Entrustable Professional Activities

LG6: Assessment and management - developmental and behavioural

Learning Goal 6

Assessment and management - developmental and behavioural

Provide comprehensive assessment and management of children who have been referred because of development and behavioural problems

This activity requires the ability to:

  • identify and access sources of relevant information about patients
  • perform a comprehensive assessment of an infant, child or young person’s health, development, behaviour, learning and emotional state, taking into account biological, psychological, cultural, and social environmental factors
  • provide an explanation for an infant, child or young person’s presenting concerns
  • be familiar with, and use, standardised screening, and assessment tools, where applicable, for developmental and mental health presentations
  • appraise developmental and behavioural status of a child at any age by observation, physical examination, and neurodevelopmental assessment
  • synthesise findings to develop provisional and differential diagnoses
  • use diagnostic formulations to construct an individualised, multi-modal management plan
  • communicate findings and recommendations with patients, other health professionals and relevant stakeholders
  • develop management plans and goals in consultation with patients
  • provide effective long-term management of developmental and behavioural conditions under a chronic disorder model
  • provide supportive family counselling, specific interventions, and targeted practical advice across the range of developmental and behavioural conditions
  • appropriately and safely prescribe and monitor the use of relevant psychotropic medication in children presenting with developmental and behavioural concerns

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

Assessment
  • assess paediatric patients’ physical and psychological symptoms and signs
  • assess common developmental and behavioural paediatric presentations
  • assess common paediatric and adolescent mental health presentations
  • use a holistic, biopsychosocial framework with identification of sources of vulnerabilities and resilience
  • perform a comprehensive assessment of a child’s development, behaviour, learning and emotions, taking into account biological, psychological, comorbidity, and social environmental factors including family dynamics
  • apply and interpret standardised screening and assessment tools, where applicable, for developmental and mental health presentations
  • interpret abnormal results of screening, and outline referral and management pathways
  • choose evidence-based investigations or assessment tools as an adjunct to comprehensive clinical assessment
  • synthesise and interpret findings from the history, examination, and investigations to devise a coherent developmental-behavioural/ biopsychosocial paediatrics diagnostic formulation
  • form a hypothesis for what neurodevelopmental processes may be underlying symptoms
  • use available clinical information to establish the most likely provisional diagnoses and reasonable differential diagnoses
  • assess the severity of problems, the likelihood of complications, likely prognosis, and clinical outcomes
Management
  • use diagnostic formulations to construct an individualised, multi-modal management plan
  • regularly revise short-term management plans, and modify goals as needed in consultation with patient
  • establish case management guidelines with clear follow-up intervals
  • introduce concepts of chronic disease management and long-term outcomes early in treatment
  • provide anticipatory guidance on key transitions, such as into primary school, into secondary school, or leaving school
  • consider psychotropic medication use, with clear therapeutic target, as part of an overall management plan
  • select appropriate pharmacological and non-pharmacological therapies considering the patient's age, comorbidities, adverse reactions, preparations and availability, and patient preference
  • refer and liaise with subspecialists and other health professionals, where appropriate
  • manage patients with common neurodevelopmental and behavioural concerns
  • manage patients with common mental health concerns in liaison with mental health support services

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • take patient-centred comprehensive histories, considering psychosocial factors
  • document medical, social, developmental, and sexual history
  • provide rationale for investigations
  • recognise and correctly interpret abnormal findings
  • synthesise pertinent information to direct the clinical encounter and diagnostic categories
  • perform basic aspects of assessing and managing common neurodevelopmental conditions, with support

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • communicate openly and respectfully
  • listen actively and use a collaborative approach to management by identifying and addressing patients’ concerns, questions, expectations, and goals
  • establish supportive relationships with patients based on trust, understanding, empathy, and confidentiality
  • explain the potential benefits, risks, costs, burdens, and side effects of investigations to patients
  • explain outcomes of assessment, diagnosis, and other relevant information to patients
  • communicate the management plan with recommendations and goals for treatment to patient effectively, including in written form
  • clearly and concisely document assessment findings, recommendations and management plan in patients’ medical record and written reports
  • help patients navigate the healthcare system and improve access to care by collaboration with other services and agencies, such as child protection, community health centres, consumer organisations, funding, and intervention pathways
  • write comprehensive and accurate assessment and management reports and summaries of care, including discharge summaries, comprehensive clinic letters, and transfer documentation
  • provide clear, safe, effective, and timely handover between transitions of care
  • communicate with referring and receiving health services, such as local health services and primary health care provider
  • check quality and accuracy of reports or documentation generated by others and technologies such as artificial intelligence informed Large Language Models

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • anticipate, read, and respond to verbal and non-verbal cues
  • demonstrate empathetic, compassionate, respectful, and active listening and communication skills
  • communicate patients’ situations to colleagues, including senior clinicians
  • explain helpful resources
  • explain specified tasks or requests for general practitioners, or other professionals, where appropriate
  • explain schedule and purpose of follow up clearly
  • explain the benefits and burdens of therapies, considering patients’ individual circumstances
  • seek further advice from experienced clinicians where appropriate

