documentation. So, it's really simple, it's eye catching. And things like lanyards and wristbands are really helpful as well. But really, they are based on what you would find useful in your service. And going back to that point of you guys being the experts at your service, you all know what will work best.

So, when we're thinking here about safe handling, preparation and consumption of food, a lot of the life-threatening medical conditions are due to food allergy. For those people who are diagnosed with food allergies usually they, they are the biggest risks of anaphylaxis come from food. So to really think about what measures we have in place and examples of what can be implemented to reduce that are that we have clear expectations that children don't trade or share food or utensils or food canisters. So, we always talk about sharing as caring with, with young children, but in this regard, I think most schools and most early childhood and most OSHC services are very clear that children aren't to share food. And for obvious reasons. There, thinking about other things like bottles or drinks and lunch boxes being really clearly labelled with children's names. So really high highly allergic children will have a reaction from even trace elements. So, things need to be very, very clearly labelled and if we're not sure not to take the risk. So having thought about that and setting those expectations and giving families the why. So, if we're asking families to clearly label those things, you might ask them, but you might also sometimes give them the why so that they take it seriously as well.

Educators and staff involved in food implementation or food preparation implement measures necessary to prevent cross contamination. Food Authority New South Wales has really good fact sheets on their website that you can use to think about preventing cross contamination to ensure that food handling, preparation of food and careful cleaning of the food preparation areas, and especially effective hand washing is used when there are foods that are an allergy trigger for, for children when you are providing foods. In our larger services especially, we have a 2-person check thought when serving food in an OSHC service. So, when preparing food, 2 educators at Gowrie always check against what food is provided and what children are attending, and especially children attending casual sessions. So that's a what systems do we have in place? A lot of our services won't accept casual sessions after 1:00 PM on the day off because if we need to know which children are attending so that we can know what allergy allergens we need to avoid. And anything after 1:00 PM just creates a bit of a margin for error. So, at Gowrie, we have after 1:00 PM that day, we won't accept any more casual bookings, especially for the medical management situation and where possible, if it's a highly allergic food that lots of children might be allergic to, we eliminate that if possible. So, we don't use whole eggs and we don't use obviously nuts. And we don't use foods containing those things because like we mentioned earlier, children could have their first reaction at the service. And we know those are common all allergens that children can have anaphylaxis to as well, where it's not possible to eliminate a food. So especially things like milk products and margarines implementing strategies so that children with high allergies to that don't come in contact with the allergen.

So we do have different coloured serving plates, for example, and it's a very subtle shift. So it could be pattern plates and one pattern indicates an allergy safe food. So, we use the blue flowers on pattern plates for children who have that allergy, for example. So, it, it might not be very obvious to other children, children are still included as part of that mealtime, but educators, it's a bit of a little bit of a hint or just something to catch their eye. Say this, this food is allergy safe for these children. Sometimes you have to think about the risk benefit of inclusion versus safety. So sometimes children are so allergic to an allergen that they might have to sit away from the other children. So, it isn't we have to really talk to families about this, and this is where the risk minimisation plan really comes to life. So, you would then talk to families about it, what does the child do at school and then how do we include that child but also prioritise their health and safety. So, we've gone through a lot of these different suggestions. I can see there are a few comments in the chat, which I haven't been able to look at while I've been speaking. So, what I'm going to do is hand over to Belinda now, and I'll see if we answer some of those things while Belinda's chatting and all we will go and answer them at the end. Thanks Belinda.

Belinda: Thank you, Meray. We're now going to explore the National Quality Standards and how these guide our practices in relation to medical management. So, there are direct correlations between regulation 90 and the National Quality Areas that relate to the specific policy and procedures discussed during this webinar today. The spotlight here is on Quality Area 2 and Quality Areas.

So, on the following slide, you'll see these broken down. So, within element 2.1.2, there are several direct connections to the practices in place for management of children's medical conditions. During the assessment and rating visit. And throughout all embedded practices, the authorising officer will discuss how the service communicates information about a child's individual health requirements to staff members, how the service conveys concerns or questions about a child's health needs to the family. How information about a specific child's individual health is kept confidential and specific reference to school aged care settings are services to consider the following. So, the arrangements for negotiating individual procedures for the administration of medication with families and children and how and if information about the child's individual health requirements is communicated to the school. Element 2.1.3 references the requirement for services to be able to demonstrate how they meet the needs of children with special dietary requirements and to have a current service policy on dealing with medical conditions such as anaphylaxis and allergies.

And in the following slide, we'll look at Quality Area 7. So, Element 7.1.2 references that require policies and procedures are available at the service, which are also available to families of which dealing with medical conditions is mandatory as discussed earlier. Additionally, consider Quality Area 6 specifically when we're at the point of enrolment and creating new partnerships with new families. So, element 6.2.2 discusses access, inclusion and participation reflecting this in your program in relation to both connections with families and with the school. And how will or do you collaborate with your local school to devise complimentary support plans for individual children. Now we’ll look more in more detail at Quality Area 6 in the upcoming webinars over the next few days.

So where to go next? We are coming to the end of this session, so I encourage you to type any questions you may have into the chat box if you haven't already, so we can answer them at the end. And you can see here as discussed at the beginning, these sessions are recorded and will be provided after the series is completed, along with a resource pack listed here. These will be provided on the Department of Education website and a link sent to all participants. We've also included a list of references from this session, which you might like to explore further on your own.

And finally, thank you for taking the time out of your day to attend these sessions. We hope you found them informative and relevant. We value your feedback and encourage you to participate in the feedback survey that you'll receive in your email to further improve our professional learning. We also encourage you to share any feedback or questions you may have in the chat box so we can answer them now if you have somewhere to be once the session is finished. Well, the session is finished now, so you're welcome to ask questions. However, we understand that some of you may be getting ready to prepare for the afternoon session. And a final reminder that if you would like to participate in the focus group on Monday morning, please keep an eye out for an email this afternoon with a link to the Zoom session. We really hope to see you there as these sessions inform future projects and training initiatives for both Gowrie New South Wales and the Department of Education. There is often not too much OSHC specific training made available in the sector, so it'll be great to get your feedback to assist us in advocating for more. Thank you everyone. And I'm going to hand over to Meray who's had a look at some of those questions.

Meray: So, we've got some questions. So, before we get into the specific questions from today, there have been questions from earlier sessions around a certificate. I can confirm that if you've attended any of the sessions over the last week or so and any of the upcoming ones, we will be issuing certificates to the email address that you registered with. So, I think there's been lots of requests for that. So yes, you will all get some certificates about your attendance, and also the session on Monday is a little bit more of a critical reflection as well. So, if you want to participate in Monday's session and we have some open-ended questions, we'll be really looking at critical critically reflecting on this content, what went well, what didn't go well, what you wanted more of what you learned. If you then do attend, you'll also get a certificate to recognise that process as well. So just wanted to state that from an overall perspective, but there have been some great questions.

So first one here being in terms of a risk minimisation plans, is there a specific format that this needs to follow? No, there isn't a specific format. There are some good templates on the ACECQA website. But what the risk minimisation has to include is it just has to, if you look at regulation 90, it says what that risk risk minimisation has to include. There's no requirement that families sign off on it, but it is a requirement that families are consulted. And there is a point where children obviously families might not want to be consulted. And so, consultation might look like, here's what we've developed. Do you agree with it? Consultation might be, can we have a meeting and talk about those risk management strategies together? Consultation might look like, here's a blank risk minimisation form, what do you think can happen? Although I think that will probably not get the best response from very busy families. So, what we do at Gowrie is, we have a draft risk minimisation form because we know the services operations best and the family knows the child best. And then we send it to families to sort of get their buy in. If they don't respond or if they don't engage in that process, then we then use that risk minimisation draft and then we go ahead with it. So sometimes there isn't a lot of buy in but as long as we've provided families with the opportunity to consult and we've sought that on multiple occasions, I think just one email probably won't be enough. So hopefully Kathy that's answered your question.

Kelly has asked about recent medical management plans that have no expiry and absolutely they do now say whilst this plan review is recommended it doesn't expire, and so then it depends on your service policy. So then, the plan doesn't expire. But what is your service policy? If the policy at your service is that they are reviewed every year, then you would ensure that that's happened so that you are meeting your own policies. Hopefully that's answered that question.

And sorry, I do there are some comments around facilities in OSHC spaces. Absolutely, so some of our OSHC spaces have designated offices, some of them don't. We have multiple pack up, pack down services, but there might be a designated area for your files or a cupboard for your documentation. So where would they be kept? If we are doing a, I'm just having a look at, some people are giving suggestions and some are questions, so I'll just keep looking through that.

Julia's added a great resource and I think there has been a comment here about a service not being able to discuss medical management with the school, which is I would agree with you, is absolutely frustrating. And can be quite it, it's not for the best outcomes of children. So, we do have one of our OSHCs. We really have to work really hard for to establish good relationships with the stakeholders at that OSHC service. And we, after lots of persistence have practice and the families well the families were always working with the service, but the school is now working with the service. I would say don't give up and keep explaining the why. The why is usually hard to ignore. If you're saying it's about children's health and safety, we need to make sure we're doing everything we can to get that information. So, I agree with you Leslie, that would be really difficult as well. I don't think we have too many other questions. Sorry. One more to add. Yeah, add more to that, those questions.

Belinda: No, you're right. I saw at the top that they have some children with allergies or anaphylaxis to egg, and they asked for feedback on making their service egg aware or egg free. I think one, it comes down to your policies and 2, it's that risk minimisation, isn't it? But I'll hand over to Meray for,

Meray: For that question. It, it's not a regulatory matter necessarily in terms of what the regs say, what the regs don't say. But I think if you have highly allergic children to egg, and, especially if it's anaphylaxis. And I feel that if egg is something that you don't have to have as part of your service. So, if it's not a requirement to have egg, I would, I would do a risk benefit analysis there. And I would say, what's the risk here? So, it's catastrophic and it's, if they are exposed, it's likely that it's going to be at the very least a hospital visit. If not more catastrophic. And then I would think about what the benefit is to have that egg. So, is there a need for it? So could you be allergy egg aware, remove those things from your menu and encourage families to not pack it in lunchboxes and talk to the school. What are they doing for that child who is highly allergic to eggs? So, it might not be that we do what the school does either. So it could be that we consult with the school, but ultimately, we are regulated under the Education and Care National Law and Regulations. So, it's about thinking. I always think about this from a risk benefit analysis and think, what's the risk here? What's the benefit? And that usually will tell you where you need to go.

Belinda: And we had another question. Someone just shared they are finding it hard, the families aren't updating the minimisation plan then there's no review date. Yeah. So, as we discussed earlier, there's no regulatory requirement like review date, however, you do have to follow your policy and then it's referring back to that policy. What are the next steps? Do you state in your policy that families are unable to come if you don't have that policy updated?

Meray: Absolutely. And I think it's, it's also, I mean, we've had services where families haven't engaged in that process, haven't engaged in that process. We've asked them at 3 months, at one month, talk to them at drop off and pick up. And we have had to put ‘stop cares’ in place because we did not have the right medication. We weren't able to contact the family's doctor and we could not maintain the safety of that child. So, we couldn't go back to section 167 of the National Law, every reasonable precaution is taken to prevent harm and hazard to children. We couldn't do that. And that's why we then we have had to put ‘stop cares’ in place even momentarily, just until we get the medication back from families as well.

Belinda: Absolutely, one more thing I guess we could add too, if you do join the focus group, and if you are thinking about your assessment and rating and critical reflections in that, we will be discussing changes that you've made to practices. So, it would be very advantageous for you to attend, put them in your self-assessment tool. It is a critical, reflective, critically reflective process for you. So, we encourage you to attend that focus session too.

Meray: It's a good sell. Belinda?

Belinda: Yes and no. It wasn't on the website. <Laugh>. We're going. We, this is invite only. So, it's just to the participants who've joined us. So, if you have joined one of these live webinars, which you all have today you will get the invite. And it is.

Meray: 9 to 9:45 I believe it is. Julia, any other questions? Like Belinda said, if you need to go and start your after-school care session or you have other things on, we are not offended at all if you need to head off. But if you would like to ask more questions, we also can stay on the line for another 10 minutes and answer questions that you might have from the content that we've covered today. For the Monday session. Also use Kahoot, I think to get some of that feedback and that information. So, it's only half an hour and it's not going to be as regulatory focused. It's about your experience and your learning. So, I think it will be an interactive session. Yes, we like Kahoot as well Julia. There are a few organisations I probably do have to see if I can talk to you about commissions here because there's a few organisations we use a lot and I also recommend them to lots of other people. Thanks everyone. Like we said, I think there's a few people logging off and few people still on. We will answer any questions if you have them. But also, we will probably close off the session in about 5 minutes. So, if you have any questions, please feel free to pop them in now.

Belinda: Any feedback? I think the important thing to note is we have been really trying to respond to everyone's feedback. So, we have got some questions about certificates of attendance and then we've been able to go back and make those adjustments. We can't promise we'll meet all your needs, but when you do give us that feedback, we do try and implement it for a better experience for everyone here.

