Last updated: 12/05/2024

Guidance

Specialised assessments and support needs

We work in partnership with tamariki and rangatahi and their whānau or family and collaborate with specialised assessors to ensure that health and disability needs are understood and well supported.

Ko te raranga o te harakeke ka whakatau i te kaha o te kete.

The weave of the flax determines the strength of the basket.

Supporting tamariki and rangatahi and their whānau or family to have their needs understood and met (ngākau whakairo)

Tamariki and rangatahi and their whānau or family have the right to:

have appropriate assessments and plans to address their needs and support them to achieve their oranga aspirations
be heard and have their opinions considered during assessment and planning
participate in decisions that affect them, including what assessments are undertaken, who undertakes the assessment and how the assessment informs plans to address their needs and aspirations
have their cultural needs addressed during assessment, and for assessment and planning to reflect their understanding of oranga, their needs and their aspirations.

We have an obligation to ensure that assessments are purposeful and meaningful and contribute to the oranga aspirations of te tamaiti or rangatahi and their whānau or family.

Collaborating with whānau or family and other agencies to build understanding and meet support needs (whai mātauranga)

Te Puna Oranga is a holistic approach to practice with 6 interconnected dimensions of wellbeing. The metaphor of casting a stone into a puna demonstrates the dynamic nature of oranga.

Holistic view of health – Whai mātauranga in relational and inclusive disability practice

Case scenario: When te tamaiti or rangatahi has FASD, they have brain-based challenges and when their support needs are not met, the ripple that forms in hinengaro can flow across the other dimensions. This may impact on their ability to feel safe and form trusting relationships (ngākau) and potentially their school participation (waiora).

Their parents may be struggling and feel judged by other whānau or family members, professionals, and the wider community. At the same time, they may be stressed by their efforts to raise a tamaiti who isn't developing or behaving in ways that meet expectations for their chronological age. Problems at school may mean te tamaiti or rangatahi can't attend and a parent missing work to be at home with them.

Collaboration with other practitioners, clinicians and services is often required as we work with tamariki and rangatahi and their whānau or family to develop shared understandings of their strengths, challenges and support requirements, and their oranga needs and aspirations.

Understanding the roles, referral pathways and functions of other agencies and services can be difficult. The Regional Disability Advisors and Health and Education Advisors can help us to understand the purpose, eligibility criteria and language used by organisations, and to develop multi-agency plans.

Specialised assessments for tamariki and rangatahi

Needs are not always visible. This can be especially true for tamariki and rangatahi who may not have had full access to health and disability services. When whānau, family and caregivers tell us about concerns for the oranga, development or behaviour of tamariki or rangatahi, we have a duty to ask questions and find out more.

Many tamariki and rangatahi will have previously had a specialised assessment and diagnosis, and a well-documented history of their therapeutic and support needs. Others will not, or a previous assessment may be outdated, and we may need a better understanding of their needs. If this isn't addressed, opportunities for early intervention and to properly support whānau and families can be lost.

With Te Puna Oranga as our starting place, we add specialised assessments that help identify unique needs and build our shared understanding of tamariki and rangatahi. Specialised assessments are an opportunity for whānau, family and caregivers to receive information about any health, mental health, disability or learning issues affecting te tamaiti or rangatahi and help them better understand how to care for and support te tamaiti or rangatahi.

A specialised assessment should lead to:

increased understanding of the situation and what's happening for te tamaiti or rangatahi and their whānau, family and caregivers
enhanced understanding of the strengths, needs and support requirements of tamariki and rangatahi
recommendations tailored to the specific needs of te tamaiti or rangatahi within their whānau, family, care, education and community settings
more effective plans, including multi-agency and All About Me plans.

We work with te tamaiti or rangatahi and their whānau or family to decide which organisation is best placed to undertake the specialised assessment. We also talk with the guardian and gain their agreement and consent before making a referral.

The most common providers of specialised assessments are:

Child Development Services

Infant, Child and Adolescent Mental Health Services

Gateway assessments

Clinical Services (staff resource) – referrals are made through CYRAS

In some cases, ACC Sensitive Claims will be an option:

Counselling and therapy | acc.co.nz

The Ministry of Education Learning Support may be an option. It is only accessed through a referral from the school.

These options are best because they connect tamariki, rangatahi, whānau, family and caregivers to longer-term services. However, these options aren't always available, particularly for older tamariki and rangatahi, and we may need to arrange an assessment with a private clinician.

If we can't access a specialised assessment through publicly funded health and disability services or Clinical Services, we may arrange for and fund a private clinician (such as a psychologist, speech language therapist, occupational therapist) to undertake a specialised assessment.

We need to be sure that an assessor with the right skills is appointed and that they are appropriately briefed on the requirements.

Before engaging a private clinician

The social worker:

seeks a case consult with Clinical Services or a Regional Disability Advisor and their supervisor
confirms with Clinical Services that they are unable to provide the assessment
talks with te tamaiti or rangatahi and their whānau or family to understand what is important to them (such as the gender or culture of the assessor)
subject to agreement at the case consult, seeks financial approval to contract a private clinician to undertake the assessment
talks to Clinical Services or a Regional Disability Advisor to:
- identify a clinician with the knowledge and cultural experience needed to assess te tamaiti or rangatahi
- develop a brief for the specialised assessor that states what the clinician is being asked to do and any timeframes
submits the brief to their supervisor for approval.

