Guidance
Medical examinations and treatment
Tamariki or rangatahi may need a medical exam or treatment for obvious illness or injury, or at other times such as after an unauthorised absence or being missing, engaging in high-risk behaviour or sharing they've been harmed but we can’t see an injury.Updates made to this guidance
Applying our practice framework when supporting medical and dental examinations and treatment
Tamariki and rangatahi and their whānau or family have the right to be heard about participating in a medical or dental examination and treatment. Before we make a referral for any type of medical examination or treatment, we kōrero with te tamaiti or rangatahi and their whānau or family or caregivers so they are fully informed about what need this is meeting.
All guardians of tamariki and rangatahi (both natural and court appointed) have rights, powers and responsibilities in important matters affecting the oranga of tamariki and rangatahi. This includes health care, and consent to major medical, psychological, psychiatric or dental treatment, including blood transfusions, vaccinations and sterilisation.
Any form of medical or dental examination or intervention can be traumatic and impacts people in different ways and can feel like an invasion of their privacy. We are sensitive to people’s feelings when we work with te tamaiti or rangatahi and their whānau or family.
Involving te tamaiti or rangatahi and whānau or family early
Whakamana te tamaiti
We involve te tamaiti or rangatahi and their whānau or family as early in the process as possible. This gives them time to talk things over with wider whānau or family and others, seek advice from medical professionals, ask questions and make an informed decision in their own best interests.
This need for considered decision-making may particularly apply when a physical examination is being proposed for siblings of those who may have been harmed and whānau or family believe the siblings may not need to have an examination.
If we are working with tamariki and rangatahi who identify as part of the rainbow and takatāpui community, especially if they identify as non-binary, transgender or gender diverse or are intersex, we take extra care to understand their social, emotional and physical needs around participating in a medical examination.
Some tamariki and rangatahi may have complex health care needs or health care-related trauma. Experiences of stigma, discrimination and lack of knowledge from clinicians has meant many takatāpui and rainbow people have had negative and distressing interactions with medical professionals and therefore have high anxiety in these situations. We can do several key things to support tamariki and rangatahi in these cases:
- Always listen to te tamaiti and rangatahi to hear what is important to them, what kinds of support they need, and who they want this from.
- Be aware that we may need to act as an advocate for te tamaiti or rangatahi, ensuring that the health care professional:
- uses the correct pronouns and name for te tamaiti (we check with te tamaiti before we do this as they may not be comfortable being ‘out’ as rainbow or takatāpui to the health care professional)
- does not ask unnecessary or invasive questions related to the sexual orientation or gender identity of te tamaiti or rangatahi
- does not provide unsolicited advice or opinions related to the sexual orientation or gender identity of te tamaiti or rangatahi.
Additional guidance is available internally from the Senior Advisor, Rainbow Voices or from the employee-led Rainbow Network.
For tamariki Māori, we get additional guidance from the kairaranga ā-whānau, a senior Māori practitioner or a bicultural practitioner:
For Pacific children or young people, we apply Va’aifetū and seek advice from an appropriate cultural advisor:
Working with Pacific peoples: Va’aifetū
Rangatahi and tamariki in residences
For rangatahi and tamariki in a care and protection or youth justice residence, there are some differences with how we approach medical consent and treatment in some circumstances. Alongside this guidance, we refer to the appropriate policies and current Standard Operating Procedures (SOPs) to ensure we are engaging appropriately with rangatahi and tamariki in these care arrangements.
Youth justice residences standard operating procedures
Practice framework domain: Ngākau whakairo
Practice standard: Whakamana te tamaiti – Practice empowering tamariki Māori
Practice framework domain: Whai mātauranga
We gain knowledge and build our understanding about the physical, emotional and psychological oranga of te tamaiti or rangatahi from them and their whānau or family. When medical or dental examinations are needed, we also seek the support and advice of the appropriate medical and dental professionals.
Sometimes, whānau and families will speak to us about indigenous or ‘alternative’ healing practices and interventions they would like to use. When this happens, some key things to be considered alongside whānau and family preferences include:
- holding a meeting with the whānau or family, social worker and medical professionals involved to discuss the benefits and possible risks to the oranga of te tamaiti or rangatahi
- how the use of traditional or alternative options can complement the recommended examination or treatment.
If whānau or family decide to seek alternative medical or dental treatment against professional advice, we seek legal advice about next steps.
Whai mātauranga in relational and inclusive disability practice
Seeking consent to talk to tamariki and rangatahi
Explaining rights and entitlements to tamariki and rangatahi
Indigenous medical and healing practices
Indigenous approaches to understanding and treating ill health have been around for thousands of years and continue to be widely used around the world and can complement scientifically sourced treatments. When talking with whānau or family about medical and dental examinations and treatment for their tamaiti or rangatahi, ask if they have any indigenous or alternative practices they want considered.