Toolbox 2: Best Practice in the Management of Children’s Medical Conditions in Outside School Hours Care- Partnerships with Families with Regards to Medical Conditions

Vanessa Taylor: Hi, I'm Vanessa Taylor from Erskineville OSHC. We are talking today about partnerships with families regarding children's medical conditions.

Question: How are partnerships formed at your service?

Vanessa: Our partnership starts from as early as the enrolment process. When there are families joining our service, we ask them to complete an enrolment form, and on there it does ask questions as far as, does your child have a medical condition or any other requirements? Then we ask them out for the orientation process. During this process, we take them through our medical policies and procedures. We also build that open communication and really work on building those positive relationships, so they feel comfortable even before their child starts attending the service.

Question: How do you support new families to understand the medical conditions policies and procedures?

Vanessa: When the families come out for that orientation process, we take them through our policies and procedures and show them examples of how they are followed in the service. We also do follow-ups with calls and emails. We encourage them to come out prior to meetings so we can go through the risk minimisation plan regarding their medical management plans. We have also created an Excel spreadsheet for due dates. Families will be notified 3 months prior to their medication expiring, or plans expiring, and then there's another phone call one month prior to say that day is coming up, and to ensure that we've got all those on site.

Question: For children with significant or multiple medical conditions, what practices do you put in place?

Vanessa: For those children, we check in regularly with the family because, with these conditions as well, things can change as far as strategies or practices for them. Ensuring we've got that open communication with the families. Also with their permission, we check in with that child's school teacher and any other medical professionals. This helps us work together as a team and ensure we've got the same outcomes for that child. At Erskineville, we also print off a photo with the child's medical condition, and that's displayed on the days that child comes. Therefore, it's not only permanent educators that are aware of these medical conditions, but also casuals.

Question: Share how you identify and address potential opportunities and obstacles in communication styles with families

Vanessa: First and foremost, we need to see families as the experts of their child or children, we need to have that open communication from early on. As early as the enrolment process as stated before, and the orientation process and setting those expectations, what is that going to look like for this family to ensure this child succeeds and we've got their wellbeing at heart? We also need to make sure we meet families on a regular basis. However, this may look different depending on the family's lifestyle, their work, and things like that. So ensuring we've got a range of communication styles for them, whether that be via email, setting up meetings, also organising times where those families can come in if they want with other professionals so we can understand the needs of the family, plus the child that's attending the service.

Meray Parsons: Recording, but it will only be Belinda and I who will be on the screen. So, if you'd like to put your camera on, you can, you don't have to. We also let everyone know that you're more than welcome to ask questions during the session. We will answer them at the end, but you don't have to wait until the end to put the questions in. Okay. I think we will get started. So, it's the third topic of toolbox 2, but topic 8 in the entire best practice series. We are looking at the best practice in management of children's medical conditions in outside of ours care. My name is Meray Parsons. I am the quality and compliance manager for Gowrie New South Wales. I work with Belinda and nominated supervisors, educators, and staff on supporting services in proactive compliance, but also working with them on embedding high quality practices throughout our outside of school hours care (OSHC) and the early years learning services. On the session with me today is Belinda. Belinda, would you like to introduce yourself?

Belinda Rouhan: Thanks, Meray. Hi, everyone. My name's Belinda Rouhan and I'm the general manager of outside of school hours care for Gowrie New South Wales. In my role, I support our OSHC teams and families, and I work closely with the OSHC managers in their daily practices within our OSHC services.

Meray: So, as mentioned, this is about partnership. This session today is about partnerships with families and the role that families play in managing medical conditions at the OSHC service. It's important at this juncture to note that this resource is developed by Gowrie New South Wales and funded by the New South Wales Regulatory Authority. And before we get started Gowrie New South Wales acknowledges our First Nations people as the Traditional Custodians of our land on waterways. We also acknowledge that continued connection to the land, sea, and traditional countries across this nation. We thank Traditional Custodians for caring for Country for thousands of generations, and we recognise this country was never relinquished by Traditional Custodians, and that their continued connection and commitment remains to Country. Gowrie New South Wales pays, respects to Elders past, present, and emerging, and all First Nations people, including those joining us today. And I'm currently joining you from the traditional lands of the Bidjigal people. I'm now going to hand over to Belinda to unpack the learning outcomes for today's session. Thanks, Belinda.

Belinda: Thanks, Meray. So today we'll cover the following. In this webinar, we are going to look at what National Regulations and National Quality Standards influence your practices in regard to medical conditions and partnerships with families. How strong collaborative partnerships with families support best practice management of medical conditions in outside school hours, care, the specific role families play in management of medical conditions, in children, tips for clear and effective communication with families. Information about an educational theory that underpins strong trusting partnerships with families. And again, if you have any questions throughout the session, please put them in the chat box and if we don't answer them in our presentation, we do have scheduled time at the end to answer any questions.

So, I want to direct everyone's attention to this quote from Helen Keller as a way to set the scene for this session, focused on building trusting partnerships with families in the service. This is especially important when we are supporting children with specific medical conditions. Families are an essential source providing practical information about their child's medical condition and its management with the child when the child is in attendance at OSHC.

So, on our next slide, we're going to change direction and unpack the laws and regulations along with the responsibilities of the roles for the management of medical conditions. And you may have noticed that a lot of these laws and regulations are, we are consistently using them across different webinars because they are all really interrelated. So, for medical management, it's National Law, section 167. We must ensure that every reasonable precaution is taken to protect children being educated and cared for by the service from harm and from any hazard likely to cause harm. This is the responsibility of the approved provider and the nominated supervisor. Regulation 90 and medical conditions policy is required. And under regulation 90 are examples of what must be included in this policy. Here, there are different responsibilities for all roles of the service, including for staff and volunteers who are responsible for implementing the policy. And National Regulation. 91, the requirement for the service to provide families with a copy of the medical conditions policy is the responsibility of the approved provider. Now, I do want to preface that there's something we always say, the standard you walk past is the standard you accept. So, it really should be the responsibility of all of us. We do have a duty of care, but under the laws and regulations, there are specified responsibilities.

Now let's look at how National Quality Standards, 6.1.1, 6.1.2, and 6.1.3, guide our practices in relation to medical conditions. If you have a pen and paper ready, I encourage you to make some notes of any action items or strengths you may feel, you feel you may have in relation to what we are to unpack. It's always handy to have these notes ready when you're going through your self-assessment tool and starting to jot down your practices. So, National Quality Standard 6.1.1, families are supported from enrolment to be involved in the service and contribute to service decisions. So here, who makes first contact with the family in your service? Is it the nominated supervisor or is it someone in an office support role such as enrolments? If it is a member of an enrolments team, are they aware of what information to collect? And do they advise the family of their obligation under National Regulations as well as your service policy? So, imagine as a parent, you have a child with severe anaphylaxis to egg, and you were enrolling in OSHC for the first time. What would you want those first interactions to be like? Now think about your current practices at your service. Is there anything you would change? I want everyone to take an opportunity to critically reflect with your team on your practices regarding the above and ask your families for their input and feedback on current practices, and then consider adjusting them accordingly. Now, you are thinking about exceeding themes for 6.1.1.

National Quality Standards, 6.1.2. So, the expertise, culture, values, and beliefs of families are respected, and families share in decision making about their child's learning and wellbeing. So, when creating the risk minimisation plan with families, do you share contextual information about your service such as your routines, environment, and practices? It's really important to remember that the family manages the child's medical condition every day and likely has done so for a number of years. They would be really attuned to the symptoms and signs of a medical incident. So, it's important to ask for their input. They might also be able to suggest further training for your team. So really recognising the family as an expert in their child when changing routines or practices, consider sharing this information with families and seeking their feedback, especially for children with medical conditions. So, you could use emails, online platforms, newsletters, and even have conversations during collection time. If you aren't currently doing this, consider how you can move forward.

And finally, National Quality Standards, 6.1.3. Current information is available to families about the service and relevant community services and resources to support parenting family wellbeing. So, what systems do you have in place to provide parents advanced notice of when they will need to provide a new medical management plan or when medication is about to expire? We are going to cover some strategies later in this presentation. And how do we ensure we have received up-to-date and accurate information from families, including the most up-to-date action plan or medication before its expiry date?

Now moving on from the National Quality Framework, we're going to look at the family partnership model and how you can use this in this approach when engaging with families. So, the part family partnership model was devised in the UK in the 1980s by Hilton Davis and his colleagues at the Centre for Parent and Child Support. It is an evidence-based approach to working with families that involves building parents' capacity to utilise their own resources and establish methods for adapting to and managing problems in the long term. It's engaging parents and developing a relationship with them that is supportive in and of itself, and understanding families in a holistic way, hearing the whole story, seeing the full picture, knowing their main worries and learning their strengths, as the name suggests, at the heart of the family partnership model, is a partnership between professionals and families characterised by shared expertise and active collaboration to achieve, to achieve shared meaningful outcomes. I'm going to hand it over to Meray now to talk to you through the different aspects of this model.

Meray: Thanks, Belinda. So, when we apply the family partnerships model to our practices, we are managing medical conditions we look through, we look through this lens as one that sees the diverse knowledge and perspectives that parents bring about their children. So, I will just mention here that obviously the family partnerships model, we're talking about this here with relation to medical conditions. But of course, if we think about this family partnerships model, it will apply across all different areas of your practices and your service across all different quality areas. And it's really starting to think about that exceeding theme 3 meaningful engagement with families. So, it, there's crossover here, but we are looking at this from a medical conditions’ perspective, obviously being toolbox 2 toolbox 2. So, the family as mentioned, the family partnerships model is well established. It's evidence based and it is a good approach to use when working with families. This model, and other effective partnership practice models, are characterised by families and professionals actively working together and taking a strengths-based approach to working with families, parents, and professionals both influence decision making through open communication, shared decision making, and a willingness to negotiate and compromise. Parents and professionals will also value and use each other's strengths, skills, and knowledge. So going back to Belinda's point about families being the expert in managing their child's medical condition. Parents and professionals agree upon goals and desired outcomes and strategies to achieve them, and then focus on building the capacity for families to utilise their own resources and strengths, if that's applicable. It also includes families and professionals negotiating when disagreement and conflict occur. So, when there is a difference of opinion how do they, how do we resolve that? That's part of that partnership model as well. So, in part, as when we are thinking about this partnership model, it's about having this openness to the views and the values and experiences of others. It doesn't always necessarily mean we agree on it, but how do we resolve those disagreements?

So, what does this partnership look like in practice? So, we can talk about this theory or this partnership model, but what does it actually look like? What does it mean when we are talking about this with relation to medical conditions? And what are some of the practical attributes that might happen? We have spoken about this a lot. Enrolment is one of the most crucial, crucial times for establishing those trust, trusting relationships with new families. But it is also a good time to set those expectations as well. This may be our first or second point of contact. So, it could be the enrolments team, and then the service could be the service first. Just depending on what that, that process is at your organisation. It's important at this time that we ask families if there are obviously any medical conditions and explain to them how we support children so that families feel comfortable sharing this information as, as early as possible to support a child with a diagnosed medical condition. Use the time of enrolment to give them the information. So, provide them with the medical conditions policy. And that's based on regulation 91, gathering information about the child's medical condition. Obviously following enrolment and confirmation of enrolment, we need to complete the required risk assessments as well as really show how the, what are the risks, risks that we can identify at the service, but how these will be mitigated for that specific child's medical situation. Is there an opportunity here to ask for further training from, for our team and o obviously there may be opportunities for funding through inclusion support if necessary. This information is communicated, we've talked about this a fair bit, but through the risk minimisation plan, which is really developed with the family's input, we need to ask for the risk for the medical management plan as well. And this needs to be provided enrolment often at the point of enrolment, it's a really good time to walk through this tour of the service. So, it could be at enrolment or orientation, and show how we implement the policies in the context. So, show families, for example, where we store the medication, how we ensure educators might be across this information through their sign on or their folders that we, we mentioned before. And this can really help build a level of trust with families because they can see that you have the right procedures in place, but it also is a good opportunity to assess whether the procedures you do have in place can improve for that, specific child, or do we need to adjust it better to support their individual child's needs and circumstances.

We have talked about risk minimisation plans a lot, but they are really important tools to help support management of the child's medical condition when in the o setting. And when creating those risk minimisations plans, it's really important. The first step should be gathering the information from families regarding that condition and that management. It's then the service or the nominated supervisor or educators who are talking to who are responsible for the risk of minimisation. Plan to assess your service environment and routines for risks and exposure points. Think about high-risk activities, staffing considerations. Does your service do lots of cooking? And is the potential risk a food allergen? So have a look at those experiences. It might not just be your menu, but it could be your cooking experiences. It could be your art resource. We mentioned in one of the first sessions we did about medical conditions that it might not be the obvious things that you need to tweak. Sometimes you might look at the ingredients that you're using as part of the paints that you use might have ingredients as well. And at that stage, what are the practices you're going to put in place so that all staff are aware of children with medical conditions when they are on a shift at your service. So going back to the responsibilities under the law, it is the nominated supervisor's responsibility and the approved provider's responsibility to ensure this documentation is current. Likewise, risk minimisation plans, and communication plans go hand in hand.

