Guidance
Supporting tamariki and rangatahi with their health needs
Good health is essential to wellbeing and positive life outcomes. We need to support tamariki and rangatahi to access health services, both to maintain their good health and to meet any health and disability needs.Updates made to this guidance
Definition of health needs
These include:
- physical – including dental, auditory and nutritional health, and any health needs in relation to a disability or long-term condition
- psychological – including any need for assistance to recover from the effects of trauma
- alcohol and drug misuse.
Some examples of health needs includes:
- sexual health
- long-term conditions, such as diabetes, asthma, epilepsy, eczema and severe allergies
- disability, including physical, intellectual and sensory disability or other neuro-disabilities such as Autism Spectrum Disorder (ASD) or Fetal Alcohol Spectrum Disorder (FASD).
Working with health professionals
To ensure the right health supports are in place for te tamaiti or rangatahi, it is important to build and maintain strong relationships with health professionals.
This could include:
- public and school-based nurses
- general practitioners (GPs) and practice nurses
- gateway assessors and coordinators
- specialist health professionals, such as paediatricians, physiotherapists, speech and language therapists, and psychologists
- specialist health services, such as mental health, disability, and drug and alcohol
- Māori and Pacific health practitioners.
Assessment is critical to ensure a comprehensive understanding of the needs of te tamaiti or rangatahi, their whānau or family and their caregiver. Assessment will help identify the range of health practitioners who may be needed to support the health of te tamaiti or rangatahi. If more specialist support is needed, we consult with our supervisor and regional disability advisor.
Special considerations may apply if we are sharing information with health providers.
Enrolment with a primary health provider
To meet the health needs of tamariki and rangatahi in care or custody, we must ensure they are enrolled and engaged with a primary health provider. For most tamariki and rangatahi, this will be a GP.
If te tamaiti or rangatahi isn't enrolled with a primary health provider or engaged with a GP, we need to enrol them. Tamariki and rangatahi may require us to provide support to complete their enrolment.
Tamariki and rangatahi can only be enrolled with one GP. If tamariki and rangatahi need to be seen by a GP and don't have access to their usual GP or are in the process of being enrolled, they need to attend an appointment as a casual patient. There may be a higher charge for rangatahi who are 14 years old and over.
If tamariki and rangatahi need to change GP, it's our responsibility to advise the previous GP and enrol them with a new GP. It's the responsibility of the GP to transfer patient notes.
There may be times when, due to capacity within medical practices, it is challenging to enrol tamariki and rangatahi with a GP. It's important to explore all local options, including contacting the clinical lead at the local Primary Health Organisation (PHO).
Policy: Support for tamariki and rangatahi in care or custody
Primary health organisations | Health New Zealand Te Whatu Ora
Matching services to te tamaiti or rangatahi
It's important for any patient to have a good relationship with their health provider. Tamariki and rangatahi may have preferences for the type of GP they are likely to feel comfortable with and these preferences should be supported wherever possible.
It is important that health services have knowledge and experience of the cultural values and practices of te tamaiti or rangatahi. For tamariki and rangatahi Māori, Māori health services are likely to be best placed to achieve this.
Kaupapa Māori organisations – directory | Healthpoint
Working with Māori: Te Toka Tūmoana
At different ages and stages, tamariki and rangatahi may ask for or need different support to meet aspects of their health needs, particularly during adolescence when needs around sexual health, gender identity and sexuality start to be explored. We need to be mindful of tamariki and rangatahi who have needs relating to gender identity before they reach adolescence. This might be difficult for some tamariki and rangatahi to navigate, especially if they feel their whānau or family or caregivers don't understand. It's important to support tamariki and rangatahi to access the appropriate services and support. Consider whether there are school-based health services tamariki and rangatahi can access or specialist youth health services, such as Youth One Stop Shops (YOSS).
Identity and culture Tuituia domain – Gender and sexual identity
Accessing an annual health check
Establishing a regular routine around health is important. Tamariki and rangatahi should have at least an annual health check. Any concerns about the health and wellbeing of te tamaiti or rangatahi should be raised with the GP or practice nurse completing the check. This is a good opportunity to check the health professional has a copy of the most recent gateway assessment and any outstanding recommendations should also be discussed.
Consider the timing of the annual health check. It's important that the health information about te tamaiti or rangatahi is up to date. If te tamaiti or rangatahi has not been to their health professional for some time, make an appointment for their annual health check before the next family group conference or court review.
The annual health check is a good opportunity to talk with tamariki and rangatahi about matching the health professional to their needs as these can change over time.
Tamariki under 5 years receive free health visits and support as part of the Well Child Tamariki Ora programme, including the B4 School check. It's important to ensure te tamaiti is actively engaged with Well Child Tamariki Ora and receiving services. This will meet the annual health check requirements.
