Our practice in this area
In all of our engagement with tamariki, whānau or family and caregivers, we need to be first guided by our values and how we will ensure the oranga (safety and wellbeing) of tamariki, whānau or family and caregivers. This guidance helps us to modify our usual social work practice approach in the context of a measles outbreak to prevent the transmission of the measles virus. Please be mindful our current health and safety guidance must also be followed when applying this guidance. We should also take into account our existing practice guidance and practice policy where it does not conflict with the specific guidance provided here.
What is measles
Measles is a highly infectious viral illness that can be very serious. It can lead to pneumonia, brain infection and sometimes death. It can spread quickly and easily through breathing, sneezing and coughing. It is especially dangerous for pregnant women who are not immune, pēpi and people with weakened immune systems.
Because measles is highly infectious, it's important for us to consider when engaging with tamariki and whānau or family who are living in overcrowded households and particularly relevant if tamariki and whānau or family are living in emergency centres or temporary accommodation due to the recent Cyclone impacts as transmission can occur very rapidly.
Measles symptoms include a high fever, runny nose, cough and sore 'pink' eyes. A few days later, a rash starts on the face and neck, and then spreads to the rest of the body. A person can have measles and spread it to others before they feel sick or show any symptoms. Symptoms may take around 7 to 14 days to develop after exposure.
It is important to stay vigilant about this illness as cases are currently being reported in Aotearoa New Zealand. The country's measles vaccination rates have fallen in the recent years, and we need to boost them again as we reopen to the world after COVID-19. People are being asked to vaccinate with the MMR vaccine and be on the lookout for symptoms of measles. The MMR vaccination helps protect all of us.
Measles vaccinations should be offered to those who are not fully immunised. People born before 1 January 1969 are considered immune. People born after 1 January 1969 require 2 measles vaccinations to be fully immunised. On average, one dose is 95% effective, and two doses is more than 99% effective. People who have had their measles vaccine can’t catch measles.
MMR vaccinations are scheduled at 12 months and 15 months of age.
The vaccinations are free for New Zealand residents and contacts of cases. People who have had 2 MMR vaccinations, have had measles before or are over 50 years old are considered immune to measles, and should not worry. Everyone else over 12 months old should be immunised with at least 1 MMR vaccination.
Infants 6 months and over can be given MMR early if necessary. Advice on early vaccination would be provided by a medical practitioner:
It can take around 2 weeks for a person to be fully immune after being vaccinated. The MMR vaccination is the best protection against measles, and the most important thing people can do to protect themselves is to ensure that they and their tamariki are immunised.
Vaccination is particularly important for those planning to travel overseas – to protect them and prevent outbreaks in Aotearoa New Zealand.
Identifying tamariki and rangatahi who are not immune to measles
Good health is essential to oranga (wellbeing) and positive life outcomes. We need to support and assist tamariki and whānau or family we're working with to access health services, both to maintain their oranga and meet any health and disability needs – this includes access to immunisations and ensuring they are up to date.
For tamariki and rangatahi in the custody of the chief executive, we need to proactively engage to understand if they are already vaccinated and, if they are not, to support them to receive the MMR vaccine. Key steps include:
- Check CYRAS to see whether a tamaiti or rangatahi that we have guardianship or custody for is considered immune (they have had 1 or 2 MMR vaccinations). This should be identifiable in their gateway report.
- If it cannot be determined from CYRAS whether or not a tamaiti or rangatahi has been vaccinated or has had measles in the past, we should contact their parents or guardians to try to find out this information.
- If they don't know, we should request consent to obtain this information from the healthcare provider of te tamaiti or rangatahi.
Consent for tamariki and rangatahi to receive the vaccine
While everyone has the right to information to make an informed choice or give informed consent, the law relating to tamariki consent to medical treatment, including vaccination, is complex. We have guidance to support us with consent for medical examinations and treatment:
In addition to this guidance, there are some specific considerations in relation to vaccinations:
- Take a whole of whānau or family approach when discussing MMR vaccination, as parents and caregivers may also not be immune.
- We make sure we are familiar with the legal status and who the legal guardians are of any tamariki or rangatahi we are working with in relation to the MMR vaccine.
- For tamariki in the care or custody of the chief executive, consent must be obtained from their guardians before booking a vaccination.
- It is the role of the healthcare professional to determine whether a tamaiti or rangatahi is competent to give informed consent.
- The Oranga Tamariki Act 1989 has different requirements for guardian consent to medical treatment for rangatahi in a youth justice residence under a section 311 supervision with residence order. Rangatahi under the age of 16 under a section 311 order require guardian consent to receive the MMR vaccine.
- Caregivers are unable to take tamariki in their care to be vaccinated without the consent of the legal guardians.
- If the caregiver for te tamaiti is also a legal guardian, engagement must still occur with the other guardians, parents and whānau, and any other guardians should also provide consent.
- If tamariki or rangatahi can't provide informed consent, we should talk to them about the importance of vaccination and hear their views, considering their age and development.
- Engage with the guardians for te tamaiti – clearly record their decision about consent, their views and those of te tamaiti as a casenote on CYRAS.
