What is the caregiver support plan
All caregivers, regardless of their level of experience, or whether they are whānau or non-whānau are required to have a support plan. The purpose of the caregiver support plan is to develop caregiver capability and ensure ongoing support to enable them to:
- meet the needs of tamariki and rangatahi
- connect tamariki and rangatahi to their identity
- provide safe and loving care.
The caregiver support plan specifies the general training, resources and supports needed to build their capability to care for tamariki and rangatahi, and where required, the support to meet the unique needs of individual tamariki and rangatahi.
Caregivers are part of the team around te tamaiti or rangatahi. An effective caregiver support plan is built on good communication and respectful collaboration between the caregiver, the caregiver social worker, and the social worker for te tamaiti or rangatahi.
The National Care Standards outlines the purpose of a caregiver support plan.
When should the caregiver support plan be developed
In most situations the caregiver support plan is developed as part of the caregiver assessment and approval, and then updated when the decision is made to place te tamaiti or rangatahi with the caregiver.
Depending on the needs identified in the assessment, an early version of the support plan may be in place well before a decision is made to place te tamaiti or rangatahi with the caregivers.
Who is responsible for developing the plan
The caregiver social worker is responsible for the development of the support plan, but it’s a collaborative process with the social worker for te tamaiti or rangatahi and the caregiver.
The caregiver social worker arranges a meeting with the caregiver, and if required, the social worker for te tamaiti or rangatahi to develop the plan, then records the caregiver support plan in the template under the caregiver record.
How to create a caregiver support plan
We use the caregiver support plan template to document the support needs of caregivers.
What's in the caregiver support plan
The caregiver support plan is informed by the needs identified in the caregiver assessment and the All About Me plan for te tamaiti or rangatahi.
The caregiver support plan specifies the ongoing support required to meet these needs, including:
- the generic support and resources needed for the caregiver to build their capability and maintain their own family/whānau functioning, such as training, counselling and financial support
- the specific support to meet the unique needs of tamariki and rangatahi in their care, such as challenging behaviour, babysitting or respite care
- provisions for monitoring, visits, the reasons for the frequency of visits, and review
- assigned responsibilities and timeframes for specific actions or tasks, such as provision of support or completion of training.
The caregiver support policy outlines what the caregiver support plan must describe.
If the services, training or resources aren’t available, then the caregiver support plan will include alternative supports to meet this need. This may include more frequent visits or monitoring.
Updates to the caregiver support plan are informed by the caregiver review process, any changes in the caregivers' circumstance or needs, and after there has been an allegation of abuse, neglect or harm of a tamaiti or rangatahi in their care.
Assessing caregiver support needs
The caregiver’s support needs will be identified in the caregiver assessment and approval, and review process. Assessment of support needs includes an analysis of the needs, strengths and circumstances of the caregiver and their household, as well as the likely effect of the placement on te tamaiti or rangatahi and on the caregiver’s household.
Support needs will vary depending on the caregiver’s experience of raising tamariki, their parenting skills and knowledge of tamaiti development, resilience and life experience. Support needs will also be influenced by the needs of the caregiver’s family/whānau and, more importantly, the needs (including cultural needs) of the tamariki and rangatahi in their care.
The assessment process will include a discussion about the caregiver’s own goals, and goals for their family/whānau, what they do to keep themselves well, and the people in the caregiver’s support system.
The caregiver support plan will need to consider any training and support which might be required to enable the caregivers to meet the needs of tamariki and rangatahi placed in their care alongside any support which might be required for the caregivers and their family/whānau to maintain family/whānau life.
The support plan should be realistic and achievable for the caregiver. Some support may already be provided through the caregiver's own networks of support, or simply through timeout for recreation. Consider what additional support is needed to allow the caregiver to continue this after a tamaiti is placed in their care.
The All About Me plan is the key document through which the caregiver is able to understand why te tamaiti or rangatahi can’t live with their parents, and the specific support te tamaiti or rangatahi requires from their caregiver. Once a decision is made to place a tamaiti or rangatahi with the caregiver, consultation is required with the care and protection social worker about any specific needs to be met by the caregiver, for example cultural or disability needs. These will need to be reflected in the caregiver support plan.
You will need to discuss with the caregiver:
- how individual family/whānau members, especially tamariki and rangatahi, will cope with another tamaiti or rangatahi in the household
- the adjustments they will need to make to accommodate the needs of te tamaiti or rangatahi
- whether respite care is needed to support the caregiver, including how that respite will be available through familiar networks to te tamaiti or rangatahi
- whether another person will be required to assist the caregiver in times of high demand
- the services available in the caregiver’s community, if services or agency support is required
- if the placement is transitional, how the caregiver will support te tamaiti or rangatahi to transition back to family/whānau care or to another placement
- how the emotional needs of the caregiver and their family/whānau members will be met.