So, at Gowrie, they're 2 separate pieces of information, but we have them on one double-sided document so that they are always together. And it's important that we have this practical information to document the risk minimisations. And we then use the communication plan as a tool to track that communication processes. Not only does the communication plan outline how the surface will communicate with families and staff, but also how families and parents communicate to the service about any changes to their child's medical management plan and their risk minimisation plan. And then how does communication happen? So, for some families it will be through email. For some families it will be a meeting between the service and the family. For some families it will be at drop off and pick up. So, it's important to track this communication about the medical condition and then also subsequently to how do we communicate about medication. So, some children may take their medication from, with them from home to school, and then to OSHC, how do we manage these transitions? We had a question yesterday, I think it was, or the day before about a child having their asthma puffer in their bag. And that might be okay, but we have to remember that there are other children who might also have access to that medication. So, we think about the broader context of your service and think about, well, that might be okay because we've got a self-administration authority from the family, we have the risk minimisations in place, and we've got, we've done the risk assessment, but then what happens for the other children's access to that? So how is all of this documented especially if medication is provided by the school. And then how do we know about that and how does that play into that child's management of that medical condition?

So, we've talked a little bit about obviously, the practical sides of these partnerships with families and how they can really be implemented in a practical sense. But we are going to think about important elements and tips for effective communication. So, we're going to look at some guidelines for communication negotiation. And as I share the following tips for communication and examples of how this might look like, take a moment to reflect and consider what examples could be suitable for you, for your context.

So empathetic responding, the more personal and engaging the conversation is, the more effective it'll be. So, there's a quote here that I'm going to tell you, people don't care how much you know until they know how much you care. So, it's really important to think about that when you approach a family. And when we communicate with an empathetic and caring nature, good things can happen. Empathetic communication displays a level of authenticity and transparency that is not really present when we try to communicate behind an ego. So, when we respond with empathy in our communication, we mirror and, to some extent, what we think the other person is saying and thinking without assumption. For example, a family sharing information about their child's medical condition may be worried if this is the child's first time in care. We can reflect this by saying how much we understand how this could be a worrying situation, but that the service has all these measures in place to adequately care for their child. Ensure also that empathy is not confused with sympathy. So, sympathy is the harmony in feeling and sharing feelings with others. So, sharing those tastes and sharing in the, that worry, sharing in the sorrow, empathy is actually identifying those feelings and thoughts or attitudes. It doesn't necessarily mean we have to replicate that feeling ourselves, but we can identify and appreciate that feeling and it's about that ability to understand thoughts, feelings, or emotions of somebody else. But we don't have to have those same thoughts. So, if the family is really worried, we can identify that, we can appreciate that, but we don't have to be worried if we have those measures in place and we can explain that to families and provide them with that reassurance.

So being specific with questioning. Now as I mentioned, we are talking about this in the context of medical conditions, but I am really encouraging you to think about these tips across all different aspects of your service. This could be about talking about a child's supporting children's behaviour. It could be talking about staffing arrangements, for example, and changing staffing arrangements. But for this session, we are going to really try to link these back to medical management and how do we utilise medical, these tips for medical management. So when we are specific with our questions, we then are able to communicate at clarity, so we can recognise that there are many different communication styles and even with our sessions we've been presenting, Belinda has a communication style and I have a communication style, but we, when we use questions specific questions, we can be very clear and be specific. And when we are specific, we can ensure that we meet the communication needs a var of a variety of people. So be simple and concise rather than too complicated. Make your questions count and use appropriate and open questions to allow the other person to speak freely and openly about the situation you're discussing. Where necessary, especially when it is about medical conditions, you can use some time sensitive words to be clear. So, on Monday, we really need the management plan before Monday or before 4:30 today, and so that way families have a good understanding of what you are asking them. So, when we are thinking about communicating with families or even with colleagues, I sometimes use the framework of who, what, when, where, and how. And I answer those questions in my head so that when I'm providing that information that can be clear to the other person in relation to medical management and man medical conditions and managing those medical conditions, open-ended questions could go could look, what would you like to see happen in this scenario, for example, that can then provide us with information about what families', ex expectations are about managing their child's medical condition.

A really great one here is active listening. So, it's knowing when to talk, when to listen, and when to listen alone. So, broadcasting a message over a PA system will not have the same result as engaging obviously in a meaningful conversation. You are showing that you understand the greatest discourse or communication takes place within a conversation rather than a lecture or a monologue. So hence, while we ask you to give us these questions during the session, obviously some things are going to communication with families are going to be more effective if they're as part of that conversation. And active listening involves being receptive to what the other person is saying and showing through that your body language that you are listening, and you are attentive, for example. You will be focused on what the other person is saying looking interested and if culturally appropriate, making eye contact with that person, you might ask questions such, can you clarify that for me? Do you have any examples and are there other ideas that you have that we could implement? So, by asking those questions, it really then does indicate that you have been actively listening to a family or a parent who's talking telling you about their medical management plan.

And a really great tool is summarising, it's an important strategy for communication, especially if you've covered something like medical conditions that can be really complex. And you've covered lots of different aspects of this. I would use summarising statements to pull everything together to ensure that you understand what the other person has said. So, an example could be, you've told me this is the best way to manage Toby's symptoms if they occur, as well as some thoughts on how we can help your child be calm in this situation. This is what I've understood from our conversation and just giving a really rounding out that conversation so that nothing is lost in, in that.

And so, it's important that we, you, are speaking to families and as part of our role as professionals, that we are informed and that we do know what we're talking about. So, at this point, you might need to develop a technical command or competence over the subject that you're talking about. So doing some research or upskilling your knowledge, especially when it comes to a medical condition. So having a look at the Education and Care National Regulations and other legislation is really important. As I mentioned before, good communicators can really address the ‘what’ and the ‘how’ of the message we're trying to convey so that people that we're talking to can understand the substance. And so, when we are competent with this, it becomes it relates to our professional ethics as well as the skills behold to, to really have the knowledge to bring to our roles as professionals. So, having this information and knowing the information about why do we need this medical management plan? What is required of us knowing that it relates back to this the reg, the regulatory requirements or the section of the law that you can quote that we've provided you through those sessions, gives us a level of professionalism that we can then bring to the table when talking to families.

This is one that I always love negotiation. So effective negotiation is a skill of being able to find a way through a difference of opinion, and it's really important for partnerships. So, Fisher and Ury talk about, it's a really great text ‘Getting to Yes, Negotiating Agreement Without Giving In’. And this text really provides some key areas to consider. So, separating the person from the problem. So, if we are talking, if there is a disagreement, really thinking about what the issue that we're trying to solve is here, rather than a disagreement with the person and really focus on the interests rather than the position. So, what are we trying to get to when it comes to medical conditions? It could be something that we are trying to keep this child from being exposed to an allergen that they're anaphylactic to. That's the interest as opposed to, the family wants us to do this and we can't do that, or the different positions you might take, or we need this and the family's not cooperating, that becomes a position. But actually, the interest is that we need the medical management plan because of our regulatory requirements and keeping children safe, and then that becomes the interest. So, generating a variety of options before settling an agreement. Sometimes one of the most effective things is just to lay out what are the options that we have. So, when thinking about a medical condition, and it might have a review date, the review date might have been coming up. And your policy says that if there is a review date, that you have to have medical condition reviewed. And the family is saying, well, look, actually the doctor, the last time we saw them, the immunologist or the GP said, we don't need to come back, and I can't get in. So, what are the options here? So, having a think about what are the options, perhaps it's the service providing a letter to the doctor that then says, we can you provide us a, an updated medical condition medical management plan without the date? Option 2 is that the parent can administer the medication if it's not an emergency or that the parent that the child's condition is removed from the enrolment form. The other option is that we might think about our own policy and if that needs to change. So, having a think about what are the options here that we can think about and are any of those options possible? And so, when we are thinking about the agreement, we really want to insist that there is this objective criterion. So going back to the regulatory requirements, going back to the section of the National Law, going back to your policies, removes the person from that face-to-face interaction or that person-to-person disagreement. And it becomes about the objective data or the objective criteria.

So, it's important to remember when we are thinking about the principles of family-centred partnerships and the model we were talking about, we remember that negotiation that to negotiate in a successful way, it's important to, to really under have empathy and believe that the person has a right to a viewpoint. And even if we don't agree with that viewpoint, they still have a right to that. It's important to ask, why does this person see the situation in the way that they do and why? So, in simple terms, how can we put ourselves in their position and understand why they see it the way they see it. So, I'm going to, we've talked a little bit about those communication strategies. As I said, it, it, this relates to across all different areas of our work with children and with families. But I will now hand over to Belinda to share some more practical strategies as well as link this to ‘My Time, Our Place’ version 2. Thanks Belinda.

Belinda: Thank you Meray. So can everyone take a look at the slide here and choose one or 2 questions as a point of reflection when we unpack it in the following over the following sections. So, when we consider the strategies for negotiation, it is also important to consider the perspective of the other person. So, in this case, it would be the parents or the family, and any barriers that we might not have considered in our service or communication. So, barriers could include things such as language barriers. So here it might be important to consider the use of images to support written information, provide information in home languages, or use, utilise multilingual staff. It's about respecting different cultural lenses by developing cultural competence. Yes, we are all different, but we do share a common humanity. Family structures can also be a barrier. So, putting ourselves in a parent's shoes can be easy to judge, but often we don't know everything about their situation. And that small thing that we do might mean the world to a family. And time can even be a barrier. So, think about your parents rushing to the service to make it in time. After a long day at work, they might already be asking themselves what they are going to make for dinner or how are they going to manage the bedtime routines? So how can you approach the conversation regarding medical management so that it doesn't seem like an additional task or load at the end of a long day? Maybe you could consider sending an email and letting them know when they arrive that there is an email if they want to look at it the following day and respond or ask them when a good time is to discuss their child's medical management plan. These are all ways we can start to unpack the barriers and break them down and work together.

So, recognising on the next slide, we are going to look at 'My Time, Our Place’ version 2 and recognising just how important partnerships and relationships are within the middle childhood context. So, this is further articulated in the framework for school aged care, which might be 'My Time, Our Place’ version 2. And in statements such as the one on the slide, partnerships are based on effective communication, which builds the foundations of respecting each other's perspectives, expectations, and values, and built on the strength of each other's knowledge. Children and young people feel positive when there are strong links between these settings and outcomes and are most likely to be achieved when educators work in partnership with these contributors. So, take a moment with this statement. What does it mean for you? How could we translate this into how we approach conversations with families about their child, especially in relation to medical conditions? The framework acts as an important foundation along with the standards and elements of Quality Area 6, which will be discussed in the session, deep dive into National Quality Standards, Quality Area 2, which we will be presenting tomorrow evening if you haven't signed up already.

So now I’m going to discuss some practical strategies. So, we’ve unpacked these earlier in the webinar, but we’ve included them here in this slide. And on the next slide we’re going to show you some visual examples.

So here you can see reminders in the diary for doctor follow up as well as a spreadsheet in Excel highlighting the medication expiry dates. These are just 2 examples of how to put systems in place to manage the medication used by dates and review dates for medical management and risk minimisation plans. If you have other systems that work well for you and would like to share them, we encourage you to put these in the chat box. Also, sometimes our best resources are the people around us and services who are experiencing exactly what we are.

So as discussed please add any questions you might have to the chat box now because we are about to start question time and again at the beginning of this webinar. This session is recorded and will be provided after the series is completed as part of a resource pack. You'll also be able to access the fact sheet video vignette and critical reflection pack along with it on the Department of Education website. And we've also included a list of resources for these sessions here. You can access them for your own further learning after the session.

And finally, thank you for taking daytime out of your day to attend these sessions. We hope you found them informative and relevant. We value your feedback and encourage you to participate in the feedback survey that you will receive in your email. Further to further improve our professional learning, we also encourage you to share any feedback or questions you may have in the chat box so we can answer them. Now, we understand that you have somewhere to be. The session is finished, so you are welcome to stay for questions. However, you can also leave if you need to get ready to prepare for the afternoon session. And a final reminder that if you would like to participate in the focus group on Monday morning, please keep an eye out for an email in the yesterday afternoon or following this webinar with a link to the Zoom session. We really hope to see you there as these sessions inform future projects and training initiatives for both Gowrie New South Wales and the Department of Education. And there is not often too much OSHC specific training made available in the sector. So, it would be great to get your feedback and advocate for more. And also, as we will be critically reflecting on changes to practices, you could use this session to inform your self-assessment tool and link to exceeding themes 2 and 3.

Meray: Thanks Belinda. We don't have any chat questions in the chat at the moment, but we do have one around do we have a communication plan on what that looks like? I can probably stop sharing and pull an example of Gowrie's communication plan from yesterday. It's really dependent on the service, right? So how, what that communication looks like. I will, I will bring one up that we could share. Just give me a second. And that was in, I think, yesterday's session where we had it on the screen. We aren't sharing the document itself, but I'm sure that you can, you'll be able to get an idea of what yours could look like as well.

Belinda: And I think as Meray said, it's really important that it's contextual to your service and it takes into consideration your service policy as well. So, you can, have a look at Gowrie’s and what we use here, and then you can look into your own service policy and then how you might use some of our information with your service policy and information about your service as well. And I think that's probably a key reason why we haven't shared our communication plans and risk minimisation plans with you all as part of our resource pack. Because we don't want to give you something and then your service policy requires something else. So, they are contextual to Gowrie New South Wales. Does anyone else have any questions while we wait? Any feedback?