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • ensure patients are informed of the risks associated with any part of management plans
  • obtain informed consent before undertaking any investigation
  • ensure that patients are informed about fees and charges
  • identify and manage key risks for patients during transitions of care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • keep patients' information secure, adhering to relevant legislation regarding personal information and privacy
  • identify medication errors and institute appropriate measures

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • set defined objectives for clinical teaching encounters, and solicit feedback on mutually agreed goals
  • regularly reflect upon and self-evaluate professional development
  • obtain informed consent before involving patients in teaching activities
  • use clinical activities as learning and teaching opportunities, appropriate to the setting and learner
  • provide appropriate supervision of junior staff in their clinical assessment of patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • set goals and objectives for selflearning
  • self-reflect infrequently
  • deliver teaching considering learners’ level of training

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • critically analyse relevant literature and refer to evidence based guidelines
  • participate in clinical research and follow research protocols where appropriate
  • critically analyse relevant literature and refer to evidence-based guidelines

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • refer to guidelines and medical literature to assist in clinical assessments when required
  • demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • engage with patient and family to gather information in an atmosphere of trust and cooperation
  • acknowledge and reflect on patients’ beliefs and values, and how these might impact on health
  • recognise the impact of cultural differences on understanding and acceptance of neurodevelopmental concerns and diagnoses
  • recognise the role of cultural factors on developmental assessment and testing performance
  • recognise the role of social and cultural factors in the development of somatic symptoms
  • demonstrate cultural safety with implementation of appropriate and necessary supports
  • demonstrate effective and culturally safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples, and members of other cultural groups
  • observe the complex interactions between the child, siblings, caregivers, support agencies, and the broader social context for protecting children and promoting child wellbeing
  • actively support, and effectively use, interpreters and other communication assistance means during every clinical encounter with patients who cannot communicate confidently or verbally in English, and document this in the medical record
  • use qualified language interpreters or cultural interpreters to help meet patients’ communication needs

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • display respect for patients’ cultures, and attentiveness to social determinants of health
  • display an understanding of at least the most prevalent cultures in society, and an appreciation of their sensitivities
  • appropriately access interpretive or culturally focused services
  • identify vulnerable or marginalized populations and respond appropriately

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients
  • demonstrate, and advocate for, consideration of the comfort of the patient by minimising any distress and harm caused by medical assessment
  • hold information about patients in confidence, unless the release of information is required by law or public interest
  • assess patients’ capacity for decision making, involving a proxy decision maker appropriately
  • demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate professional conduct, honesty, and integrity
  • consider patients’ decision-making capacity
  • identify patients’ preferences regarding management and the role of families in decision making
  • not advance personal interest or professional agendas at the expense of patient or social welfare
  • demonstrate professional conduct, honesty, and integrity

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • engage patients in the decision-making process at an appropriate developmental level
  • identify and address risk and resilience factors impacting on infant, child, and young person’s development
  • advise on any proposed complementary or alternative treatments in a non-judgemental fashion
  • apply knowledge and experience to identify patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for patients
  • evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
  • review the best available evidence for the most effective therapies and interventions to ensure quality care
  • formulate an opinion regarding risk of, and resilience to, adverse outcomes for the subject child, include safety, physical health, development, relationships, behaviour, and psychological wellbeing
  • determine the need for referral to subspecialists
  • make appropriate decisions regarding referring or transferring patients to other services for further assessment, including regional and remote patients
  • use appropriate guidelines, evidence sources, and decision support tools
  • consider potential bias and gaps in the presentation of history

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate clinical reasoning by gathering focused information relevant to patients’ care
  • choose the most appropriate investigation for the clinical scenario in discussion with patients
  • recognise personal limitations and seek help in an appropriate way when required
  • assess family dynamics, including the family’s capacity to follow recommendations

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • develop collaborative relationships with patients and a range of health professionals
  • work effectively as a member of multidisciplinary teams to achieve the best health outcome for patients
  • facilitate and coordinate interventions by other medical or non-medical professionals
  • collaborate with other health professionals to achieve accurate and thorough assessments of patients
  • manage cross referral for assessments by allied health professionals

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • share relevant information with members of the health care team
  • ensure results are checked in a timely manner, taking responsibility for following up results

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • educate patients about nature of developmental and behavioural problems
  • use local, regional, and national health services and systems appropriately
  • advocate for appropriate resources to assist families
  • aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources
  • support systems to improve access to healthcare such as telehealth

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • identify and navigate components of the healthcare system relevant to patient care
  • identify and access relevant community resources to support patient care
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  • identify and access relevant community resources to support patient care
  • factor transport issues and costs to patients into arrangements for transferring patients to other settings