Consideration also needs to be given to the age of te tamaiti or rangatahi and the nature of the care provided when developing the support plan. A respite carer may not have the same support needs as a transitional or permanent caregiver.
Particular care should be given with whānau caregivers who may believe it’s their responsibility to care for te tamaiti or rangatahi – they may feel whakamā about asking for support for caring for their own family/whānau.
The process of developing the caregiver support plan provides a further opportunity for discussion with the caregiver about their understanding of the expectations of the caregiver role, their understanding of tamariki or rangatahi needs and rights, and the support they require to uphold and meet these.
Caregivers have a key role in upholding mana tamaiti, protecting their whakapapa, and strengthening whanaungatanga connections with whānau, hapū and iwi in the day-to-day care of tamariki and rangatahi.
The Oranga Tamariki Act 1989 outlines our obligations to improve outcomes for tamariki and rangatahi Māori.
Discussion with the caregiver should explore how they respond to the particular identity needs of te tamaiti or rangatahi, including any gender, sexual orientation, disability, spirituality or religion, cultural and language needs.
The caregiver support plan may include support to:
- connect tamariki and rangatahi with whenua and participate in activities and experiences relevant to their culture and identity, such as marae events and kapa haka
- enable and support tamariki to participate in important family events such as tangihanga
- celebrate significant events for te tamaiti or rangatahi and their family/whānau — for example, siblings' and significant whānau birthdays
- maintain or improve proficiency in the languages te tamaiti or rangatahi identifies with — for example, te reo Māori.
These needs are generally well met for tamariki and rangatahi who are cared for by whānau members. However it shouldn’t be assumed that whānau caregivers do not need support.
The support plan requires us to consider the cultural identity of the caregivers and te tamaiti or rangatahi. If they aren’t whānau caregivers, do they share hapū or iwi connections?
It’s important not to make assumptions about caregivers and tamariki who are of the same culture. For example, if the caregivers are Māori but don’t speak te reo Māori, how will they support a tamaiti or rangatahi whose first language is te reo Māori? What additional support might be required to meet the cultural needs of this tamaiti or rangatahi?
Because Aotearoa is increasingly multicultural, tamariki and rangatahi may whakapapa to more than one culture. In some situations it’s not always possible to find caregivers of the same culture as te tamaiti or rangatahi, especially if te tamaiti or rangatahi has been placed under an emergency order, such as a place of safety warrant. The support plan must consider the caregiver’s ability to understand, respect, and support the cultural needs of tamariki and rangatahi in their care, and specify any training, support or resources to enable them to meet the cultural needs of the tamariki and rangatahi.
Consider how the caregiver will:
- recognise and support the individual strengths and talents of te tamaiti or rangatahi and motivate them to reach their potential
- support te tamaiti or rangatahi to have a voice in decisions and plans, to be proud of their culture and identity and value their whakapapa
- listen to the concerns of te tamaiti or rangatahi and advocate for them when required.
The support plan needs to include the training or support required to understand and meet these needs.
Support for maintaining family/whānau connections
The caregiver support plan includes the maintenance and recognition of the vital role that identity, connection and belonging play in the life of a tamaiti in care, and in particular through direct relationships with their extended family/whānau.
The caregiver needs to understand the significance of whanaungatanga for tamariki Māori in promoting a sense of connection, belonging and identity. This is important to support te tamaiti or rangatahi to maintain and strengthen relationships with their family/whānau, hapū and iwi.
Consider how the caregiver will foster a positive view of both maternal and paternal family/whānau to support the relationship between te tamaiti and their family/whānau. This will include discussion about whānau involvement in the life of te tamaiti or rangatahi and how the caregiver will support and prepare te tamaiti or rangatahi for contact with family/whānau so that it’s a positive experience.
Caregivers may need specific support to manage tamariki and rangatahi contact with parents and siblings. The caregiver support plan must specify the training, support or resources required to enable the caregiver to meet these needs.
Supporting tamariki and rangatahi who are affected by trauma
The impact of past trauma coupled with the distress of being moved from their family/whānau and then placed in an unfamiliar environment may be reflected in the presentation of te tamaiti or rangatahi. This can be seen in:
- challenging or acting out behaviour
- attention seeking or clingy behaviour
- changes to eating sleeping and toileting habits
- running away
- self-harming or suicidal behaviour
- addictions or obsessive behaviour
- overly compliant or “parentified” behaviour.
Occasionally behaviour associated with trauma may not be immediately apparent, or the initial behaviour may settle down only to reoccur weeks or even months later.
