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Client Details
UR No.:
D.O.B:       /         /                   Male              Female
(or affix patient ID label here)
While being a parent can be rewarding it can also be very challenging at times - more so if you or
your partner are struggling with a mental health issue. Planning for your children's needs is
important and ensures that you have a say in what happens to them should you become unwell.
Supporting children (under the age of 12 years),
young mental health carers (13 - 18 years of age)
For a Baby Care Plan download from www.copmi.net.au
Important Telephone Numbers
Parent's Mental Health Worker (Name and Number)
GP (Name and Number)
Kids Helpline
1800 55 1800
1300 30 1300
Crisis Care
Emergency (Fire, Ambulance, Police)
An initiative of COMIC (Children of Mentally Ill Consumers)
under the auspices of the Mental Illness Fellowship of South Australia
This Child's Care Plan aims to help parents if they become unwell and are temporarily unable to care for their
children. Please fill out your details and your children's details. If you are unsure, ask your mental health worker,
your Doctor, or a close trusted relative or friend for help.
It is important to  include your child  in the planning and ask for their input. It can be so reassuring for your child
to know what will happen should you become unwell and either need respite or spend time in hospital.
Name of Child
Date of Birth
Medicare Number
Name of Parent
or Other Primary Carer
Phone No.
Mobile No.
Do any of your children have allergies?
Child's Name
Known Reaction
Are any of your children on any current medication?
Child's Name
Name of Medication
Dose of Medication
Times to be given
Are there any contact restrictions? (ie. CUSTODY Restrictions)
Do any of the children have any specific concerns or worries? This may include events which have previously
happened in the child/young person's life.
Child's Name
Concerns or Worries
School Contact Details
Name of Child
Name of School, After
School Care or Childcare
Teacher's Name
Phone Number
Please list in order of preference, adult carers that your child/children can stay with if you need to go to
hospital. Have you asked your child/children who they would prefer to stay with? Are these people aware
that you have nominated them? (See Parent Checklist)
Child's Name
Name of Proposed Carer Address
Phone No.
People to Notify and inform if you need to go to hospital
Contact Details
Are there any cultural, religious, spiritual or language influences for the child/young persons?
Child's Name
Cultural, religious, spiritual or language influences
Family Doctor/s
Phone No.
Mental Health Worker/s or other Support Services
Phone No.
Child/Children's Other Needs or special dietary requirements, i.e. diabetic, gluten free, lactose intolerant, etc.?
Child's Name
Food likes/dislikes
Including baby
formula details
Bedtime and other
routines including
settling routines
Special Toys
Care of Pets
(Add Pet's name).
Sports etc.
Pocket Money
Parent Tick Checklist
(Tick when completed)
I have informed my mental health worker that I have children
I have informed my GP that I have children
I have explained to my child what my illness is and how it can affect me
I have completed a Child Care Plan for my children in case I need to go into hospital
The adult carers that I have nominated to care for my children are in agreement to provide temporary
care for my children if I am not able
I have given a copy of a Child Care Plan to my mental health worker
I have given a copy of a Child Care Plan to my GP
I have given a copy of a Child Care Plan to their teacher/s
Other people and organisations who have a copy of my Child Care Plan
Please list:
If I become unwell and temporarily unable to care for my children,
I give consent for this Child Care Plan to be actioned:
Name of parent/carer:
Name of witness:
Signature of parent/carer:
Signature of witness:
For further information:
COMIC (Children Of Mentally Ill Consumers)  www.howstat.com/comic
COPMI (Children Of Parents with a Mental Illness) National Initiative  www.copmi.net.au
MIFA (Mental Illness Fellowship Australia) www.mifa.org
Young Carers  www.youngcarers.net.au
This Child Care Plan is a guide only. COMIC accepts no responsibility for people relying on, or using the information in this plan.
Produced in association with the Koping Forum and COMIC (Children Of Mentally Ill Consumers)
Kindly Funded by:
Children of Mentally Ill Consumers
under the auspices of the Mental Illness Fellowship of South Australia
Revised December 2008