Examples might include acupuncture, herbal medicines, homeopathy, traditional Chinese medicine, spiritual therapies, yoga, naturopathy, chiropractic, osteopathy, ayurvedic and Unani medicine.
WHO Global Traditional Medicine Centre
Rongoā Māori
Rongoā is a traditional Māori healing system. It involves the use of native plant-based remedies (rongoā rākau), massage (mirimiri) and spiritual healing through prayer (karakia).
Rongoā is about wellbeing: the wellbeing of the person, the whenua, the soil, and the water flowing through the whenua. Rongoā is a way of being healthy rather than just for healing. It aims to recreate balance and harmony within the spiritual, psychological, environmental, physical and family dimensions.
Healing with Tutu: Rongoā Māori | YouTube
Medicinal plants Ngā rākau rongoā | Canopy Tirohanga Ngahere
Find an ACC-registered rongoā Māori practitioner | ACC
Find a Māori health provider | Medical Council of New Zealand
The Pacific Nations
Across the islands of the Pacific, traditional healers (such as Taulasea and Fofo in Samoa, Kau Faito’o in Tonga, Ta’unga in Cook Islands, and Vuniwai in Fiji) play an active part in the health and wellbeing of fanau and communities, using a combination of medicinal herbs, therapeutic massage and therapeutic techniques. Families living in Aotearoa New Zealand often consider the use of indigenous methods to diagnose and treat health needs, alongside western medicine and treatment options.
Consent for medical examinations and treatment
The decision to consent to medical and dental examinations and treatment needs to be carefully considered. We make all reasonable efforts to get consent for a medical examination or treatment from the parents or guardians and te tamaiti or rangatahi, whatever phase of work we are in.
For tamariki and rangatahi in Oranga Tamariki care or custody, the social worker should always be informed whenever a medical or dental examination and treatment is required whether it's a routine or non-routine procedure. If an urgent, non-routine medical examination or treatment is required after hours (before the next business day), it is the role of the after-hours duty social worker to contact the parents or guardians to seek informed consent.
Informed consent
When tamariki or rangatahi in our care need medical or dental examinations or treatment, we get the appropriate informed consent and keep te tamaiti or rangatahi and their whānau or family well informed. We need to get consent from all guardians, and from te tamaiti or rangatahi.
Before a person can give consent to any medical or dental treatment, we ensure that te tamaiti or rangatahi and their whānau or family have all the relevant information from the appropriate medical professionals. We may support this by facilitating a kōrero between te tamaiti or rangatahi and their whānau or family and the medical profession. They must clearly understand:
- what is being proposed
- why the intervention is needed
- whether there are alternatives
- the benefits
- the implications for te tamaiti or rangatahi in terms of pain or invasiveness
- the risk of unexpected complications.
When we can't get consent from parents or guardians
If parents or guardians disagree about the proposed examination or treatment or refuse to give consent, we make sure everyone has all the available information to help them consider the options and access to medical professionals who can answer their questions.
If a medical examination or treatment is required in urgent or emergency situations (for example, a hospital admission, an operation) and a parent or guardian cannot be found or refuses consent, consultation should occur with our supervisor, a practice leader, site manager and legal representative if the proposed treatment is considered to promote the wellbeing of te tamaiti or rangatahi. In some circumstances, hospitals can proceed without guardians' consent – this is a decision for the medical professionals in line with their own policies, procedures and legal advice.
Where we have either sole guardianship or additional guardianship, and only in exceptional circumstances, we may consent without the agreement of parents or other guardians. Before we do this, we always consult with our supervisor, site manager and legal team. We do not proceed with the examination or treatment without consent unless, in exceptional circumstances, an order (by the court) has been gained to give us the authority to proceed.
If there's difficulty getting consent – Gateway assessments
Legal provisions for medical examinations
Consent to procedures generally – section 36(3) of the Care of Children Act 2004
Rights to make decisions about their own lives
Rangatahi aged 16 years or older who are able to give consent can consent or refuse to consent to medical procedures. A tamaiti of any age can consent or refuse to consent to a procedure to terminate a pregnancy (unless there's a reason they are not deemed to be competent). This is a decision for the health care professional in terms of their professional and ethicial obligations and not something we can decide on. A medical competency assessment (known as the Gillick competency assessment) may be applied in this instance.
If it is decided te tamaiti or rangatahi is Gillick competent, we make comprehensive notes about what has informed the decision by the medical professional and record it in CYRAS.
While it may have been determined by a medical professional that te tamaiti or rangatahi has capacity to consent independent of whānau or family, we should speak with them about the importance of sharing what is happening for them with their parents, caregivers or guardians. We need to let te tamaiti or rangatahi under 16 know that their parents are entitled to request their health information under the Health Information Privacy Code 2020. The decision on what information will and won’t be released lies with the medical professionals and their agencies.