Once these steps are completed, the social worker can engage with the private clinician or specialised assessor to discuss the brief and timeframes and ensure they are available to conduct the assessment.

If te tamaiti or rangatahi has an intellectual disability or autism, ask for this to be explicitly stated in the specialised assessment report. A diagnosis of intellectual disability or autism can help tamariki or rangatahi and their whānau, family and caregivers to access Whaikaha-funded disability support services through Needs Assessment Service Coordination (NASC) or Enabling Good Lives (EGL).
Needs Assessment Service Coordination (NASC), Enabling Good Lives (EGL) and Whaikaha Ministry of Disabled People

There can be a waiting time for a specialised assessment and receiving the report. Rangatahi involved with youth justice or transitioning out of care may be referred for an assessment but leave care before the first appointment is made. In this case, the social worker should discuss the options with the rangatahi and their whānau or family. The aim is to identify a whānau or family member or other trusted adult (such as a transition worker) who can support the rangatahi with the assessment and report process.

Supporting tamariki and rangatahi and their whānau or family to understand the outcomes of an assessment

The clinician who undertook the specialised assessment and made any diagnosis has a responsibility to explain it to the whānau or family, caregivers and others working with te tamaiti or rangatahi, and respond to their questions.

Te tamaiti or rangatahi and their whānau or family and caregivers may want to discuss the assessment outcomes further with their social worker. Seek advice from the specialised assessor or a Regional Disability Advisor or Clinical Services team member about how we can support these discussions and support te tamaiti or rangatahi and their whānau or family to build their understanding.

Good practice means we:

consider the developmental age of te tamaiti or rangatahi and don't give more information than they can understand
give messages in strength-based ways
keep it relevant to the way te tamaiti or rangatahi and their whānau or family see the world
make sure that no one is giving contrary messages
allow time for te tamaiti or rangatahi and their whānau or family to process the information – they may experience grief about a diagnosis. Once they've had time to process, we ask how we can help them to find out more.

A specialised assessment should include strategies for addressing needs and supporting te tamaiti or rangatahi. Key people working with te tamaiti or rangatahi and their whānau or family need to have a shared understanding of how best to provide support and interventions.

Talk with te tamaiti or rangatahi and their whānau or family about how the information from the assessment and any strategies provided can be shared with caregivers, other practitioners, teachers, and support people, and incorporated into plans.

Sharing information about tamariki and rangatahi

There is no single domain within Tuituia where mental health and disability needs are considered or captured. We therefore take particular care to ensure that other social workers or practitioners can easily find specialised assessments and recorded information on CYRAS. We:

upload any assessments, reports and plans into CYRAS and give them a clear casenote title
record any diagnoses under the person characteristics
duplicate key information under both intervention phases for tamariki and rangatahi with a dual care and protection and youth justice status.

Practising effectively to support understanding (whai pūkenga)

We use our social work skills when working with tamariki and rangatahi and their whānau or family to understand developmental, behavioural, mental health and wellbeing concerns, or where a disability has been identified. In particular, we use:

listening skills – to hear what te tamaiti or rangatahi, whānau or family and others are telling us about their concerns, experience, needs and aspirations
diverse communication skills – to support engagement with te tamaiti or rangatahi, whānau or family, to understand their experience, find out their perspectives and share new understandings as assessments are completed and plans developed
interpersonal skills – to show compassion for te tamaiti or rangatahi and their whānau or family as they journey through the assessment, diagnosis and planning process
internal collaboration – to seek advice from internal experts including Regional Disability Advisors, Health and Education Advisors and Clinical Services
advocacy for the whānau or family as they begin engagement with new services, and as needs are identified and service provision determined
coordination/networking – knowledge of and networks within the assessment, mental health and disability sectors will help us support whānau or family to navigate the systems. Making connections and building relationships with professionals and providers is important.

Whai ākona

Supervision and reflexive practices help us strengthen our responses and deepen our understanding of how we are working with whānau or family. We use these processes to consider how we are contributing to building a shared understanding with the whānau or family, and how working together to access services and supports can positively impact on oranga.

What helps me take a wide view of the oranga needs of this tamaiti or rangatahi and their whānau or family?
How is my understanding of mental health and disability influencing my approach to addressing any concerns? Is anything getting in the way of deepening my understanding and support?
Does the whānau or family see me as an advocate for them in terms of accessing supports? How does this sit with my role as an Oranga Tamariki social worker? Is this approach to advocacy working or is a different approach needed?
Am I informed about the assessment and service provision options available, and what advice or support do I need to better advocate for the whānau or family? How is my own knowledge or experience of services influencing my approach?
How can I use the Te Toka Tūmoana takepū to support my engagement, understanding and advocacy for the whānau or family?
How can I use Va'aifetū to support relational, inclusive and restorative support and advocacy for Pacific families?
How am I demonstrating a commitment to whānau or family rights, supports and advocacy as we work together in a way that will support and enhance their oranga?