Upcoming changes for this guidance
This content will be strengthened so it more completely reflects our commitment to practice framed by te Tiriti o Waitangi, based on a mana-enhancing paradigm for practice, and drawing from Te Ao Māori principles of oranga to support mana tamaiti, whakapapa and whanaungatanga. We each need to consider how we can apply these principles to our practice when reading this guidance. The following resources provide support:
Practice for working effectively with Māori
Our practice shift
The definition of health needs
- 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, 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 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, psychologists
- specialist health services, such as mental health, disability, drug and alcohol
- Māori health practitioners.
Assessment is critical to ensure a comprehensive understanding of the needs of te tamaiti, their whānau or family and their caregiver. Assessment will assist in identifying the range of health practitioners who may be required to support the health of te tamaiti. If more specialist support is required, consult with your supervisor and your regional disability advisor.
Special considerations may apply if you are sharing information with health providers.
Enrolling with a primary health provider
The foundation for ensuring health needs are met is enrolling and engaging tamariki with a primary health provider. For most tamariki their primary health provider will be a GP.
If te tamaiti isn’t enrolled with a primary health provider or engaged with a GP we need to enrol them. Things to consider when enrolling tamariki include:
- what service does te tamaiti wants to be enrolled with
- availability of a Māori health practitioner who is suitable to meet the needs of te tamaiti Māori
- availability of a health practitioner who has knowledge and experience of cultural values and practices of te tamaiti
- what support does te tamaiti need to complete their enrolment
- is the information held by the GP up to date
- has te tamaiti moved out of the area and do they need a new GP
- who does te tamaiti and/or their caregiver want to attend the first appointment
- does te tamaiti want their GP to know they’re in care
- does the GP have a copy of their gateway assessment
- do parents and whānau or family have any views about who te tamaiti should be referred to.
Tamariki can only be enrolled with one GP. If tamariki need to be seen by a GP and don’t have access to their usual GP or are in the middle 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 need to move 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 with a GP. It is important that you explore all local options including contacting the clinical lead at your local Primary Health Organisation (PHO) or, the primary care portfolio manager at the local District Health Board (DHB) for assistance.
Matching services to te tamaiti
It’s important for any patient to have a good relationship with their health provider. Tamariki 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 temaiti. For tamariki Māori, Māori health services are likely to be best placed to achieve this.
At different ages and stages, tamariki 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 especially mindful of tamariki who have needs relating to gender identity before they reach adolescence. This might be difficult for some tamariki to navigate especially if they feel their whānau or family or caregivers don’t understand. It’s important to support tamariki to access the appropriate services and support. Consider whether there are school-based health services tamariki can access or specialist youth health services, such as Youth One Stop Shops (YOSS).
When working with rangatahi and their health needs, we need to think very carefully about their privacy and what information it is and is not okay to share. Sharing health information about tamariki can be more complex than sharing other information as there are particular codes of practice that health practitioners work within and generally a higher expectation to maintain confidentiality and trust with rangatahi. When we are working with older rangatahi in regards to these particularly sensitive areas of health, we must balance their age, level of understanding and wishes in regards to whether information should be shared with our obligations to ensure their safety and wellbeing.
To help us determine what information we should or should not share, we should:
- consider the advice about youth health, information sharing and privacy on the Children’s and Privacy Commissioners websites
- be clear that we understand the views of rangatahi — be specific about what information they are okay for us to share and with who, and about what information they definitely don't want us to share (the My Rights My Plan cards talk can be used to support this discussion)
- talk to our supervisor about how the decision to share or not share information could impact the safety and wellbeing of te tamaiti — if in doubt, seek further advice from Legal Services.
Accessing an annual health check
Establishing a regular routine around health is important. Some tamariki will have more frequent engagement with their health professionals, but ensuring tamariki have at least an annual health check will help provide support for tamariki to have their health needs met. Any concerns about the health and wellbeing of te tamaiti should be raised with the doctor or the practice nurse completing the check. Outstanding recommendations from the gateway interagency services agreement of te tamaiti should also be discussed.
Consider the timing of the annual health check. To inform plans (family group conference or court) and ensure we have the right supports in place to meet tamariki health needs, it’s important that the health information about tamariki is up to date. If tamariki have not been to their health professional for some time, make an appointment for their annual health check before the family group conference or court review.