Well Child Tamariki Ora programme | Te Whatu Ora Health New Zealand
For school-aged tamariki and rangatahi, their annual health check will be completed by 1 of the following:
- GP or practice nurse
- school-based health providers
- youth health service
- Māori health practitioner.
Arranging the annual health check
In some cases, the health provider will schedule a check-up as part of usual service delivery. This is more likely for Well Child Tamariki Ora and some school-based health services.
In all other cases, the social worker will ensure an appointment is made with the health provider.
Rangatahi may want to manage their own appointments. In these cases, the social worker casenotes their agreement with the rangatahi. If rangatahi want to attend their appointment alone, we check if they need any help, such as transport and money to pay for the appointment.
Follow-up after the annual health check – addressing health needs
The GP or practice nurse should contact the social worker or caregiver to let them know what is happening and to ensure te tamaiti or rangatahi is supported to take medication or attend further appointments. Sometimes, test results and other information will be posted or emailed. Who receives the information depends on the individual circumstances of each tamaiti or rangatahi.
Where no information is provided by the GP or practice nurse, the social worker should contact the GP and ask about any follow-up actions that may be needed.
Rangatahi may decide what, if any, information is provided to the caregiver or social worker.
The annual health check provider arranges any referrals to other health services that are needed. This is recorded in the All About Me plan.
All About Me plan to meet the needs of tamariki
Consider how we can involve whānau or family in physically assisting tamariki and rangatahi with their health needs. This can provide an opportunity for whānau or family to meet their whanaungatanga responsibilities for tamariki and rangatahi.
Situations where an annual health check is not completed
In some situations, it may be reasonable that an annual health check is not completed, such as:
- for tamariki and rangatahi with long-term health conditions and who regularly (3 to 6 monthly) have contact with their GP or a practice nurse or specialist health practitioner (such as a paediatrician)
- rangatahi who don't consent – in this instance, we should take some time to talk through the options available to rangatahi and to understand the reasons they don't consent, and make sure we discuss this regularly with them and offer to help find the right support to meet their health needs.
When an annual health check isn't completed, record the reason.
Accessing an annual dental check
All tamariki and rangatahi under the age of 18 years are eligible to access the Community Oral Health Service (COHS) for standard annual dental checks. Tamariki and rangatahi should be enrolled with the COHS soon after birth and are usually first examined by a dental or oral health therapist between 1 year and 2 years of age. It's important to ensure tamariki and rangatahi are engaged in this service early to help establish healthy dental habits.
Social workers should ensure tamariki and rangatahi receive an annual dental check. Social workers should provide the caregiver with support if tamariki and rangatahi are anxious about visits to the dentist or oral health therapist. School-aged tamariki and rangatahi usually receive publicly funded dental care from private dentists contracted by DHBs for this service. If this is not available for te tamaiti or rangatahi and they don't receive a publicly funded annual dental check, we may need to fund a private dental appointment for this purpose.
Sometimes, tamariki and rangatahi need a referral for extra treatment (such as orthodontic treatment). Discuss the treatment plan with te tamaiti or rangatahi, their caregivers and the dentist or oral health technician, including any costs. We should consult with our supervisor and site manager when there are additional treatment costs.
When tamariki and rangatahi move, it's important to ensure that they are enrolled with an oral health service provider in their new area. If te tamaiti or rangatahi can stay enrolled with their current provider, we should ensure their contact details are updated.
COHS provides for tamariki and rangatahi who have higher dental needs to receive 6-monthly checks – for example, in some DHB areas, this is used to provide regular fluoride varnish. Most tamariki and rangatahi in care will qualify for these 6-monthly examinations. Ask the oral health provider te tamaiti or rangatahi is enrolled with to check their eligibility.
Phone: 0800 TALK TEETH or 0800 825 583
Engaging tamariki and rangatahi about their health information
Uphold the mana of te tamaiti or rangatahi by engaging with them about their health needs and when sharing their health information. Support te tamaiti or rangatahi to express their views and actively participate in identifying any health needs they have and supports they may need. This includes enabling and supporting te tamaiti or rangatahi to make choices about treatment or intervention in their health. If te tamaiti needs additional support and assistance to participate, consider how we can provide this.
Consider the cultural values and beliefs of te tamaiti or rangatahi and how they influence their understanding of health needs and supports.
Offer opportunities for te tamaiti or rangatahi to ask questions about their health and wellbeing, and support te tamaiti or rangatahi to access information to answer their questions. Consider what health information might be relevant to provide to tamariki and rangatahi to meet their needs – for example, information on physical development and growth, healthy relationships, and positive attitudes to sexual health, and psychological and emotional health. Sources of information include:
- health practitioners who are working with tamariki and rangatahi
- trusted New Zealand-based internet sources, such as Aunty Dee, the Lowdown and patient portals.