Belinda: So, I can see Julia's developed an Excel spreadsheet, which she's great. One of our program managers, our OSHC program managers is our wizard Excel, and I don’t know how he does it, but he has a spreadsheet that he's created as well for all the teams, and it even has like the countdown. So, he'll put the date in when it's due and it starts counting down for him the number of days. And then as it reduces in days, it kind of changes colour to, green, amber red. So that's really helpful. And he shared that with a number of our program managers who then utilise it and included it in there they included it in their self-assessment tool now as a strength.

Meray: For anyone else on the chat that just wanted to see, the risk minimisation plan Gowrie uses basically has all the information at the top here about the child, their condition. It might be multiple conditions as well. The date that this is created and when it's been reviewed, we reviewed these documents annually, if not more often, so at a minimum annually, but also if there's been an incident, what the allergens are, what the potential times for exposures are, and then the strategies to reduce, that's the, that's the risk minimisation plan. Now, if you, we then look at the communication plan we shared, this is the communication plan we have adopted. So similar to what there was one in the chat, the screenshot of one in the chat, similar to that. It's got actions to be completed by the service, actions to be completed by the family. And that these things have been checked. And it stipulates, for example, the nominated supervisor will communicate with communicate with the cook about the child's medical condition. But the family has been obviously consulted actions to be completed by the family that they, they consult with the medical the risk minimisation plan. So that's an example. I'm happy for you guys to take a screenshot, but we aren't providing them necessarily at this point. Hopefully that's, but like I said, it's probably very similar to Julia. I think Julia, you have a bit more detail there as well and about who and when. It's about really understanding who's going to be communicating what they need to communicate and what needs to, how that process needs to happen. Any other questions at this stage? Guys? I can see there's a few more people left. As Belinda mentioned if you have more questions, you're more than welcome to ask them at this stage. Otherwise, we, if you need to go, you're ready for the day, you're more than welcome to do that too.

Belinda: I think someone asked if we have the standard ACECQA medical risk minimisation and communication templates. I don't think I actually have templates on ACECQA so it's something that perhaps we can all advocate for because I understand can be challenging, especially when you are in a small service, and you are the nominated supervisor who's developing all the policies and you are the coordinator as well.

Meray: Oh, thanks Kylie for just showing your examples that you've created for putting those things in place. ACECQA has a good risk assessment, but not the risk minimisation plans and communication plans. But this is a really great system, Kylie, so thanks so much for sharing. It's really great when people are sharing because I think, why start from, why start, and wonder if it's going to work if someone's already tried and tested it.

Belinda: Absolutely. Does anyone have any questions about the Monday session? We're running the focus group or is anyone interested in attending? You may have signed up already or are thinking about signing up. We're really excited. I think about the upcoming focus group as well.

Meray: So, Kelly has added in some software programs. You can set an expire date. Yes, I think in Xplor you can, I'm pretty sure in OWNA and in Storypark manage you can do that. We also utilise a system called 1Place and that can be added. The systems there. I haven't heard, so that's fantastic. Thanks, Kelly, for sharing. This has been,

Belinda: And if you don't have any more questions, you are welcome to go to your afternoon session, these are recorded.

Meray: I know some of our services also have, so they've got the spreadsheet, but they've also got them just printed, literally just near their computer. Like I think Kylie's one there. And for me, I'm a visual person. Unless the system nags me every day, sometimes I'm very easily silent silence an alarm, but having it in front of me is a fantastic way to do it. There's also Folio we also use Folio that gives us those reminders too. So, there's lots of systems and I think when we talk about Quality Area 2, 6 and 7 tomorrow, we'll, we'll talk about them in a little bit more detail as well. Thanks everyone for joining. We will be pausing the recording and logging everyone out. I don't think there's too many more questions.

Toolbox 2: Best Practice in the Management of Children’s Medical Conditions in Outside School Hours Care- Deep Dive into the National Quality Standards: Quality Areas 2 and 7

Meray Parsons: Hi, my name is Meray Parsons. I'm the quality and compliance manager at Gowrie New South Wales. Today, I'm going to be talking to you a little bit about how Quality Area 2, children's health and safety, interplays with Quality Area 7 and Quality Area 6.

Question: Why are family relationships important when thinking about Quality Area 2?

Meray: So, when thinking about Quality Area 2 and children's healthcare needs, whether it be the incident response to a medical condition or children's wellbeing in general, we recognise that families are the experts in their child's healthcare needs. So when we establish really open reciprocal partnerships with families that are positive and there's two-way communication, we are really able to enhance the outcomes for children when it comes to their healthcare needs.

Question: Can you provide an example of how family partnerships can impact the delivery of standard 2.2?

Meray: An example of how open collaborative partnerships can work really well in a service is through the risk minimisation and communication plan. So those two procedures that we implement as part of a child's medical management plan are collaborated on with the family and families can let us know what those triggers are in advance and what to do in those circumstances, but also how to communicate with the family. Families also can then provide us with additional resources around training, so a child that I've worked with in the past had a nasogastric tube and we had their health practitioner come out and provide training to the staff. So when we've established those partnerships with families, ultimately that reciprocal communication and information sharing becomes really critical, and it eventually improves the outcomes for children and enhances those outcomes for those children in our service.

Question: How do leadership and governance enhance the delivery of children’s medical management?

Meray: When we are talking about children's medical management plans and Quality Area 7 there are two things to think about, the first one being roles and responsibilities. So when we do have children with medical conditions, we have to each delegate in the team at the service who is responsible for updating risk minimisation, who is responsible for making sure the medication is always kept in date. Those dates don't always align, so there has to be really clear roles and responsibilities across those people in the service. What's the role of the nominated supervisor in communicating with the school and what's the role of educators when a family member passes information on at drop off or pick up in the afternoons? So really having clear established roles and responsibilities will enhance the response to that medical management plan. And also, thinking about systems and how systems can help us with that. So with medical management plans or medication or the review of risk minimisation, do we have a calendar system set up? Do we invite families into meetings one month before the expiry of the medical management plan? Do we use things like reminders and meeting invites to really keep us accountable and keep things in check?

Meray Parsons: A snack or some tea we are expecting probably. So, a fair few people have registered. We understand sometimes there's a drop off, but there are a few more people that might be jumping on. What we'll do is give everyone a minute longer, so probably 6:18 and we'll get started. Today's session is a little shorter than others. But obviously that just gives us more time for questions. So, if we do finish up about 6:45, 6:50 don't be too surprised, obviously there's questions as well, and we can go through those.

Belinda Rouhan: As always, feel free to pop your questions in the chat box throughout the session. And if you do have a pen and paper, I suggest you keep it handy. There are some practical strategies, or you might jot down some ideas or from the reflective conversations, you might even have some further things to take back to your service and discuss with your team.

Meray: Another point and we'll talk about this more so on the slides that relate but we are looking at a deep dive in Quality Area 2, 6 and 7. And so, if you have your self-assessment whether it's through your notes that Belinda just mentioned, or you want to have your self-assessment up and you can type straight into it we will talk about some examples and key practices that you can add to as examples. And so, these are things that you might think, actually we already do that. Let's pop that in as a key practice. Or you might think, actually we want to do that. So, we can add that to the quip part of your self-assessment if you are using the self-assessment. Otherwise, you can pop it into the key practices in your strength section or use the quip the main quip if you're still using Quip. So just to give everyone a bit of a heads up on that, we will get started. So, welcome everyone. Today is topic 9. It is a deep dive into Quality Areas 2, 6 and 7 in relation to medical conditions. This is the fourth session for toolbox 2 of the OSHC Best Practice series. My name is Meray Parsons. I'm the quality and compliance manager for Gowrie New South Wales. I work with nominated supervisors and educators and staff on supporting services in proactive compliance and working on embedding high quality practices throughout both our outside of school hours care (OSHC) services and our early education services. With me today is Belinda. Belinda, would you like to introduce yourself?

Belinda: Thanks, Meray. My name is Belinda Rouhan and I'm the general manager of outside of school hours care for Gowrie New South Wales. I support our OSHC teams and families and work closely with the OSHC managers in their daily practices within our services.

Meray: So, as we mentioned, this is the fourth topic of toolbox 2. It's session number 9 in total. So, we obviously did toolbox one was around supervision, and today we're going to unpack Quality Areas 2, 6, and 7 in relation to medical conditions. At this point, I'd like to note that this resource has been developed by Gowrie New South Wales and is funded by the New South Wales Regulatory Authority. And before we get started, I'd like to acknowledge our First Nations people as the Traditional Custodians of our land and waterways. I would also like to acknowledge the continued connection to the land, sea, and traditional countries across this nation. We thank Traditional Custodians for caring for Country for thousands of generations, and we recognise this country was never relinquished by Traditional Custodians, and that their continued connection and commitment remains to Country. Gowrie New South Wales pays respects to Elders past, present, and emerging, and all First Nations people, including those joining us today. I'm currently joining you from the traditional lands of the Bidjigal people, and Belinda will take us through the learning objectives for today's session.

Belinda: Thanks, Meray. So in this webinar, we will be covering an overview of the National Quality Framework including the why, an introduction to the standards, elements and concepts of Quality Areas 2, 6, and 7 that relate to management of medical conditions in OSHC tools for critical reflection to support understandings about these 3 Quality Areas and where to find further resources for ongoing knowledge and learning.

So, before we begin to unpack the 3 key areas of the National Quality Standard that relate to the management of medical conditions, we are first going to briefly revisit what the National Quality Framework is and how it came about. So, this is a really important starting point, and I don't think we do this enough. So, to begin with, the National Quality Framework came about as a result of an agreement between all Australian governments to work together to provide better educational and developmental outcomes for children. It was first introduced in 2012 and the National Quality Framework provided a new standard focused on improving quality in education and care across long daycare, family, daycare, preschool, Kindergarten, and outside school hours care services. After review in 2019, there have been a number of suggested changes, some of which will come into effect later this year. And we have covered in earlier webinars and some such as a change to transporting children already have, which we covered in the second webinar. Toolbox 2, topic one.

So on this slide, you may be familiar with this image and have seen it before. It's helpful to see where all the components of the National Quality Framework fit together. And we must remember that the overarching aim of the National Quality Framework is to raise quality and drive continuous improvement and consistency in children's education and care services through the key components of the NQF. So, as you can see on this slide, these components of the National Law and National Regulations, which we've covered in great detail in our sessions, the National Quality Standard, the assessment and quality rating process, and national approved learning frameworks of which OSHC services use ‘My Time, Our Place.’ Now again, in these webinars, we have referred to the recently updated my Timeout place, version 2. There is a regulatory authority in each state and territory responsible for the approval, monitoring and quality assessment of services in their date or territory. And there is also a national body, ACECQA, which guides the implementation of the NQF and works with regulatory authorities.

So on the next page, which discuss the key objectives of the NQF, these key objectives are to ensure the safety, health, and wellbeing of children attending education and care services, improve the educational and developmental outcomes for children attending education and care services, promote continuous improvement in the provision of quality education and care services, establish a system of national integration and shared responsibility between participating jurisdictions and the Commonwealth in the administration of the National Quality Framework, improve public knowledge and access to information about the quality of education and care services, and reduce the regulatory and administrative burden for education and care services by enabling information to be shared between participating jurisdictions and the commonwealth. So that's a bit of a background about the National Quality Framework.

Now today in this webinar, we are going to shine a spotlight on the National Quality Standards and specifically deep dive into Quality Areas 2, 6, and 7. So, our aim is to support you to develop an understanding of the relationship between these 3 areas of practice and how they influence the management of medical conditions. So, I'm now going to hand over to Meray to unpack Quality Area 2 with you.

Meray: Thanks, Belinda. So as Belinda mentioned, we are talking about Quality Areas 2, 6 and 7, and so many of you will be very familiar with these Quality Areas. We're using them regularly. I think what we found really helpful when we talk to our teams is we talk about the regulatory requirements and the National Law quite extensively, which we, we have in these topics. And then we look at some of these then, the National Quality Standards as guideposts for how we can then continue to build and improve practices. I would say Billy, I'm sure you'd agree, the guide to the National Quality Framework is the best resource to give you examples and scenarios of how those National Laws and the National Regulations are put into practice. But also, we will talk a little bit about what an authorised officer might ask when either visiting a service for a monitoring visit, visiting a service after an incident has occurred, or a complaint or visiting a service as part of as assessment rating. So, we start to use the language and that really helps services, and we know that it helps our teams not be so nervous and, and, and really be confident in that they are the experts in their service as well.