Can I get my child's health information? | Privacy Commissioner
Understand if they have any worries about doing this or if they would like some support to have these conversations. Te tamaiti or rangatahi may require post examination or treatment care and support in their recovery and this is most likely to come from caregivers and whānau or family members – for example, assistance with moving around, taking medication, showering following a surgical procedure.
When te tamaiti or rangatahi cannot consent to a medical treatment or examination but it is determined to be in their best interests, we uphold the mana of te tamaiti or rangatahi by telling them in an age-appropriate way what is happening and why. We consider their views on what might happen in consultation with their parents or guardians. We record comprehensive notes about how a decision was reached for te tamaiti or rangatahi to have an examination or treatment, who was involved, and how this was explained to them.
If te tamaiti or rangatahi is not capable of consenting to medical procedures, the process for getting consent will depend on the type of medical treatment te tamaiti or rangatahi needs.
Routine medical procedures
Routine medical and dental procedures are procedures that a tamaiti or rangatahi generally needs to have for their day-to-day care – for example, visiting a GP if they’re unwell, and routine checks such as dental check-ups and Plunket or Well Child Tamariki Ora checks.
The caregiver will seek permission from a social worker before any routine medical and dental procedures take place for tamariki and rangatahi in care, and a social worker or a supervisor makes the decision. This information needs to be recorded in the tamariki All About Me plan and in the caregiver support plan, as well as any other case recording as appropriate.
Non-routine medical procedures
Non-routine medical procedures include immunisation, injections, examinations under anaesthetic, internal examinations, examination of the anal or genital region, and examinations relating to alleged sexual abuse, physical abuse or neglect, and operations.
We require a guardian to give consent to these important medical procedures. Where a guardian cannot be found or refuses consent, consultation should occur with our supervisor, practice leader, site manager and legal representative if the proposed treatment is required for the wellbeing of te tamaiti or rangatahi.
Rights to make decisions about their own lives
Supporting tamariki with their health needs
Talking to tamariki, whānau or family and caregivers about the COVID-19 vaccine
Sexual abuse care
We consult with the Police and follow the Child Protection Protocol (CPP).
As part of the care and protection assessment, we may arrange for a medical practitioner to do an examination. These doctors are Medical Sexual Assault Clinicians (MEDSAC) who are trained in determining sexual abuse.
When a medical examination requires an internal examination of the genital or anal area, te tamaiti or rangatahi is required to give consent if they are considered competent, as described in the Gillick competency guidelines above.
Testing for Gillick competency
The purpose of the internal examination is to:
- address any health concerns – for example, injury, sexually transmitted infections or pregnancy
- help the Police investigation through the collection of evidence, if appropriate
- support Police proceedings in court.
When deciding whether an internal or genital examination is in the best interests of te tamaiti or rangatahi, we:
- consider the views of guardians, whānau or family and significant professionals about a treatment or an examination for forensic purposes, and the potential benefits
- balance this with the impact and trauma of the examination itself on te tamaiti or rangatahi and any concerns they or their whānau or family might have
- consider any cognitive or other impairments for tamariki and rangatahi that may affect their ability to give consent
- ensure they have all the information available.
This will be a difficult process for te tamaiti or rangatahi. Find out if they want to have someone with them at the examination for support and reassurance.
Medical Sexual Assault Clinicians Aotearoa (MEDSAC)
Confidentiality
Under the Gateway process, we offer confidentiality to te tamaiti or rangatahi and their parents or guardians when they share information, unless there are concerns about the safety of te tamaiti or rangatahi, such as self-harm, harm to someone else, or the potential to be harmed by another person.
If we need to share their information with others as part of a medical or dental examination or treatment, we discuss with te tamaiti or rangatahi the reasons for sharing information before we share it. When a medical examination is part of an investigation, we should tell te tamaiti or rangatahi what the information will be used for and who will have access to it and why.
When we collect and use information within the Gateway assessment process, we are governed by the Privacy Act 2020, the Oranga Tamariki Act 1989 and to an extent the Official Information Act 1982 and the Health Act 1956.
Personal information must be kept safe and secure and only released where we have authority to do so.
Legal aspects relating to the Gateway assessment process (DOCX 103 KB)
Recording
Whether it is for a tamaiti or rangatahi in our care, or during an investigation or child and family assessment, whenever a tamaiti or rangatahi participates in a medical or dental examination, we record this clearly in CYRAS. We need to:
- include what we discussed with te tamaiti or rangatahi and their whānau or family
- include how this decision was reached with te tamaiti or rangatahi and their whānau or family, or how we have kept the parents and guardians of te tamaiti or rangatahi informed
- clearly capture each of their views and wishes
- use clear casenote headings so the information can be easily found
- capture the medical professional's decision if the Gillick competency test has been applied.