The annual health check is a good opportunity to talk with tamariki 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.
For school-aged tamariki their annual health check will be completed by 1 of the following:
- GP or practice nurse
- school-based health providers
- youth health service
- a 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 GP or practice nurse or Māori health provider.
Rangatahi may want to manage their own appointments. In these cases the social worker will casenote their agreement with rangatahi. If rangatahi want to attend their appointment alone, we will 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 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.
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 will arrange any referrals to other health services that are needed and this will be recorded in the All About Me plan.
Consider how we can involve whānau or family in physically assisting tamariki with their health needs. This can provide an opportunity for whānau or family to meet their whanaungatanga responsibilities for tamariki.
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 with long-term health conditions and who regularly (3–6 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 under the age of 18 years are eligible to access the Community Oral Health Service (COHS) for standard annual dental checks. Social workers should ensure tamariki receive an annual dental check.
Tamariki should be enrolled with the COHS soon after birth and are usually first examined by a dental or oral health therapist between one year and two years of age. It’s important to ensure tamariki are engaged in this service early to help establish healthy dental habits. Make sure you provide the caregiver with support if tamariki are anxious about visits to the dentist or oral health therapist. School-aged tamariki usually receive publicly funded dental care from private dentists contracted by DHBs for this service.
Sometimes tamariki need a referral for extra treatment (such as orthodontic treatment). Discuss the treatment plan with tamariki, 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 move it’s important to ensure that they are enrolled with an oral health service provider in their new area. If te tamaiti can stay enrolled with their current provider, we should ensure their contact details are updated.
COHS provides for tamariki 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 in care will qualify for these 6-monthly examinations. Ask the oral health provider te tamaiti is enrolled with to check their eligibility.
Phone: 0800 TALK TEETH or 0800 825 583
Engaging tamariki about their health information
Uphold the mana of te tamaiti by engaging with them about their health needs and when sharing their health information. Support te tamaiti 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 to make choices about treatment or intervention in their health — this is especially important for tamariki considering matters like puberty blockers or other medical interventions that impact on te tamaiti.
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 and how they influence their understanding of health needs and supports.
Offer opportunities for te tamaiti to ask questions about their health and wellbeing and support te tamaiti to access information to answer their questions. Consider what health information might be relevant to provide to tamariki to meet their needs, for example information on physical development and growth, healthy relationships, and positive attitudes to sexual health, psychological, and emotional health. Sources of information include:
- health practitioners who are working with tamariki
- trusted New Zealand based internet sources, such as Aunty Dee, the Lowdown and patient portals.
Accessing publicly funded specialist services
To ensure te tamaiti 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 to address mental health or physical health needs. It’s important that, if specialist services are identified, te tamaiti 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 and their whānau or family or carer needs to be heard. It’s important we work with te tamaiti, 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, for example trauma experience or mental health needs.
We must follow the information sharing policy and guidance when sharing information with health providers.
Policy: Sharing information
Keep te tamaiti, 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 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 may have incurred a non-accidental traumatic brain injury:
- If te tamaiti 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 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 who have been sexually abused should have an ACC claim registered. If this hasn’t happened, talk to te tamaiti 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 may have significant needs as a result of an accident or injury, including disabilities that require specialist support. It’s important to establish entitlement for these tamariki as this can open doors to accessing services to meet their needs.
Once entitlement to ACC has been established, talk to the ACC case manager about what is available to te tamaiti.
Accessing private health services
Assessment is a crucial part of establishing how to meet the health needs of te tamaiti 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 is unable to access publically 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 when assessing the impact of waitlists. The amount of time te tamaiti should wait for services to support them will depend on the individual needs of each tamaiti.
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
Oranga Tamariki must ensure that a record of the health history of te tamaiti is maintained. To provide an accurate record of the health needs of te tamaiti, 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, along with any medical records obtained from GPs and other health practitioners.
Ask te tamaiti if they would like to record any significant health events in their life storybook.
Let tamariki know about their health information and support them if they want to know more about their health history. This could include supporting te tamaiti to access their health records held by other professionals. Tamariki 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. To access hospital information te tamaiti should contact their DHB — again they may want or need support to do this.
A GP can also help get the information te tamaiti wants.
Keep information on the health needs and supports updated as part of ongoing assessment, including accurate recording on CYRAS.