So, for Quality Area 2 will shine a spotlight on the elements. You can see here the image shows how these elements fit into the bigger picture. The standards are high level outcome statements that support the implementation of the quality area. So, you can see here, standard 2.1, looks at health and standard 2.2 looks at safety. And then within those standards we have the elements. When we are looking at the image on the slide here, obviously there's a lot of, 2.1.1, 2.1.2. That's sometimes that can really get confusing <laugh> because there are a lot of differences, there are 40 elements. So you do have to think about that. But when you're looking at that column that says concepts, these are really fantastic signpost words that really help educators and services navigate and reflect on what this element actually means. So obviously health is a really broad topic. You can see that for standard 2.1 health is the main topic. And then underneath health we've got wellbeing. And we've got the different elements and the concepts are fantastic because they really summarise what that is. The elements that will focus on today are going to be 2.1.2. So, health practices and procedures at 2.1.3, a healthy lifestyle, 2.2.1 and 2.2.2. So, you can see here that healthy practices and procedures are obviously important as they relate very closely to medical conditions. Healthy lifestyle is also very relating quite heavily because we are talking about things like healthy eating and safe food supervision. Obviously, we can't think about medical management without thinking about supervision and ensuring that we have a good understanding of that supervision. And then obviously those things can prevent an incident, but when an incident happens, how do we then manage that incident and the, and the emergency management around that. So as a bit of an activity at this point, if you've got a pen and paper, if you would like to pop it in the chat box, we are going to ask you to think about any of these elements or you can relate it to a standard. It doesn't have to be at element level. You can think about the broad standard and provide an example of how of a high-quality practice that relates to any of those elements and standards. And obviously bonus points if you can talk about that high quality practice in the lens of the exceeding themes.

So if everyone wants to, I know we've had fantastic engagement in the chat box to date, so I'm hoping everyone's not too tired, but if you can pop some examples of high quality practices that relate to any of the standards and elements in the chat, we'll give everyone a couple, probably half a minute to put them in. And I would encourage you guys to go in and have a look. And the reason we're doing this is we found that when we are sharing together, people are, are getting a lot out of it and we're getting a lot out of it because we can see where the interest and the professional development interest is and where the need is. So, if I haven't seen anyone pop anything yet, I'm going to give everyone probably about 30 seconds, just any example. So, something could be that we have a meeting with families before they start as part of the orientation and we coincide, coincided with the school orientation. It could be that children help develop their own risk minimisation plans after we've also developed it with educators. So, children have input to the, to the risk minimisation plans for medical conditions. We've got Natalie, thank you, Natalie, for the first bonus points for you around a critical reflection on supervision plans and all procedures on a regular basis. So, fantastic. When we do have an incident, a really great thing that we do at Gowrie is we have a debrief after the incident and exactly that, Natalie, they have a bit of a critical reflection on the root cause. What was then, the matter at hand that occurred, what was, sometimes we call it a single point of failure, what was the single or, or maybe there were more one that, maybe there were multiple systemic issues. So, I would encourage if you wanted to if you're not comfortable putting it in the chat, you're more than welcome to just write these things down. And then what we can do is use that in your self-assessment. So, we're trying to have you guys spend 45 to an hour with us, but then walk away with a little bit more information, but also a little bit of information to pop into your self-assessment too,

Belinda: And it might be practices that you are already doing at your service, or maybe you are considering implementing as a flow on effect from attending some of these sessions as well. So, it might be something that you are documenting that you want to maybe start doing that you haven't yet. Feel free to add those as well.

Meray: I'll keep going, but please don't feel that if you want to add something and you know that we can definitely keep putting them in. And it's around sharing information. So, thank you Natalie, for doing that, for being the first one at this stage. And, but we will keep going. So, what we did here, this is a word cloud that's been created with some commonly used words within standard 2.1. So, using it here to unpack some of the key terminology that you'll often find and in essence standard 2.1 is about recognising that children's health needs will change over time and they as they develop and grow. So, part of this is obviously working together with families, and we can see here the really strong link with Quality Area 6 is starting to come through. And obviously not just families, but we are relevant. We also work with health professionals. So standard 2.1 also notes that we must have effective processes in place to support all aspects of children's health. And this is especially pertinent in our discussion around the management of medical conditions. So, there might be some words here that really stand out for what might those words be. And have a think about what some of these things that are, are really talking to you about your practices in the service that they are at. So with a word cloud like this, it's interesting because the bigger the word is, the more often it's been used in the text that's been used for the word cloud. So I can just see here, obviously wellbeing, healthy physical health requirements seem to really jump out at me.

Okay, so we're going to now unpack the elements of Quality Area 2. So the first one being element 2.1.2. And so there are several direct connections to the practices in place for management of children's medical conditions. If you are in you find yourself in during an assessment rating or during a service visit by the Regulatory Authority the authorised officer may ask you some of the questions on the slide. So maybe think about how do you observe and recognise and respond to children's signs of medical conditions? How do we record and share this information and what practices are in place for communicating information about a child's individual health requirements for all staff? So, as you can see here, there are some questions that you might think. Actually, these questions, we've, we've covered this in previous sessions, but it doesn't always necessarily ask about a risk minimisation plan or a communication plan. Sometimes the questions are a bit more open ended and sometimes we have to be able to make the links ourselves as well. So for example, what practices are in place for communicating information about a child's individual health requirements to all staff that would be documented in your communication plan that you would have for each child. Obviously there might be other things that you might want to talk about as well, but some, but what I do find is when we are looking at the elements and unpacking those elements, looking at what the questions are that the authorised officers might ask aren't necessarily the exact words of what the requirements are from the regulations. So have a think about those examples there. And do you communicate information about the children in individual health needs with the school? So, this is starting to go more and more into Quality Area 2 overlapping with Quality Area 6 and think about medical and medical management plan where medication is listed but not required to be administered by the service. So, there might be really important reasons for this, why we do still need that medical management plan. It could be that if a child has an escalation of that medical condition, that the paramedics or the medical staff that need to treat that child need to know what medication they're on in case there is a contradiction with another medication. It could be that the, we've talked about this a little bit as well in previous sessions. Children need to have their insulin administered, but it will happen straight after lunch or an hour after lunch. So, it's going to be administered, but it will not be administered during the OSHC service timeframe. But we still need to know that because we need to know if that child then a has a hypo, what has happened, did they get their medication, do we know that they had their insulin medication, et cetera, et cetera. So, there are some reasons for that as well.

And in terms of unpacking this further for 2.1.3, regulation 90 has really direct connections with Quality Area 2 and 7. And within this, this element, you might have some different questions that the authorised offices might ask. So how does the service communicate about the children's requirements too, to other staff? How is information about a child's individual health need kept confidential? So, this is an important question because we did, we did talk a little bit about medical management plans being on display. Some services don't have an office might not have a space where only staff utilise. It could be a desk area within the OSHC hub we have some of our services that have the office set up is within the sports equipment area. So how do we make sure that when we are not using that space, we're not having children's confidential information on display? So have a think about negotiating those procedures as well with the school and with, with what different, creative ways you can, you can get around that. And so, element 2.1.3 also references how services are able to demonstrate how do we meet the needs of children with dietary requirements. So, this is also medical condition requirements, but just general dietary requirements and do we have a policy in place? So, while the regulatory requirements state that you have to have a policy in place, that as part of the National Quality Standard and the questions that authorised officers will ask is to also double check that those things are happening. And then when we talk about Quality Area 7, it references that required policies and procedures are at the service. So of course, when we are dealing with medical conditions, that's a mandatory policy. So, you can see here we've talked about Quality Area 2, but there are very strong links with Quality Area 7 as well. So, Belinda was going to take us through the next few slides and we're going to focus on bullet area 6 too.

Belinda: Thanks, Meray. So, in terms of medical management of medical conditions, Quality Area 6 is key in emphasising the importance of collaborative relationships with families as essential in how we support and enhance children's inclusion, learning and wellbeing. Quality Area 6 requires us to see the expertise of families to identify and remove potential barriers to the provision of an inclusive learning environment that supports the wellbeing of all children and families. And I know we've talked about some practical strategies on how to do this in previous sessions.

So, within Quality Area 6, we're going to shine a light, a spotlight on the following elements. So, 6.1.1, which is enrolments 6.1.2, respecting parents' views, 6.1.3 families being supported, 6.2.1 transitions and 6.2.2 access and participation. And again, the image on the slide shows how these fit into the bigger picture of this quality area. We're going to look at these elements through some reflective questions that relate to management of medical conditions. But first, let us look at the standards. So, as Meray referenced earlier, the standards are high-level outcome statements supporting the implementation of this quality area. Elements underpin the standards and are the elements of a quality area. So, the things that make it up, the elements describe the outcomes that contribute to the standard being achieved, and they break down the high-level concept so that we can focus on specific aspects of practice. So again, looking at the slide here parents' views are respected is, focusing on practices there compared to focusing on practices of transitions, which is 6.2.1. The key concepts for this Quality Area are listed on the slide.

So, you can see in the under the concept it's got the key concepts written there. The concepts are a tool to support services to unpack ideas related to these specific standards and elements. The concepts are like the signpost words, as Meray said, to support services to navigate and reflect on the National Quality Standard. And you can also see listed on the side of this slide how the management of medical conditions and Quality Area 6 interplay. So, we are asking you to reflect on your current practices in relation to these. So, take a moment, think about what you're doing at your service currently, which is, like our quality practice, maybe from information from a previous webinar that you'd like to include as an area to focus on to embed a new practice. We if you look at the guide to the National Quality Framework as well, and I just want to remind everyone if not aware, it actually has a section at the end of each standard which focuses on exceeding things. And it has a number of questions to guide your reflections. And I think something we talk about a lot at a Gowrie is about when our teams write their self-assessment, they really focus on things that can be just the regulatory requirements when really a lot of their practices are exceeding. But sometimes, our own exceeding things in our services, we just see as normal practice. So, to be able to unpack, unpack and differentiate between an exceeding practice and a standard practice we do, I do encourage you to reference the guide to the National Quality Framework and also the questions under the exceeding themes to guide your reflections. So an example of this would be under exceeding theme 2 for Quality Area 6, it asks what how our practices are informed or how our critical reflections are informed by current recognised guidance on supporting relationships with families. Now, if we use that as an example, and you go back to one of our earlier, one of our earlier webinars from this week, we really unpacked the family partnerships model. So if you attended this session and then you took away information from it and then you're implementing it in your practices with your families you are actually implementing, and then you do a critical reflection on how that's impacted your communication with your families, that's an exceeding theme in itself. So we are really just trying to bring this all around so everyone, tie up all those loose ends for you because sometimes it can be really overwhelming and really big but you're doing it a lot of the time anyway.

Okay, next page we're going to look at, again, a world a word cloud. This word cloud has been created with the commonly found words used within standard 6.1 and standard 6.2. Again, we are using it here as a starting point in our thinking and knowledge building for Quality Area 6. So after we finish delivering these webinars, I strongly encourage you when you have access with to them to unpack them with your teams. And it might even be, you do a 15 minute session with your service one afternoon before the afternoon session. And you really look at all the words on this world cloud, what jumps out at you and what jumps out at your team and unpack it together. You know, different things will jump out.

Meray: Sorry, Siri just jumped in there,

Belinda: Oh, <laugh>. So you can unpack it with your team. What words are important to you when thinking about your relationships with families and what words are new to you? And you might find some different words important to different members of your team. Or you might have some new educators who really have a different perspective and find some words that they're unfamiliar with. So in essence, we just explained how Quality Area 6 relates to the management of medical conditions in the way we build strong family-centred partnerships, see and draw on the expertise of families, and identify and remove potential barriers in the learning environment to focus on inclusivity and equity for all children. So in a moment we're going to unpack some of the key elements that fit within this picture of Quality Area 6 and medical management conditions in OSHC. And you can see on the next slide we've got the elements that align with the management of medical conditions in OSHC. We're going to unpack these and list some practical strategies and practices within your service. Again, feel free to take notes at this point and use them as a starting point for your self-assessment tool. And I know we're referencing this self-assessment a lot, but I think it's really important to do so considering we're doing a deep dive in the National Quality Areas.

So element 6.1.1, it’s important to establish a relationship with the family early in their experience with your program or service. Enrolment is also an important time to include any external stakeholders and consider what additional resources you may need to support the child’s inclusion in your service. So we have covered off this in an earlier webinar as well, but again, I can’t stress enough the importance of including the school, if you can, the inclusion support professionals, asking the family what other supports they have in the community, and if it is asthma or an allergy diabetes, then accessing those different foundations as well.

Element 6.1.2. So through this element, we're acknowledging that the family is the expert on their child and it's really important to acknowledge that with the family too, I think to voice that. And to welcome those in, welcome them into the conversations and make them feel like their voice is being heard. So here we put aside any assumptions and use our family-centred communication strategies, which we discussed last webinar in toolbox topic 7, to be open to what we can learn about the child, especially in relation to their specific medical condition,

6.1.3. It's important to meet with the family regularly to share updates and where appropriate, depending on the relationship. You can also include the school to ensure all stakeholders are in support of the child. Information from external agencies such as occupational therapists, Epilepsy Australia, or the Inclusion Agency is also important to share here with families to support them in their role. And I think sometimes this is something that can drop off. We can get really good at gathering the information from families in the beginning, but where are our touch points? Are they regular enough? Do we touch base just that once a year when the plans coming up for review? Or do we try and, touching regularly maybe once a term? Are there any changes? Do we have that kind of relationship with the family where they'll tell us about changes? And I know, for some of our families, we might not know they have a medical condition until the child has their first cough or something and we mention it to the families. It can happen <laugh> and it's just, you don't know what kind of experience they've had with a previous provider as well.