The quality of the care environment and the role of the caregiver is a critical element in helping tamariki to recover from the impact of trauma. The caregiver needs to be able to provide a safe, calm environment, and predictable, reassuring responses to support te tamaiti or rangatahi to stabilise and heal.
The caregiver’s understanding of the effects of trauma, and what to expect when a tamaiti or rangatahi who has experienced trauma comes into their home, should be considered in the caregiver support plan. Good information, training and support will increase placement stability and support te tamaiti or rangatahi to recover from trauma. Conversely, a lack of support for caregivers can contribute to placement breakdown, and a sense of rejection for te tamaiti or rangatahi who may be left feeling responsible for the placement breakdown.
Additional training or resources required to assist the caregiver to understand how trauma impacts on behaviour and emotional health need to be clearly specified in the caregiver support plan.
Caring for tamariki and rangatahi with disability needs
Tamariki and rangatahi with disabilities are disproportionately represented in the care population. Their vulnerability needs to be recognised because they may not be able to express their views or protect themselves. Inadequate caregiver support may contribute to tamariki and rangatahi feeling defined by their disability, or being stigmatised or even harmed in care. A robust support plan will not only provide increased safety for te tamaiti or rangatahi, but should also enhance their inclusion and participation in decisions and plans, for their daily life and future.
Caring for a tamaiti or rangatahi with a disability may require the caregiver to develop new skills to meet their needs. You will need to consider:
- the caregivers’ knowledge and experience in managing tamariki and rangatahi with disabilities
- how the caregivers will meet the needs of te tamaiti or rangatahi, and how will they manage these alongside the needs of their own family/whānau
- the impact of having a tamaiti or rangatahi with a disability in the home on the caregiver’s family/whānau
- the impact of the caregiving family/whānau on te tamaiti or rangatahi
- how the caregiver will support te tamaiti or rangatahi to have a voice
- how the caregiver will support the connection of te tamaiti or rangatahi with communities of support, for example the Blind Foundation.
Support for health needs
The support plan must consider the resources, training and other supports to enable the caregiver to meet any increased responsibilities that health issues can bring.
Tamariki or rangatahi in care frequently have health needs which require knowledge and skills to manage. Physical health needs may require the caregiver to manage and dispense medication, attend specialist appointments and keep a watchful eye on symptoms.
Health also includes emotional and psychological needs which caregivers may not have encountered before – for example, tamariki and rangatahi with anorexia, depression or suicidal ideation. This may require the caregiver to understand how these health issues manifest and how to respond in order to manage them. It’s important that full information, including details of medication, is provided to the caregiver to enable them to adequately support and care for te tamaiti or rangatahi.
Support for education
The caregiver support plan must specify any additional training, support or resources required to enable them to support the educational needs of tamariki and rangatahi in their care.
Caregivers have a key role in supporting the educational achievement and progress of tamariki and rangatahi, so that they can meet their potential. This includes:
- providing quiet space and time for homework
- encouraging te tamaiti or rangatahi with their school work
- ensuring te tamaiti or rangatahi is well equipped and prepared for school
- establishing good communication with the school
- liaising with the school about any trauma or disability related needs
- supporting opportunities for participation in school activities
- supporting recreational opportunities, and activities at home which support learning
- supporting training or work experience opportunities for rangatahi approaching independence
- providing opportunities for te tamaiti or rangatahi to have school friends after school.
Gender identity and sexual orientation
The caregiver support plan needs to identify any additional supports, such as services or resources, they need to support a tamaiti or rangatahi who struggles with gender identity, or identifies as gender diverse.
Tamariki and rangatahi who experience issues with gender identity or sexual orientation will ideally be matched with caregivers who are experienced and able to support them in their developing sexuality and identity.
It’s important that the caregiver’s beliefs and views about gender identity and sexual orientation are explored in the caregiver assessment process.
Support for tamariki and rangatahi who have offended
The caregiver support plan needs to include any additional support required for the caregiver to help tamariki and rangatahi to take responsibility for their offending. Key considerations are:
- how the caregiver will ensure that the placement satisfies the elements of detention if the rangatahi is detained in custody
- how the caregiver will respond to any re-offending, especially offences which might occur in the caregiver’s home – for example, an assault on another tamaiti or rangatahi in the home
- how the caregiver will support the rangatahi to complete the youth justice plan, including the restorative justice plan – consider what other support is required to help the caregiver meet these needs
- how the caregiver responds to a tamaiti offender whose needs are predominately care and protection related
- how the caregiver meets the wellbeing needs of te tamiti and rangatahi while supporting them to be accountable for their offending
- the caregiver’s understanding of legal issues, including bail conditions.
Meeting independence needs
The caregiver support plan needs to consider the caregivers’ experience caring for rangatahi as they transition to adulthood and the support they might require to enable them to support rangatahi through this developmental stage.
