We modify our usual social work practice approach in the context of a measles or whooping cough outbreak to prevent the transmission of the viruses. Measles, whooping cough and immunisation

Page URL: https://practice.orangatamariki.govt.nz/our-work/care/caring-for-tamariki-in-care/supporting-tamariki-with-their-health-needs/medical-examinations-and-treatment/
Printed: 06/12/2024
Printed pages may be out of date. Please check this information is current before using it in your practice.

Last updated: 14/10/2024

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

This guidance has been strengthened with clearer practice considerations for social work kaimahi regarding medical or dental examinations and treatments, and to reflect our practice approach.

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.

Gender Minorities Aotearoa

What transgender health promoters want you to know (presentation from the New Zealand Sexual Health Society Conference 2019) | Gender Minorities Aotearoa

Intersex Aotearoa

Making Ourselves Visible: the experiences of takatāpui and rainbow rangatahi in care (PDF 2.4 MB) | Te Ngākau Kahukura

Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa New Zealand

For tamariki Māori, we get additional guidance from the kairaranga ā-whānau, a senior Māori practitioner or a bicultural practitioner:

Kairaranga ā-whānau

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.

Residences – links

Youth justice residences standard operating procedures

Practice framework domain: Ngākau whakairo

Practice standard: Whakamana te tamaiti – Practice empowering tamariki Māori

Policy: Participation of tamariki – Providing information, ensuring understanding and incorporating their views

Policy: Sharing information

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

Policy: All About Me plan

Measles and immunisation

Gateway assessments

Engaging tamariki and rangatahi about their health information – Supporting tamariki and rangatahi with their health needs

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.

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

Female genital mutilation

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.

Even if the assault happened in the past, tamariki and rangatahi may benefit from a MEDSAC doctor reassuring them that they are physically healthy and well.

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)

Sexual Abuse Assessment and Treatment Service (SAATS)

Child Protection Protocol (CPP)

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)

Policy: Sharing information

Engaging tamariki and rangatahi about their health information – Supporting tamariki and rangatahi with their health needs

Practice framework domain: Whai pūkenga

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.

Practice standard: Keep accurate records

Policy: Case recording

Working with tamariki and rangatahi when allegations of abuse, neglect or harm are made against their caregiver