6.2.1. So it's important to consider how all children, but especially with respect to children with specific medical conditions, experience the transition between home and the OSHC program between OSHC and school and then school and OSHC. So consider what documented procedures and communication are in place for transitioning children to provide a better handover related to medication or an incident that has arisen in relation to the child's health and wellbeing. So again, we are referencing the communication plan, which will be important to consider as a tool

6.2.2, effective partnership support, children's access, inclusion, and participation in the program. So it's essential to work from a strengths-based perspective with the ultimate goal being for the child to have the best possible outcomes in our child, in our program. And I always, when we talk to our staff, we and especially if we have to have a tough conversation with the family, it's about reminding them that our biggest goal, our first priority is their child's safety and their child's wellbeing in our program. So we all want to come together and work together in the best way possible for the child. And when you approach it that way, you'll see families are much more open to working with you within area 6.2.2. We are actively identifying potential barriers to inclusion of the child in relation to their medical condition and through our risk assessments, ensuring that the environment and routines are adapted appropriately to facilitate the participation in an equitable and inclusive way.

And finally, 6.2.3 families will often have community members part of their support circle. Are there partnerships we can forge with the community? And what other community resources can we access to support the child's inclusion in the program? So there's a lot of questions and some practical advice there for you to digest. Now I'm going to hand back to Meray to walk you through Quality Area 7.

Meray: Thank you. Thanks Belinda. So Quality Area 7 and medical management or the management of medical conditions. So specifically we are looking at standard 7.1 here and element 7.1.2 and 7.1.3. So with Quality Area 7, it holds within at the structures or leadership and governance. And it's important to remember that when we talk about the responsibilities under the National Law and Regulations, the approved provider and the nominated supervisor have lots of responsibilities under those under those laws and regs. So then we really can start to unpack what that might look like. And so there might be effective systems procedures and processes in place to support the service to operate effectively but also ethically. And this promotes this confidence of families. So going we are trying to make as many links as possible here, but if you're thinking about Quality Area 6, if we've got really good processes in place there, effective systems and procedures and policies are up to date. And if everyone's across what policies relate to medical management then that really builds on families' confidence in the service and also within the local community. So here you can think about a school or other stakeholders that you work with, really thinking about your service as an expert in how to do these things because you have effective systems and processes. So we're going to do one more word cloud and it's Quality Area 7 of course.

So if we're playing around with this word cloud, again as a tool for reflection think about what words here stand out to you. And why, why do those things stand out to you? So when we put these the text of Quality Area 7 into the word cloud, obviously the words effective in service really, really come out, but there might be others that speak to you. So one that really speaks to me is consistent. And in terms of something that really grabs me there is, is consistent, but also the operational things. So Quality Area 7, we do look at leadership, but I also encourage you to look at the day-to-day operations of the service. Are there systems in place or do we have those single points of failure where if one person forgets something, does it completely fall apart? So is it just up to one person to remember that the Epi-Pen needs to be updated? Or do we have systems in place for reminders? Do we have calendar invites? Do multiple people have access to that information?

And so again, we are going to spotlight here on Quality Area 7, and just have a think about some of those key terms and words in, in this summary page. So as we did before, you can have a look at the concepts here and these elements are important to provide an understanding of how their relationship with medical management works in OSHC. So definitely 7.1.2 and 7.1.3. We won't do the activity for this one but I do think that, for you guys, you can absolutely use this as a team exercise where you look at the summary page of the Quality Area and think about what high quality practices you do at your service and how can you then build on that them, or do you, have you thought of something throughout these sessions, whether it be in toolbox one or toolbox 2, where you think actually we're going to implement this new quality practice, where can it link into? So some things will link very, very closely to Quality Area 2, some things might be a system that you're going to implement that might help with medical conditions, but it might be a system that can help with other forms as well. So it's a good opportunity to start to get feedback into your self-assessment from your team that then helps you build those high quality practices even further.

So for 7.1.2 we're going to talk about here what this aims to achieve. And so it's really about efficient and effective services are in place at your ser at your service. And allow you both as the nominated supervisor and the approved provider to identify and manage organ organisational risks and carry out, carry out risk assessments. So when we think about risk, it's always a good way to think about, what is it that could happen and what is it that we don't want to happen and how do we stop those things from happening? That's a really someone that once said that to me and I found that really useful to really think about what a risk assessment is essentially. In other sessions about this toolbox, we have spoken and provided information about the documentation required under regulation 90. And this is very much part of this element is having systems in place that align with this policy. So a system that to have in place is your risk minimisation plan and your communication plan. So although it is a requirement under regulation only, it is also an example of a system that fits within 7.1.2 confidentiality and adequate systems in place to manage records. This is especially important when enrolling new children. And even more important when that that child has a medical condition. So families can be sensitive to this information and some medical conditions aren't just around physical and physical health, they might be about mental health. So having a think about what how we respond to those sensitivities as well. And we must also consider how we store this information. So who has access to it and how current is it part of this? Part of the Quality Area 7 is to also understand that we do have obligations about reporting to the regulatory authority when there are operational changes or incidents and complaints. So this is the part where we have to think about being really across what our requirements are for reporting. And if there are serious incidents, how are we ensuring that they are reported documented policies and procedures. Absolutely having a think about what your policies and procedures are, are they up to date? Do educators know them? Are they maintained and are they accessible? So and accessibility doesn't just mean are they accessible, can they get them off a shelf or are they on a desktop, but are they accessible to the average person reading them? Sometimes we can make them really academic, but you want somebody who might be a trainee to be really clear with the understanding. And you also want them to be clear for families that have English as a second language or culturally and linguistically diverse communities as well.

So in terms of 7.1.3 remember that it is a legal responsibility of approved providers to ensure these systems are in place to manage risk and ensure health and safety procedures are, are implemented by the responsible people. Ultimately the responsibility does lie with the with the approved provider to meet these requirements. However, the specific health and safety measures in place are specified by the policies and procedures, however, with them specific responsibilities for roles within the, within the team. So while it is the ultimate responsibility of the approved provider (AP) when the, those policies and procedures are in place, they, they then have specific roles. So it might be that the responsible person (RP) has a specific role. It might be that the nominated supervisor has a role or that the educating team has to implement things as part of their role as well. So to have an understanding of these responsibilities, they do start to then support the effective running of a service. So as an educator, I know I'm starting my day-to-day and I'm working, as a casual or even a permanent. I know what my role is in respect to medical management and, and, and those procedures. So I know that I'm not to be serving food because I'm a new casual to the service and I don't know who is who has medical conditions just yet. So I'm just going to be supporting another educator. That might be one thing, it might not work at a service as well. It might be that you have specific responsibilities for the responsible person (RP), for example, and that's their role to ensure that children that have medical conditions have the wristband on for that day. So when you allocate those roles, you stop people from thinking somebody else is going to do it. And we've all heard, heard that saying if it's everyone's responsibility, it's nobody's responsibility and it doesn't get done. So ensuring those medical management plans are explicit and there are clear instructions for medical usage. So thinking about that, do you have 2 people signing off? Who are those 2 people? So at Gowrie when we have someone administering medication, obviously they have to have their first aid qualification and it has to be a 2 person check. And both those educators have to be signed off as an RP (responsible person). So that's what we have in place that might not work at services. Some services might not have enough RPS on a particular shift. But what are those systems you have in place?

I'm going to now give an example that I thought was really quite important here. And it's really around medication that needs to be administered outside of the service, like during the home environment or the school environment. We did mention it earlier but this has been a really big area that we wanted to focus on. So with a child that attends after school care at 3:00 PM and the child then starts to show symptoms of having hives developed on their body. And so the child develops those hives at about one o'clock. So the child doesn't attend the service until 3:00 PM, but at about one o'clock the child develops, develops these hives, and the school nurse gives the child a dosage of antihistamine at one o'clock, 1:30. So at a service, if you are the service on that school premises, what do you have in place to make sure that the school is letting you know? Because as you get to after school care at 3:00 PM and then an educator notices, actually this little boy has hives and that's one of the mild symptoms of his allergic reaction, I'm going to go and give him another dose of antihistamine. Now you wouldn't, how do we know that there has been already a dose given? So similarly that could also happen at home. So a child could be coming to before school care and has already had 4 puffs of their Ventolin puffer because they started to cough and they started to have those mild symptoms. Are we asking those questions at drop off? And, and, and obviously when we pick children up from the for after school care, do we make sure families know that that is something we do need to know so that they can communicate? And what reminders do we have in place across the year? So I'm sure we can all imagine, I don't really remember what you know, what conversations I had in January, let alone March, let alone even May. So if we are putting those reminders in place and thinking about the different communication styles we talked about yesterday, that's a really good place to start. For that example. I'm going to now hand over to Belinda to talk us through the next few slides. Thanks Belinda.

Belinda: Thanks Meray. So on this slide you can see we've included some further resources to support you. When you start to document your practices in the self-assessment tool. We strongly encourage you to access these, which will pro be provided with the webinar after the toolbox series are finalised. And you can see the NQF review has a really great risk assessment and management tool, which is helpful. And we also have some ACECQA fact sheets reporting requirements about children. And I can't stress enough how important a document the guide to the National Quality Standards is as well.

So where to next? As discussed, please add any questions you might have to the chat box. Now as we are about to start question time, and we're coming to the end of our session at the beginning of the webinar, we did mention the session is recorded and will be provided after the series is completed as part of a resource pack, you'll be able to access the video vignette and critical reflection pack along with this on the Department of Education website. And we've also included a further list of references for these sessions here. You can access these references for your own further learning after the session and we encourage you to explore these resources further when you start to document your practices in the self-assessment tool. Again, especially the guide to the National Quality Standards and ACECQA website has lots of great resources.

And finally, thank you for taking the time out of your day to attend these sessions. We hope you found this evening sessions informative and relevant and we do appreciate with the cold and the terrible weather that, it would've been a bit hard to stay back. So I'm hoping everyone's heading home soon or already at home whilst they're listening, we do value your feedback and encourage you to participate in the feedback survey that you'll receive in your email to further improve our professional learning. We also encourage you to share any feedback or questions you may have in the chat box so we can answer them. Now, if you do have somewhere to be, the session is finished.

So you are welcome to say for questions, however, we do understand that it's late and you may need to get home or have family commitments. And a final reminder that if you'd like to participate in the focus group on Monday morning, that's Monday coming. Please keep an eye out for the email, the link to the Zoom session if you haven't already done so. We really hope to see you there as these sessions inform future projects and training initiatives for both Gowrie New South Wales and the Department of Education. There is not often too much OSHC specific training made available in the sector, so it'll be great to get your feedback and advocate for more. So if you can please respond to the invite, it would be much appreciated. And also another point of interest to mention is that you can use this in this session the focus session to inform your self-assessment tool. And if you adjust your practices as a response, you can then include it as an exceeding theme because we are unpacking it as a critical reflection. So that's exceeding theme too. Thank you everyone. And we are going to open up questions. Like I said, if you don't have any questions, you are more than welcome to finish up. We do appreciate it's late, it's cold, it's rainy. Thanks everyone.

Toolbox 2: Best Practice in the Management of Children’s Medical Conditions in Outside School Hours Care- The Role of the Enrolment or Orientation Process in Ensuring Effective Management of Children’s Medical Conditions in an OSHC Service.

Belinda Rouhan: Hi, I am Belinda Rouhan, the General Manager of OSHC Programs with Gowrie NSW.

Question: Why is the enrolment process so crucial to the way we manage children’s medical conditions in OSHC?

Belinda: So, the first step is for the nominated supervisor to reach out directly to the families. Even if you have an enrolments team, it's really important for the nominated supervisor to establish that relationship at such an early stage with the families. At this point, the nominated supervisor can request any documentation they need, they can provide additional documentation, and start setting up those meetings with the families. They can also include external stakeholders. So, in a lot of situations, you might include the school. There might be an occupational therapist the family works with. You might reach out to Epilepsy Australia. And in a lot of cases, we also work closely with the Inclusion Agency.

Question: What questions need to be asked and what information needs to be gathered from families at the initial point of contact?

Belinda: So, when we first make contact with the families, it's really important that if it's a diagnosed medical condition, there's an action plan provided by the doctor. We should use this to create the risk minimisation plan and communication plan in consultation with the families. So, it absolutely should be a joint project with the families, and we should use their knowledge and expertise. Because at the end of the day, our families know their children best. They know what works for them at home and how to manage the condition. So, we should be asking questions and really guiding them on the answers we want. So, what do you do at home? What would you do in this situation? Are there any additional risks that we have not considered here? It's really important that we remember we have the laws and regulations to work with, and we're the experts in regard to that. So many of our families, when they first come to care, like to an OSHC program, they may not have had to provide this documentation before, or if they did provide it, what kind of relationship did they have? Were they providing it to the level we require? So, helping the parent understand that process, providing them with the medical management policy as well, it is actually a regulation that we do provide the medical management policy.

Question: What important practices have been integrated into the orientation between stakeholders, including parents, school and OSHC?