Accessing publicly funded specialist services
To ensure te tamaiti or rangatahi receives the right health supports to meet their needs, there may be times where a specialist health service is required. This could include supporting te tamaiti or rangatahi to address mental health or physical health needs. It's important that, if specialist services are identified, te tamaiti or rangatahi is supported to access them in a timely manner.
Most specialist services require a referral from a primary care provider, such as their GP, Well Child Tamariki Ora nurse or Māori health provider.
Assessments are a partnership and the voice of te tamaiti or rangatahi and their whānau or family or caregiver needs to be heard. It's important we work with te tamaiti or rangatahi, their caregiver and their whānau or family to support any referral to a specialist service. This will include making sure the specialist service has access to relevant information about te tamaiti or rangatahi – for example, trauma experience or mental health needs.
Practice standard: See and engage tamariki
Keep te tamaiti or rangatahi, whānau or family and caregivers informed about progress, timelines and outcomes in relation to specialist services.
Advice on wait times for services will usually come either from the primary care provider or in response to the referral from the service provider.
Accessing ACC services
ACC can provide assistance where te tamaiti or rangatahi has health and disability-related needs that are caused by injury or injuries or accident. This can include:
- injuries caused by everyday accidents
- injuries arising from serious harm events that gave rise to a care or protection concern
- sensitive claims that relate to sexual abuse.
Tamariki or rangatahi may have incurred a non-accidental traumatic brain injury:
- If te tamaiti or rangatahi saw a health practitioner when their brain injury occurred, they are likely to have cover and may have an ACC case manager. If not, the GP is usually the best person to follow up with ACC about this.
- If te tamaiti or rangatahi did not visit a medical service at the time of their injury, they are unlikely to have ACC cover. ACC cover can be difficult to establish after the event so we should talk to ACC and get advice from our regional disability advisor.
Tamariki and rangatahi who have been sexually abused should have an ACC claim registered. If this hasn't happened, talk to te tamaiti or rangatahi and, with their consent, seek registration using information Oranga Tamariki holds. We can talk to our regional disability advisor about how to register directly with an ACC provider. ACC determines eligibility for their response – note that there is no requirement for the perpetrator to be charged with a crime for the consideration of cover.
Tamariki and rangatahi may have significant needs because of an accident or injury, including disabilities that require specialist support. It's important to establish entitlement for these tamariki and rangatahi as this can open doors to accessing services to meet their needs.
Working with disability and learning supports, mental health and ACC
Once entitlement to ACC has been established, talk to the ACC case manager about what is available to te tamaiti or rangatahi.
Accessing private health services
Assessment is a crucial part of establishing how to meet the health needs of te tamaiti or rangatahi and should be recorded in the All About Me plan. When making decisions about accessing private healthcare, the recommendations of health practitioners need to be taken into account. If te tamaiti or rangatahi is unable to access publicly funded services in a timely manner, or at all, due to a lack of availability, explore access to other health services and investigate options for privately funded health or therapeutic services. Consider the needs of te tamaiti or rangatahi when assessing the impact of waitlists. The amount of time te tamaiti or rangatahi should wait for services to support them will depend on the individual needs of each tamaiti or rangatahi.
We should identify the cost implications of engaging private health services and discuss these with our supervisor and site manager.
Providing a record of health for tamariki and rangatahi
Oranga Tamariki must ensure that a record of the health history of te tamaiti or rangatahi is maintained. To provide an accurate record of the health needs of te tamaiti or rangatahi, we need to include visits to health professionals and any operations or treatments in the All About Me plan – My Health Information section.
This is also where regular supports (such as medications) should be recorded. It's important we monitor progress of supports as part of the regular plan review.
The All About Me plan – My Health Information section will form the health record for te tamaiti or rangatahi, along with any medical records obtained from GPs and other health practitioners.
Ask te tamaiti or rangatahi if they would like to record any significant health events in their life storybook.
Maintaining a record of important life events
Let tamariki and rangatahi know about their health information and support them if they want to know more about their health history. This could include supporting te tamaiti or rangatahi to access their health records held by other professionals. Tamariki and rangatahi may want or need support navigating this. The best place to access primary health information is by signing up for a patient portal – check if this is available through the primary healthcare provider for te tamaiti or rangatahi. To access hospital information, te tamaiti or rangatahi should contact their primary health provider and they may want or need support to do this. A GP may also help get the information te tamaiti or rangatahi wants.
Keep information on the health needs and supports updated as part of ongoing assessment, including accurate recording on CYRAS.