Domain 4 - Impact of co-existing conditions (Primary Domain)

Overview

Increasingly, individuals are experiencing and managing multi-morbidity (coexistence of multiple conditions, including chronic disease).

This domain considers the extent to which other conditions contribute to (or have the potential to contribute to) increased severity of the mental health issue or compromise the child’s ability to participate in the recommended services and support.

Assessment of a child on this domain should consider the presence, and impact of, three possible coexisting conditions:

  • Physical health conditions.

  • Cognitive impairment, intellectual disability, developmental delay, neurological conditions, or learning and communication disorders.

  • Substance use.

Where the child has more than one of the coexisting conditions, consider the condition which has the most impact.

PRACTICE POINT - definitions of cognitive impairment, intellectual disability, developmental delay, neurological condition, and learning and communication disorders

The terms cognitive impairment, intellectual disability, developmental delay, neurological condition, and learning and communication disorders have no universally agreed definitions. For this Guidance, the below definitions will apply:

Cognitive impairment – A description of a person’s current functioning regarding learning, communication, attention, memory, thinking and problem-solving. Cognitive impairment can be temporary, permanent, mild, moderate, or severe. Cognitive impairment can affect what the person can understand and how they relate to others and interpret the environment.

Intellectual disability – A disability characterised by significant intellectual functioning and adaptive behaviour limitations, covering many everyday social and practical skills. This disability originates before the age of 18. Genetic factors cause most intellectual disabilities. However, there are other causes of intellectual disabilities, such as brain injury or being born prematurely.

Developmental delay – A developmental delay is when a child’s physical, social, emotional, language or communication skill development is not at the level expected for their age and significantly affects their ability to engage in daily routines and activities.

Neurological condition – Neurological conditions affect the brain, spinal cord, and the nerves that connect them. There are more than 600 nervous system diseases (e.g., epilepsy, motor neurone disease, traumatic brain injury, multiple sclerosis).

Learning and communication disorders – Learning and communication disorders may affect how a child comprehends, recalls, understands, or expresses information. These disorders are often dynamic and can improve over time. The impairment caused by these disorders might be minimal or significant and vary from person to person.

Scoring

0 = No problem in this domain

1 = Minor impact

  1. Physical health condition(s) present but are stable and have no or a minimal impact on the child’s mental health.

  2. Cognitive impairment, intellectual disability, developmental delay, neurological condition, or learning and communication disorder present but has no or minimal impact on the child’s mental health.

  3. Past experimentation or experience with substance use, but no recent episodes and no impact on the child’s mental health.

2 = Moderate impact

  1. Physical health condition(s) present and moderately impacts the child’s mental health.

  2. Cognitive impairment, intellectual disability, developmental delay, neurological condition, or learning and communication disorder and moderately impacts, or has the potential to moderately impact the mental health of the child.

  3. Occasional substance use impacts on, or has the potential to impact on, the child’s mental health.

  4. Non prescribed use of prescription medications that impacts on, or has the potential to impact on, the child’s mental health.

3 = Severe impact

  1. Physical health condition(s) present, which requires intensive medical monitoring, and severely impacts the child’s mental health (e.g., worsened symptoms, heightened distress).

  2. Cognitive impairment, intellectual disability, developmental delay, neurological condition, or learning and communication disorder present and severely impacts the child’s mental health.

  3. Frequent substance use threatens health and wellbeing or represents a barrier to mental health-related recovery.

  4. Non prescribed use of prescription medications significantly impacts the child’s mental health or presents a barrier to mental health-related recovery.

  5. Occasional use of high or extreme risk substances. (e.g., substances with a high risk of adverse outcomes such as injury, loss of life, criminal charges and/or use of injection drugs which have a high risk of infection of blood-borne diseases).

4 = Very severe impact

  1. One or more significant physical health conditions exist that are poorly managed or life-threatening and in the context of a concurrent mental health condition.

  2. Cognitive impairment, intellectual disability, developmental delay, neurological condition, or learning and communication disorder present and very severely impacts the child’s mental health.

  3. Regular and uncontrolled substance use.

  4. Frequent non-prescribed use of prescribed medications that has the potential to threaten health and well-being.

  5. Frequent use of high or extreme-risk substances (e.g., substances with a high risk of adverse outcomes such as injury, loss of life, criminal charges and/or use of injection drugs which have a high risk of infection of blood-borne diseases).