Belinda: I think this is something we do really well at Gowrie NSW. We definitely engage the schools through the process where possible. We want that consistency for children, so through families, home, and the school. And in a lot of situations, we might be that one point of contact that child has between the school and their home life. We also like to include other professionals where possible. We work closely with the Inclusion Agency. We do invite families if they are accessing a mental health professional, an occupational therapist, or a speech pathologist. There's so many people that impact on each child's life. We are all working together for the best outcomes for the child in our OSHC environment. So, it's really important we come and do this collaboratively and holistically. We also need to consider what training our staff need. So, do we need to seek out further external training opportunities? Do we need professional development in relation to our medical management? Any conditions that we might have come across that are new, and resources. Do we need specialised resources to support the child in our care? What routines do we need to adjust in our environment to support the inclusion of this child as well?

Belinda Rouhan: Okay, I think I might start. All right, so good morning, everyone. This is the fifth and final topic of Toolbox 2 of the OSHC best practice series. And this is also the last live webinar. My name is Belinda and I'm the general manager of outside of school hours care (OSHC) for Gowrie New South Wales. I support our OSHC teams and families and work closely with the OSHC managers on their daily practices within the services. Now going to hand over to Meray to introduce herself.

Meray Parsons: Thanks, Belinda. Hi everyone. Good morning. My name is Meray. I'm the quality and compliance manager for Gowrie New South Wales. I work with nominated supervisors, educators, and staff in supporting services be proactively compliant and working on embedding high quality practices throughout our OSHC and early education services.

Belinda: Thank you, Meray. So, we just want to let people know these topics. This webinar is recorded, however, it's only Meray and I who will be showing on the screen we're spotlighted. And the purpose of recording is so that you will have access to this webinar as well as the critical reflection and video vignette as part of a resource package after the completion of the webinars. So, expect to receive an email in the next week or 2, and you can also access it on the Department of Education website. We encourage you all to put questions in the chat box as we go along so that we can answer them at the end. And we also have, as a wrap up for today's session, a short Kahoot session at the end, too, which we'd love you to stick around for. So, this is the fifth topic as part of toolbox 2, and its enrolment and orientation, an essential factor in ensuring effective management of children's medical conditions. It's important at this juncture to note that this resource is developed by Gowrie New South Wales and funded by the New South Wales Regulatory Authority. Before we get started, Gowrie New South Wales acknowledges our First Nations people as the Traditional Custodians of our land and waterways. We also acknowledge their continued connection to the land, sea, and traditional countries across this nation. We thank Traditional Custodians for caring for Country for thousands of generations. We recognise this country was never relinquished by Traditional Custodians, and that their continued connection and commitment remains to Country. Gowrie New South Wales pays respects to Elders past, present, and emerging, and all First Nations people, including those joining us today. And I'm currently joining you from the traditional lands of the Wangal people. I'm now going to hand it over to Meray to take you through the learning outcomes for this webinar and National Regulations which relate to medical management.

Meray: Thanks, Belinda. So today, as we always do, we try to provide everyone with a bit of an outline of what the session will entail. So today we're going to look at which National Regulations relate to the enrolment process, especially in regard to medical conditions. We'll also look at how the National Quality Standard specifically element 6.1.1 supports your orientation practices and the key factors to consider at enrolment to support effective management of children's medical conditions in OSHC. We'll also look at the link between 'My Time, Our Place’ with respect to partnerships.

So, in regard to the medical management of medical conditions at enrolment, there are some key regulations that pertain to this with specific emphasis on medical conditions. You might have seen these before in earlier sessions, in toolbox 2. But it's just good to continually touch on these as they do form quite a significant part of our, our practices. So, with national regulation 90 medical conditions policy is required under medical, under regulation 90, and it does detail what must be included in that policy. For regulation 91, the requirement of the service to provide that copy of the policy to families of children with a medical condition. What we do at Gowrie, just to make sure we all, we are always compliant with regulation 91 is we just provide it as part of the enrolment package to all families. So, whether or not they’ve detailed to us that they child has a medical condition, we just provide it to all families also that it could be that families then have a, have a medical condition diagnosed after they’ve started, and we’ve still ensured that they’ve received that. Regulation 160 talks a little bit about child enrolment records and what must be included on the enrolment form. And regulation 162 talks about health information to be kept in the child's enrolment record. So, if you have an enrolment process that includes different people, it could be that you are responsible for the enrolment process as the nominated supervisor or an educator. It could be that there are other stakeholders involved. So, there could be an enrolments team or a support office or head office that process enrolments. It's really important that those different areas are captured. And you can see here that there are different responsibilities. So, for some of these things, staff members and volunteers are responsible. For others, the approved provider and the nominated supervisor are responsible.

When looking closely at enrolment and management of medical conditions. We come first through regulation 160, and this talks about having information in the enrolment record. So, this is the information that must be kept by the approved provider for all children enrolled at the service. And I strongly encourage you if you haven't done this in the last 6 to 8 months to review your current enrolment forms to ensure that you are capturing all the required information under the legislation for children. So, things questions and authorisations to include, what medical conditions the children have. Also included there is transport. That's been updated for almost a year now. But we do know that some enrolment records only get reviewed yearly. There is a requirement to update some information about transport as well on your enrolment record.

So, some of the information that you'll see here will be familiar to you, especially if you've attended the sessions in this toolbox. It's important to recognise that once you begin to unpack the Education and Care National Regulations, you'll see really important links and relationships between the areas that you, that support your service to be compliant. So, becoming familiar with and really confident with these tools supports the safety and wellbeing of children. What regulations are required under 162 or what requirements are, are required under regulation 162 can really help you then decide on what those enrolment and orientation procedures might look like.

So, as we've discussed regulation 90 and regulation 91 in other details in quite a lot of detail in other webinars. Regulation 90 does require a medical conditions policy at your service. As we said before, even if you don't have children enrolled with medical conditions, and this is to make sure that we do have practices and procedures in place, if a child does enrol with a medical condition or is diagnosed after enrolment and has their first medical condition incident after they've started, which is really common for children in care and many undiagnosed children might have their first incident at the service. So, we need to also be alert, and those procedures and processes are there to support the team to respond. Effectively, regulation 90 stipulates what documents you need to have as well as the procedures in place. And as we've just mentioned, regulation 91 means that the families have to have a copy of this to make a copy available for all families of children with a medical condition. So, I'm now going to hand it over to Belinda to take us through some key considerations. Thanks, Belinda.

Belinda: Thank you Meray. So, on this slide, we've listed 4 areas, which we consider key factors in the enrolment process that will be discussed. Now in relation to enrolment, we're going to give you lots of practical strategies over the following slides. So please take notes as we go, or you can re-listen to the recorded webinar and read through these notes again at a later date.

So, on the first slide, we'd like to unpack the pre-enrolment process. So, this is an opportunity to invite the family and child to tour the OSHC environment and introduce them to the children and the team. So, can everyone see that slide, the OSHC environment or pre- enrolment process? Yep. So, focus on creating an orientation experience for each family and child that feels safe, secure, and responsive. So, what do you think this would look like in your service? An orientation experience for each family and child that feels safe, secure, and responsive. This might mean that your approach for each child and family is individualised, but at the core will be framed by the, by the ideas that you see listed in the slide. There should be a focus and intention of family partnership and remember to schedule these meeting times outside of working directly with children so that you are not included in ratio, but it's also to consider confidentiality and a space and place to establish meaningful connections with the new family. Share information with the family about the medical conditions policy, and any associated policies and or procedures. So, this is the opportunity to establish the important sharing of information right from the beginning of the relationship and develop that sense of respect for each other and their appreciation for the work you do. Here. You can also advise families of the nut free or any nut free or similar policies like being nut aware. You can also set expectations about the different responsibilities, which we unpacked in the second topic of this toolbox. Tell parents and families about your service philosophy and ways of working with children and young people. So, the initial pre- enrolment visit is an opportunity for you to share who you are and what support is important to your service and how you work with children and young people. It's really important too that our service philosophy is living and breathing within our practices. At this time, you'll also share information about the waiting list and about any requirements in relation to the government's priority of access guidelines. It is important to remember that the first experience that the family has will set the scene for the coming days and weeks, and for the total long-term experience, reflect on your current practices in your service and ask yourself, if you were a new family, how would this experience for feel for you? Which of the above, if any, suggested practices do you currently implement? And if you think of any, if any of these practices might be challenging in your current service environment, then how can you consider ways in which you might be able to adjust them to meet your service environment? I think it's really important that when we give you these strategies not all of them will suit every service environment. We understand we've got a range of pack up, pack down and permanent spaces, schools that work with you and schools that don't. So how can you change and adjust these practices to meet your service needs? The environment is more than physical space. It contains layers of emotions and experiences of the children who spend time in it, the educators that work there, and the parents and carers who leave their children there.

So, on the next slide, we'll start to unpack the enrolment process and procedures. This first formal meeting is about establishing trust with the new family and to establish how they best prefer communication about their child's specific needs in the context of the service policies and procedures. So, you've had the walkthrough, you've had the introduction, and now it's that first formal meeting. This is also an opportunity to further reiterate and explain the importance of the medical conditions, policy and associated procedures and plans, and request the documentation you require as per regulation 90. So, we do encourage you to see the toolbox. Topic 2 on webinar on regulation 90 and policies and procedures for more information if you haven't already.

And on this slide, we have detailed the information you will need in relation to the medical condition on enrolment and in the medical management plan. I suggest that you review your current medical management plans in relation to the information here if you are in doubt. So, the medical management plan should detail information of the diagnosed medical condition, including the severity, any current medical medication prescribed for the child, the response required from the service in relation to the emergence of symptoms, so how we would manage it, and any medication required to be administered in an emergency. And then the response required if the child does not respond to initial treatment and when to call for an ambulance or assistance. So, if you don't feel confident that your medical management plans do have all this information, then it's time to revisit with your families and their medical practitioner.

So, on the next slide we talk about enrolment and orientation, this is a great opportunity to link in with the family and find out what additional agencies or services they access, which your service can also access. So, for example, insulin training through Diabetes Australia. The family might also encourage you to work with the school to ensure there is continuity of practices and procedures across both the school and OSHC service. Remember that if you are to reach out to the school regarding the child's health needs, you should have permission from the family to do so. You could consider creating a stakeholder analysis to consider the different internal and external stakeholders that you need to partner with and how these will influence your practices. This is also the time when you might start thinking about getting permission from the family to start applying for inclusion support funding. So, it's really important to note you will need to have permission forms signed by the family before you can discuss individual children with the inclusion support professional. And you might also use this opportunity to review your service inclusion plan and update with any additional practices or changes to routines and environment that you have implemented. So, I'm now going to hand over to Meray to go through over the orientation practices that support children.

Meray: Thanks so much, Belinda. So, in the next few slides we're going to talk about some orientation practices that support children and young people. And part of this is going to be really specific about medical conditions, but obviously these can apply for these partnerships are really good ground for different benefits across different practices in your service. So, while the lens today is medical conditions obviously these will help across all different areas.

So, when we look at the National Quality Standard 6.1 and specifically element 6.1.1 we can, we can have a look at including the family in the process from the beginning and seeing them as the expert in their child's medical conditions. That becomes a really important strategy when we know and we acknowledge that family sees the child every day and they've been managing, they might have been managing the medical condition for years. Families can tell us what risks there are, as well as identifying symptoms you should look out for. And even before symptoms, sometimes families will know that there's specific changes in behaviour, look out for that. Start when a child is starting, needing that medical management. So, when families feeling respected and their ideas are valued, they'll feel more engaged in the service. And so, you'll begin to get more information and utilise that to really improve the outcomes for children in the updated.

So, in the version 2, my time, our place framework, the principle of partnership is really key and recognises the key role that families, the OSHC service and school play in effectively managing children's medical conditions. And that's a really important concept that, that that notion of partnerships is so strong in version 2.

And so, when we're thinking about the enrolment and orientation there are some ideas on this slide. And it's a way to summarise the practices that we have discussed today that put families and children at the heart of our partnerships. We acknowledge and respect the uniqueness of each child and family, and we can be guided by these aspects. So, take a moment here to ask yourself, what do these aspects currently look like in your day-to-day practice? You can have a look at the keywords so in each of the boxes there's a keyword here and it can really help you guide and reflect how you implement those aspects in your service. So as an example, I really like the one great that really stands out for me because I think sometimes when we are going through the process of enrolment and orientation, it can sometimes be about information exchange, which it will. Part of that will be providing information and seeking information. But we want to also step outside of the paperwork and greet those families and really have that warm, reciprocal relationship with them so that the other aspects listed on this slide can come to fruition a bit more.

So where to go next? We have a few different resources for you to view after these sessions are put on the Department of Education website. We have a really great vignette with a real-life conversation between 2 educators talking about this and talking about some of the strategies. And there is a critical reflection pack also as part of this package. So, I would encourage you to have a look into it. We do know that medical conditions and, and when we have reviewed incidents or where there have been things that have not gone so well, we go back, and that orientation and enrolment process is always a contributing factor. So, a really effective enrolment and orientation process, especially considering medical conditions, can be a good way to prevent incidents happening further down the track. It's a really integral part of that. So, once you have the email, I know we've had a few questions about this. Once you, once all of the sessions are delivered. So, after today they have all been delivered live, you'll receive a link to from the Department of Education, but also from Gowrie as to where they are housed. And part of that will also include these vignettes and the critical reflection topics for other topics. We also have fact sheets as well.