This includes the nature of support required for rangatahi who want to remain in the caregiver’s home or return to that home after they turn 18 years of age.
Support plans for provisionally approved caregivers
Provisionally approved caregivers have not been through the full assessment process. They are usually family/whānau members who have been asked to care for a tamaiti or rangatahi under emergency circumstances – for example, after a tamaiti or rangatahi has come into care through a warrant.
They may not have had the opportunity to make the necessary adjustments to accommodate the needs of te tamaiti or rangatahi, or thought through what changes there may be for their own family/whānau. In some instances the proposed caregiver may not have a relationship with te tamaiti or rangatahi, or understand their needs. Provisionally approved caregivers may also need support with practical things such as beds, bedding, car seats or clothing.
Tamariki and rangatahi placed with provisionally approved caregivers need to be recognised as especially vulnerable. Similarly, the period between provisional and full approval is a time of high need for caregivers. Full assessment and approval must be completed as soon as practicable and within 25 days of the date of provisional approval.
Prioritisation of the safety needs of tamariki and rangatahi is critical during this period and, accordingly, monitoring provisions must be a key feature of the support plan. It’s expected that the frequency of visits will be increased to recognise the need for close monitoring of the safety and wellbeing of tamariki and rangatahi during this time. The frequency of visits may reduce when the caregiver has been fully assessed and there is evidence that te tamaiti or rangatahi has settled well into the new care environment. It’s important that caregiver social workers and tamariki and rangatahi social workers work together closely, particularly during this period.
Care Partner agency caregivers (section 396 provider caregivers)
If te tamaiti or rangatahi is placed with a section 396 caregiver, then the responsibility for developing and reviewing the caregiver support plan lies with the Care Partner agency social worker in collaboration with the Oranga Tamariki social workers.
Careful consultation and planning will need to occur between the section 396 provider social worker, the caregiver and the Oranga Tamariki social worker about how the support needs will be met.
The National Care Standards regulations apply to all care providers, including Care Partner agencies approved under section 396 of the Oranga Tamariki Act 1989.
Monitoring the caregiver support plan
Primary responsibility for monitoring the caregiver support plan lies with the caregiver social worker. However the social worker of te tamaiti or rangatahi also has a role in monitoring caregiver support needs through visits to te tamaiti or rangatahi and contact with the caregiver.
Effective monitoring is dependent on the quality of communication between both social workers who need to share information from their visits. The frequency of visits to te tamaiti or rangatahi will vary according to the needs of te tamaiti or rangatahi and the caregiver. For example, if te tamaiti or rangatahi has just moved to a new placement, visits by their social worker and the caregiver social worker or other caregiver support person, for example a Whānau Ora Navigator, will be more frequent and will reduce once it’s evident te tamaiti or rangatahi has settled into a routine.
Visits by the caregiver social worker are to discuss how the caregiver is managing to meet the cultural, educational, health and emotional needs of te tamaiti or rangatahi. They will also consider the support the caregiver requires to provide safe and appropriate care and the caregiver’s development plan.
The caregiver needs to understand that the social worker for te tamaiti or rangatahi will need to see te tamaiti or rangatahi on their own as well as in the caregiver’s home.
The purpose of the visits by the social worker for te tamaiti or rangatahi is to assess:
- the safety and wellbeing of te tamaiti or rangatahi
- progress with the plan for te tamaiti or rangatahi
- the caregiver’s ability to meet the needs of te tamaiti or rangatahi.
Review of the caregiver support plan
The purpose of the review is to ensure that the caregiver is still able to meet the needs of te tamaiti or rangatahi and to determine what further supports, if any, are required.
The review should include a face-to-face discussion between the caregiver and the caregiver social worker, who is responsible for updating the caregiver support plan in the CYRAS caregiver record, and where appropriate, the social worker for te tamaiti or rangatahi.
The caregiver support plan is active and will change according to the caregiver’s situation and the changing needs and circumstances of tamariki and rangatahi placed with them.
It’s expected that the support plan will be regularly reviewed when the needs or circumstances of the caregiver or te tamaiti or rangatahi change, including:
- after there has been allegation of abuse, neglect or harm of a tamaiti or rangatahi in their care
- the placement of a new tamaiti or rangatahi in the home.
Who can access the plan
The caregiver is entitled to a copy of the support plan. Parts of the plan, depending on the relevance, may also be shared with te tamaiti or rangatahi or, if appropriate, any other person who has participated or has a role in the plan. Discuss any plans to share this information with the caregiver.
When collecting and sharing information gathered for the purpose of the caregiver support plan, the privacy principles in the Privacy Act around the storage, security and use of the information will apply.