Assessing disability needs for te tamaiti
Part of the needs assessment for te tamaiti in care is to consider whether te tamaiti has a diagnosed or suspected disability and who they are involved with to meet their support needs.
Many tamariki coming into care will have had a full assessment and well-documented history of issues and their support needs and plans. Others will not. It’s the social worker’s role to ensure any potential disability or impairment issues are considered, explored and supports are put in place if necessary.
In completing the assessment of any disability needs for te tamaiti it’s important to:
- seek the views of the tamaiti and their family/whānau
- actively engage with the school, health professionals or other professionals involved with te tamaiti to seek their views and identify opportunities to work together, especially if te tamaiti is in care
- review any specialist assessments, including Gateway or Youth Justice Health and Education Assessments/screens that have been completed or ensure these are undertaken if required
- consider how the cultural perspectives of the family/whānau may influence the experience of te tamaiti and seek cultural support if required
- seek the views of the caregiver if te tamaiti is in care
- consider the relevant Tuituia domains to draw together your assessment.
While the National Care Standards require that the assessment of te tamaiti in care considers any disability needs, there is no single domain within Tuituia where this is considered or captured. Some key domains that need to be considered include:
- Identity and culture – Tuituia domain
- Health – Tuituia domain
- Education – Tuituia domain
- Behaviour – Tuituia domain
- Learning and achievement – Tuituia domain
In addition to these domains, practitioners need to give consideration to:
- whakamana te tamaiti
- the experience of whānau Māori living with disability
- ensuring tamariki with disabilities have the same rights as all tamariki
- understanding the individual tamaiti
- respecting the voice of disabled tamariki
- engaging with specialist services.
Whakamana te tamaiti
To whakamana or empower a tamaiti is a central principle in working with tamariki, rangatahi and family/whānau. To uphold the mana of te tamaiti, they must be supported, respected and given choice so that their potential can be reached.
An assessment of needs for a tamaiti in care must acknowledge, respect and protect their mana and further protect and encourage its growth and development.
The assessment needs to capture the strengths, abilities and competencies of te tamaiti and their family/whānau along with ensuring a full understanding of any disability or impairment needs.
Whānau Māori living with disability
Māori directly or indirectly experience disability at a higher rate than any other population group in Aotearoa/New Zealand. Whānau Māori living with disability (whānau hauā) have experiences and additional challenges that non-Māori people don’t, related to the impacts of colonisation and multiple other forms of oppression (for example lower income and poverty, higher unemployment and lack of education). This increases the risk tamariki Māori will be disadvantaged within the health and disability system, that their needs will not be fully assessed and that support will be more difficult to access.
For whānau Māori, the disability is not seen as an issue for just the individual, but for the whānau as a whole. An assessment for disabled tamariki Māori (as for all tamariki Māori) must therefore recognise the importance of whānau as a source of strength, support, security and identity. It’s important to support whānau so they are in the best position to support the disabled tamaiti. Cultural obligations and responsibilities that Māori whānau members have to one another and the whānau as a whole, means whānau are a crucial component of the assessment process for te tamaiti in care.
Quote from the New Zealand Disability Strategy 2016 to 2018:
Disabled tamariki have the same rights as all tamariki
An assessment of a disabled tamaiti should consider the same domains and dimensions as an assessment of a non-disabled tamaiti.
While their needs may be very complex in one dimension it’s important that all areas of their needs receive attention during an assessment.
Disabled tamariki have exactly the same human rights as non-disabled tamariki to be:
- safe from abuse and neglect
- protected from harm
- supported to achieve their full potential.
Disabled tamariki do however require additional action. Disabled tamariki experience higher rates of abuse than their non-disabled peers if they have:
- communication impairments
- behaviour difficulties
- intellectual disability
- sensory disabilities.
This isn’t necessarily as a result of the disability itself, but the interaction between the disability and the social environment in which te tamaiti lives and the level of support they receive.
Standards of care that we expect for the disabled tamaiti must be the same as we expect for the non-disabled tamaiti – we must not compromise on standards of care as a result of disability. We must not prioritise other concerns over the needs and rights of tamariki with disability.
Understanding the individual tamaiti
As a group, tamariki with disabilities are different from each other just like all tamariki. In addition to the social and cultural differences of the whole population, tamariki with disabilities can’t be categorised together.
Each tamaiti will have different issues in respect to the different categories of disabilities (neurological, vision, hearing, and physical) and their cultural and social diversity.
Behaviours demonstrated by te tamaiti need to be understood in the context of their disability or impairment. We need to understand the connection between behaviour and what te tamaiti may be needing/wanting to communicate with us.
We need to understand how the disability impacts on their specific safety, the impact this has on their behaviour and any increased needs for safety that te tamaiti may have as a result of their disability.