When Oranga Tamariki can consent to vaccination
Oranga Tamariki practice leaders have the delegation to solely consent to the vaccination being administered where we hold:
- sole guardianship
- specific guardianship for medical purposes, or
- wardship of tamariki or rangatahi and our role as an agent of the court specifies guardianship responsibilities, including relating to approving health or medical treatment.
However, we should still engage with tamariki, rangatahi and their parents, any other guardians and whānau or family around the issue of consent for vaccination. We also talk with the lawyer for child.
If Oranga Tamariki holds additional guardianship
Where we hold additional guardianship, we must talk with other guardians about the importance of vaccination. If guardians do not provide their consent, we should respect their decision not to vaccinate. We inform the lawyer for child of the outcome from these discussions.
If Oranga Tamariki holds custody but not guardianship
Where we have a custody order but no guardianship order, we cannot provide consent. We should encourage guardians to provide consent by helping them to access factual information about the benefits and known risks of the vaccine, but this is ultimately their decision to make.
If there is disagreement
If there is any disagreement from tamariki, rangatahi or guardians or between tamariki, rangatahi and guardians, seek advice from Legal Services and inform the lawyer for child.
Only in extreme circumstances (for example, where not receiving the vaccination may result in serious health concerns for tamariki or rangatahi) would we consider further options to legally enable the vaccination to be administered. This would be by way of on-notice application to the court where all parties would have the opportunity to be heard. Discuss these situations with the lawyer for child.
If we are unsure about any aspect, we get in touch with our local solicitor.
Engaging with tamariki, rangatahi, whānau or family and caregivers
Where it is known that a tamaiti or rangatahi cannot be vaccinated for medical reasons or is already susceptible to infection, we must take extra care about ensuring we don't expose them to measles. If we suspect or are unsure if a tamaiti or rangatahi is non-immune to measles, consider ensuring that the Oranga Tamariki staff they have contact with are immunised. If tamariki or rangatahi are showing symptoms, caregivers should seek medical advice. This may include being quarantined at home.
Uphold the mana of te tamaiti by engaging with them about their health needs. This includes enabling and supporting te tamaiti to make choices about treatment or intervention in their health. Offer opportunities for te tamaiti to ask questions about vaccines and give them access to information to answer their questions.
Help whānau or family to access reliable information and listen to any concerns they have. Support a whānau or family-based approach to vaccination. If whānau or family need support to be vaccinated themselves, ask how we can assist them (for example, transport or explore the possibility of them being vaccinated at the same time as their tamariki). Provide specific information about where and when whānau or family can be vaccinated in their community. Explore familiar environments and people who whānau or family trust.
Visiting with tamariki, rangatahi, whānau or family and caregivers
Oranga Tamariki provides essential services to tamariki and their whānau and we need to keep doing this in a way that keeps everyone safe and well when there are community health concerns, including when there are measles outbreaks.
That includes the manner and frequency that tamariki in care are engaged with during a measles outbreak if they are vulnerable to exposure or if they are quarantining or if there are conditions within a Public Health Order. In order to limit the spread of measles in the community, social workers may need to modify their approach to engaging with tamariki in care to ensure they are not increasing the risk of exposure to them and the wider community.
If there is widespread measles transmission in the community, there may be limitations on the social worker's ability to undertake kanohi ki te kanohi (face-to-face) visits with tamariki, whānau or family and caregivers.
If there is widespread measles in the region where we are working, our manager should support us if we need to implement Infection Prevention and Control measures, such as using appropriate personal protective equipment or only allowing immune staff to have kanohi ki te kanohi contact with tamariki or rangatahi when they have not been vaccinated or their immune status is unknown.
When measles is confirmed
Our social workers need to continue engaging with tamariki who are in care and we need to consider their needs outlined in their All About Me plan in the context of the current situation. The All About Me plan should specify the frequency of visits to te tamaiti. This should be the starting point for determining the nature and frequency of contact during a spread of measles in communities.
A measles diagnosis could add additional stress to te tamaiti or rangatahi or their whānau or family or caregivers. If anyone needs to stay at home quarantined for a long period of time, it could bring about more challenging dynamics with people in a confined space not being able to engage with their usual daily activities.
This is a time when tamariki and those who care for them are likely to need more support from us than usual. Therefore, providing support to tamariki in care presents unique challenges and we need to be creative and innovative in exploring other ways of engaging that is not person to person.
We are not prevented from person-to-person engagement (unless contrary to any Public Health Order issued by Medical Officers of Health under the Health Act 1956) but should use remote engagement wherever it is possible to do so effectively. Kanohi ki te kanohi engagement can only occur where there is a safety or welfare concern that is unable to be effectively addressed or mitigated through remote means and is required. Before undertaking kanohi ki te kanohi engagement, we must be satisfied that this cannot be done appropriately by remote means.
In the absence of kanohi ki te kanohi contact from the social worker and limited contact with whānau or family and others in their whanaungatanga networks, more frequent episodes of engagement using remote means may be appropriate to support both te tamaiti and those caring for them.