And obviously we've referenced here a few different bodies. So, the regulations, the National Quality Standard, my time out place, and ACECQA as well. We put these here from a referencing perspective, but also if you want to find out some more information, the information we've gathered is from these resources so that we always try to go to the most reliable source. And these ones are obviously the approved bodies to provide that.

And as always, we thank you. We know that it has been 10 sessions. If for some of you, we know that you have attended all 10, so that is 10 hours out of a fortnight that you have given us for some who've only attended 2 or 3. That's still a big investment in time. So, we really thank you for attending and taking the time out your day to, to come and meet with us and, and look at this information. We have a little bit more time and so we are going to do a little bit of a Kahoot, but we also will send out a survey after this session. I will just give everyone a couple of minutes to pop any questions in the chat while I set up the Kahoot. So, I'm going to stop sharing. And Belinda, you might answer questions that come through while I set that up, if that's okay.

Belinda: Absolutely. So, feel free. And I see we already have some feedback from Melanie. So, Mel, thank you so much for the feedback. We do have these recorded so you will be able to access them with your teams and hopefully when you access them with your teams and especially, coming from, you have unpacked some already, it might even be more informative so you can lead some really great robust discussions with them as well. Do we have any questions about the enrolment process or would anyone like to share anything they do in enrolments that they think might be helpful for another service? I think it is something in OSHC that can sometimes get missed. You know, some of our big organisations have enrolment teams and then, you are working, you don't have all that many admin hours and it's hit the floor running and you've got these new children coming in. So, especially for those services, how can we support you with strategies or how can you share ideas? I think.

Meray: Belinda, I've got a direct question actually. Yes, what are the nominated supervisor rights and responsibilities if we find some details are missing on the enrolment form, which are completed by the admin team? I have addressed these issues with the admin teams and the approved provider. They have a place they; they have place on, with procedures, but there are still errors. So, I think it's a really good question. I am going to keep it anonymous because it came directly, I'm guessing maybe that's one of the reasons it's a very good question. If it is out of the enrolment form and the enrolment form is not being completed and it's especially to do with medical conditions. So, some things on the enrolment form are not regulatory requirements. They might be for your own processes, some things are for Child Care Subsidy (CCS) requirements, but if it is to do with medical conditions, I would then go back and show the approved provider the law that it relates to. So, I think we talked about regulation 160 I believe it was which stipulates what has to be on an enrolment record and there are fines associated with that sort of stuff. What you can do if that's not going moving forward is you can ask the family to complete the enrolment form before they attend and you can say, look, maybe it was missed. Do you mind completing it just before you start? So, while the enrolments team should be a little bit, we would, I would say this has happened Gowrie before, and once we have unpacked the why people are a lot more willing to comply, to adhere to it. But sometimes our nominated supervisors do also have to chase the families up as well. So, it's a bit of stakeholder management there and managing those partnerships.

Going back to that notion of partnerships, I always start with if you attended the session around communication and negotiation, if we remove the person from the issue and say the thing we're trying to achieve here is ensuring children are safe. So, nobody wants anything to happen where children aren't safe, I'm sure that you've provided more so than most people and definitely the family. So that could be a strategy I would use. We have another question. Just wondering for enrolment forms, is paper or on digital or digital preferred for documenting which is more acceptable to the Regulatory Authority? We have a paper master enrolment than a digital re-enrolment form. It's a really good question, Natalie. We are toying with this all the time at Gowrie. So the regulations don't specify if it has to be paper or if it can be digital. And what I would say is, if it is paper, how do we ensure that things are documented and kept up to date? So, if you have a filing system with 300 odd children in there, how do we know do we have systems in place where the enrolment forms are being up kept up to date? I think sometimes digital copies are really good like that, but with digital copies, who has access to them? So, if it's just the nominated supervisor and none of the responsible persons (RPs) have access to the enrolment system, then that creates another con. So, I would look at it from a risk benefit analysis. We have paper copies for all enrolments, but we transfer all that, all of that, those details onto the child's enrolment record in the system. So, we have them, we have them on both. We are looking at going to digital, but we haven't taken that step yet just because of all the things you've brought up in your questions. So, I don’t know if anyone else wants to add to that. What I might do is share my screen and we can get this Kahoot going before we take up any more time. With paper enrolments, there is also a human error for data entry. Absolutely, that's exactly, so the service that my children attend, they are both in digital and it is up to the family who complete it. And we can't move forward unless we complete the enrolment record on the digital platform. And that is a really good way to ensure that all of the information is taken.

So back to that first question, what happens if there's something missing? What we are finding is with digital, with some of our regional sites, our ability to connect to those online platforms isn't always reliable. So, what then happens, there's very good questions there. Shauna, yes, we do have these sessions available in terms of the online webinars and they'll be recorded. So, what happens now is we, we are recording the live session, we will then submit this, and the Department of Education will upload it onto their website. So, if you've ever attended a safe sleep session or other sessions at the Department of Education host, it will be similar. So, it'll be uploaded onto their website. But once we have the URL, we will email you all that URL as well. So, the Department of Education will probably send it out as part of their ‘Spotlight on Quality’ newsletters, but we will also email that as well. Okay, let me share this on my screen and let's do this Kahoot. So, what you will need for a Kahoot is your phone. If you don't have your phone, I'll give everyone a minute or so to get it. There will be a QR code that you scan, or you can go onto Kahoot.com and type in, there will be a little code. So, I'll, I'll share, I'll share that with everyone, and we'll get started. So, can everyone see something loading there?

Belinda: Yep.

Meray: Okay, so if you just go to Kahoot it and there will be a game pin, or you can use the QR code. Thanks Shana.

Belinda: I've got some people joining. Great to see.

Meray: So, you can, yeah, go to Kahoot.it and add the pin or you can QR code it. We've got a few people. So, we’ve just having a look, 22 participants on the call. So, I'll just let everyone give everyone a couple more seconds to join.

Belinda: And this is a great idea to use your services too if you haven't used it previously. I think it's a nice easy way to gather information.

Meray: Yes, so there's, you can get a free version which has a few different options. You can pay for it a bit, it's a bit extra for all the different options. And we use this it's similar to Mentimeter, but anyone's use Mentimeter. So, it, it just captures some information. It's a little bit more fun and putting it in the chat box.

Belinda: And if you do have to leave, that's fine as well. We understand everyone's, it's a Friday, you've got busy days ahead, but if you are available to stick around, we'd love to use it, like we said, as a bit of a critical reflection session.

Meray: We might get started. You're more than welcome to view it if you don't want to participate, but I don't want to keep everyone waiting too long. So, we'll start. These are, there's just a few questions, so don't stress it's not going to take too long.

Meray: It's just a focus group. We're going to critical reflect on some of the topics and if you can just pop your answers. There's 90 seconds, so it's about a minute and a half to write your ideas. You can write multiple ideas as well.

Belinda: And if you didn't want to add the answers to Kahoot, feel free to put them on chat box as well. If you haven't joined up with Kahoot.

Meray: You can still join. If you are feeling that you want to, you haven't, you can still join even though we've started. So that's not an issue as well. So, you can have up to 4 ideas guys. So, we've got 9 seconds to go. You can add more ideas, you can have up to 4 in total. Let's have a look. Ok, so this is fantastic. So, we loved the communication part, we liked the active supervision and the importance of supervising all areas, adding supervision styles to the plans. Thank you. These are fantastic. So, I won't group them. What we, they you can usually do is group and vote, but we don't have enough to do that. So, we'll just keep going. Okay, so the next question is, what considerations or improvement is your service making as a result of attending toolbox one? This is only 30 seconds and so it's a quick type.

Belinda: So, Caitlin said it won't let her submit. I think maybe try again for this question, Caitlin.

Meray: If we've run out of time, Caitlin, it might do that. I don’t know if that's the reason. Maybe try keep trying. We've got 5 seconds to go. 3, 2, 1 <laugh>. So, some of these considerations are improvements. We've got supervision styles, supervision styles staff placement and reviewing plans, which is great. Thanks everyone. So, the next question is in what ways will these changes improve supporting the individual needs of children?

Belinda: I think Caitlyn had a long answer.

Meray: Ah, sorry Caitlin.

Belinda: It's a good point though. Good tip for us all.

Meray: Okay, one more second. Thank you so much to those who are on doing this, it's really highly appreciated. Fantastic. So, we've got individual attention, safety, consistency more educators involved, being more responsive and supportive zones. I think this is really a really, I like all of these actually <laugh>, so thanks. Okay, so we will then go into the box one. This is a quick one if we've already tried it or not. So, you just pick the colour that corresponds to the question to the answer. Oh, fantastic. Thanks everyone. So, we've got 3 people saying we've already implemented some strategies and some people saying not yet but can't wait. So that's really, really positive. Thank you. Are there any challenges you, you foresee implementing any of the strategies? So, this is a type of your idea and you've got 4 ideas you can type up.

Belinda: I think we've mentioned, and some people have raised the different service environments and routines as well and relationships and things that can play on this. But let's acknowledge any challenges you might have. And then what you can do from there is go, okay, well how can I address these challenges? Don't let it be that barrier for you. Address it so that you can then move forward and make some changes to make it work for you. And I know one of the examples was the displaying their medical conditions, some people can't, don't have an office to display it. So then how do they ensure that information is accessible for all staff? And we've already had some great feedback and suggestions from teams in the webinars about this. So, it is really good to see that you are thinking as you go and about how we can address these barriers and not just see them as a stoppage.

Meray: Okay, we've got a couple more seconds to go. 40 more seconds to go.

Belinda: Do you have any more barriers? Put them in now. We're almost out of time.

Meray: We've got some.

Belinda: Educators.

Meray: So, we've got educators, different staff on different days getting ready for new plans, turnover supervised areas across a large school area. That's a really good one. We have a few services in that position, and we do find that that is one of the challenges that we constantly reviewing shared environment and children hating being supervised in certain times and environments. Thanks everyone. Okay, we've got question 7, it's a brainstorm. And so, are there any so now we're talking about toolbox 2, any key takeaways here? So that's 75 characters for these answers.

Belinda: And it's interesting to say there's a lot of consistency in some of the challenges and barriers everyone's facing. With staffing being one of those key ones and it is something felt across the sector. We've got just over 30 seconds if you have any more ideas, thinking about medical management and your biggest takeaways in learning from the medical management series and sometimes it's easier to consider the medical management because that's the one you did most recently and we always find that's probably it's more than supervision in regard to what you're needing.

Meray: Absolutely. And obviously supervision is related to medical management. So those things. Absolutely part of it. Okay, let's have a look. What has everyone said? So, we've got the comms plan is something that you'll be looking at time to review enrolments, ways to implement an easier tracking system. Systems can make or break it importance of partnership and that all staff need to know. Absolutely. Thanks everyone.

Belinda: We do have these sessions recorded as well.

Meray: So what considerations are you thinking of making as a result of attending? So, this is in relation to medical management and it's 20 characters here. So, and this will end up being a word cloud, so if you've got well, it'll have the biggest answer as the largest, so we'll see if there's any, we've got review medical and changing inductions. So that's a really good one. I really especially like the changing inductions one. And then in what way will these changes improve the individual care needs for children?

Belinda: It's really interesting to see that everyone had similar ideas too.

Meray: There are 2 more questions so I really do think you could stay with us and participate in it. So, thanks for that. And I think it's just nice to see what other people are thinking so you're not alone in your own thinking but knowing that we can use this information to then develop some more professional development as well. I think I really, yeah, there's a few good ones there in terms of educator confidence. That's one we didn't touch on in the sessions, but very relevant to what we're talking about with medical conditions. Okay, second, last, thank you. And this is a similar one to the last one. Have you tried anything have you not, did you feel it was relevant? Did you not? Okay, so we've got, we've started, we have started to implement some things a few people. So, it's a very, even split 2, 2, 2. Some people have already got things happening, some people are, are about to start and some people have started already. And lucky. Last question. Thank you everyone. If we could do this one and I would be really thankful for your time. So, what other topics would you like to see? And this is just 20 characters, so just keep them short if you can. So, we've got self-assessment equipment and then our partnerships, trauma support, transport, and behaviour strategies. I think it's very interesting that trauma support and behaviour strategies are there because they are very interlinked. Mm-Hmm. <affirmative>. And then I also can see that there are more inf more information about partnerships would be one of the key ones we've found as well. Really helpful at Gowrie. So, thank you so much. I think that is it. Thanks for participating. I'm going to stop sharing the screen now and thanks everyone for being with us. Over the last 10 sessions, I know that many of the people still on this call have been here for almost all 10 sessions, so thank you. It's a big investment like we said, and hopefully you've found it useful. We will hopefully be offering some up some more sessions, so if you don't mind, we might send you some information when new sessions are available. So, thanks again.

Belinda: Thanks everyone. Absolutely. If we do have more sessions and I think it's really great to see those sessions, we run internally for our teams on behaviour guidance and trauma support is also what the external sector is looking for as well. So really great to see we're all aligned. Thanks everyone. Thanks Natalie. Do you know we're really passionate about having OSHC specific training as well and so are our team. So, we've worked really hard on that, especially in the last year to try and develop information that's OSHC specific. So, we're hoping we can do more OSHC specific training and support and really advocate for the sector. Thank you everyone for joining. Enjoy your day.

Meray: Enjoy your day. Okay?

Belinda: Yes. And don't forget to complete the surveys.