Cultural beliefs can have a strong influence on people’s understandings and experience of disability. For example, in Chinese culture, the Buddhist belief of karma provides an explanation for the cause of disability. Some Pacific people identify reasons for or causes of disability that are cultural or religious and linked to divine punishment. It’s therefore important when working with te tamaiti to understand how the perspective of te tamaiti and their family/whānau may be influenced by their culture, and how cultural perspectives of disability can shape understanding and experience.
It will be important to work with specialist disability and health professionals, along with whānau, to understand how te tamaiti is impacted by their specific disability. If te tamaiti is in care the views of the caregiver will also be important to access.
Respecting the voice of disabled tamariki
Just like all tamariki, disabled tamariki have a right to have their views, wishes and feelings taken into account when decisions are made about their lives.
All tamariki can communicate their preferences if those working with them take the time to understand how they communicate. At times of significant change disabled tamariki with communication impairments are particularly vulnerable and need support to ensure their views, wishes and feelings are taken into account in assessment and planning.
Tamariki with disabilities might require specific communication and access aids in order for them to participate effectively in the assessment process. Adaptable methods that can be adjusted for particular individual needs are important.
For example, tamariki with hearing impairments or autistic spectrum disorder, in particular, might have difficulty picking up subtleties, such as in the tone of voice to indicate what is meant by a question or comment.
There is a similar problem if body language or expressions are used to indicate meaning when talking to someone with a visual impairment.
Tamariki with Fetal Alcohol Syndrome Disorder (FASD) or other neurodisabilities may have difficulty processing verbal information. People around a tamaiti may be challenged in interpreting their behavioural responses resulting in misunderstanding and limiting their potential participation in activities that they may otherwise enjoy.
It’s important to always keep in mind the impact of the disability on te tamaiti and for the social worker to change how they interact with them accordingly in order to support their involvement.
Engagement with specialist services
Assessment is critical and engagement with a specialist service may be required to fully assess and understand the specific needs of te tamaiti. Some disabilities, especially neuro-disabilities, are not always readily identifiable and specialist assessments may be needed to obtain a full understanding of the situation for te tamaiti and to access appropriate supports. This can be especially true for tamariki who enter care, and who may not have previously had access to health and disability services.
A specialist assessment may be necessary to understand the needs of te tamaiti and how their behaviour reflects their diagnosis, or to undertake a more specific assessment of some areas of ability in order to access particular services. Assessments are a partnership and the voice of te tamaiti and their family/whānau needs to be heard.
The purpose of any assessment needs to be clearly understood, for example an assessment to:
- determine diagnosis
- access services
- analyse in detail their mobility and self-care skills to help identify the most appropriate day care or respite care resource for te tamaiti.
Ensuring that the assessment is carried out by someone with specialist knowledge and cultural expertise is important.
Where more specialist assessment is required you may need to engage with:
- your Regional Disability Advisor
- your NASC agency
- mental health
- Ministry of Education
- other specialists.
It’s important that any further assessment is fully discussed with te tamaiti and their family/whānau.
A key concern for many parents is the number of assessments completed. The Tuituia assessment must draw on existing reports (including Gateway and Youth Justice Health and Education Assessments/Screens where appropriate) and specialist assessments concerning te tamaiti and their family/whānau once we have the necessary consents to use this information.
Disability assessment prompts
- Disabled tamariki have exactly the same rights to safety, protection, care, love and being supported to achieve to their full potential as non-disabled tamariki. Standards of care must be the same as for non-disabled tamariki.
- Seek to understand the perspective and experience of this individual tamaiti. How does their disability affect their safety, behaviour, learning, social connections?
- Uphold the mana of te tamaiti by capturing the strengths, abilities and competencies of te tamaiti and their family/whānau along with ensuring a full understanding of any disability or impairment needs.
- Is te tamaiti being enabled to actively participate in whānau tikanga activities and obligations?
- Have we considered what additional support and assistance te tamaiti may need in order for them to participate and express their views within the assessment process?
- How have we utilised engagement and communication strategies to support the participation and understanding of te tamaiti?
- How is our assessment and understanding of te tamaiti considering the views, strengths and challenges for the whānau? How have we involved the whānau in our assessment?
- How do cultural values and beliefs influence the experience of te tamaiti?
- Disabilities are not always readily identifiable – if behaviour or development is a concern be alert to the possibility that further exploration may be needed. This can be especially true for tamariki who enter care, and who may not have previously had access to health and disability services.
- Have we identified and accessed existing assessments and are we utilising them to support our understanding of the needs of te tamaiti? Are we clear about the purpose of any further assessments, and are we ensuring they are carried out by someone with specialist knowledge and cultural expertise?
- Are we actively engaged with health and education professionals to assess and understand the needs of te tamaiti?
- Are we working closely with health and education professionals to meet the needs of te tamaiti?
- There may have been barriers to accessing services – consult with your Regional Disability Advisor if you need assistance or support in assessing the needs of te tamaiti. Be an advocate for te tamaiti and their whanau.