What is the health domain
The sub-domains for this domain are:
- grief and loss
- suicide and self-harm
- emotional wellbeing
- physical wellbeing.
Other domains to consider are:
- identity and culture (gender identity, disability)
- behaviour, (Pro-social, self-control, right from wrong, concerning and harmful sexual behaviour, substance use, sexual activity)
- friendships (empathy and respect)
In completing the assessment of health needs for te tamaiti it’s important to:
- seek the views of the tamaiti and their family/whānau
- engage with the school, health professionals or other professionals involved with te tamaiti to seek their views and identify opportunities to work together, especially if te tamaiti is in care
- review any specialist assessments including gateway or Youth Justice screening assessments that have been completed or ensure these are undertaken if required
- consider how the cultural perspectives of the family/whānau may influence the experience of te tamaiti and seek cultural support if required
- seek the views of the caregiver if te tamaiti is in care
- consider the relevant Tuituia domains to draw together your assessment.
The health domain also informs the emotional needs assessment required in the National Care Standards.
The health domain encompasses Māori and western health models, as well as the National Care Standards and other considerations for tamariki and rangatahi in care.
Health can change in both positive and negative ways and this may require reassessment of the tamaiti or rangatahi health needs.
Check and align your thinking with the Behaviour Domain and sub-domains – harmful sexual behaviour, substance use and sexual activity.
A gateway assessment is an interagency process that helps to clarify and identify ways to address the health and education needs of tamariki we work with. Gateway assessments are for tamariki and rangatahi at risk of coming into Oranga Tamariki care, entering care or already in care.
As a result of their backgrounds, many of these tamariki and rangatahi have a combination of health and education needs that have gone unidentified or untreated prior to coming into care. To be successful, gateway assessments require Oranga Tamariki, District Health Boards (DHBs), schools, ECE providers and other education services to work closely together.
Youth Justice health assessments
A health assessment is a wide ranging primary screening process using a holistic approach with a focus on identifying the risks and resiliencies for the tamariki or rangatahi and how to formulate a plan towards protective factors.
This is a comprehensive health assessment for tamaiti and rangatahi who offend which supports informed decision making and better outcomes at the youth justice family group conference.
Te Whare Tapa Whā – a Māori health model
For many Māori modern health services lack recognition of taha wairua (the spiritual dimension). In a traditional Māori approach, the inclusion of the wairua, the role of the family/whānau and the balance of the hinengaro (mind) are as important as the physical manifestations of illness. Te Whare Tapa Whā is a Māori health model developed by Dr Mason Durie.
Western health models
Western health models describe health as:
- the achievement and maintenance of physical fitness and mental stability. Health and wellbeing is the result of a combination of physical, social, intellectual and emotional factors
- the absence of physical illness, disease and mental distress - ideas about health and wellbeing change over time and vary between different cultures and life stages
- dental health, immunisations and enrolment in a Primary Health Organisation (GP)
- health considerations need to think about wairua, values and beliefs and how these impact on health and wellbeing. Family/whānau beliefs about treatments, traditional medicine, immunisations, food (vegans, vegetarians etc) for example can have significant impacts on decisions.
Other cultural concepts
- Health beliefs: In some cultures, people believe that talking about a possible poor health outcome will cause that outcome to occur.
- Health customs: In some cultures, family/whānau members play a large role in health care decision making.
- Ethnic customs: Differing roles of women and men in society may determine who makes decisions about accepting and following through with health services.
- Religious beliefs: Religious faith and spiritual beliefs may affect health care-seeking behaviour and people's willingness to accept specific treatments or behaviour changes.
- Interpersonal customs: Eye contact or physical touch will be expected in some cultures and inappropriate or offensive in others.
- Dietary customs of the family/whānau may mean some foods are not part of their diet. For example:
- Jewish families who follow kosher food rules have prohibitions on the consumption of certain animals, such as pork and shellfish, mixtures of meat and milk, and the commandment to slaughter mammals and birds according to a process
- Seventh Day Adventists believe a well-balanced vegetarian diet that avoids the consumption of meat coupled with intake of legumes, whole grains, nuts, fruits and vegetables, along with a source of vitamin B12, will promote vigorous health.
Ask and understand what the food choices and diet te tamaiti or rangatahi is used to – don’t assume. For tamariki in care, make sure any dietary needs and preferences are recorded in the All About Me plan.
Disability assessment prompts
- When considering the health domain any disability is a significant component of the overall health and wellbeing of te tamaiti or rangatahi to understand.
- If te tamaiti or rangatahi is in care their All About Me plan must reflect the plans in place and supports needed to address disability concerns.
- Do they have a diagnosed disability and has a NASC (Needs Assessment and Support Coordination service) assessment been done. What does this tell you?
- To be healthy, people with disabilities require health care that meets their needs as a whole person, not just as a person with a disability. Disabled tamariki have the same health needs as non-disabled tamariki.
- Disabled tamaiti or rangatahi need health care and health services the same as non-disabled, such as immunizations, screening, other aspects of health care.
- It’s important we don’t ignore health issues and blame the disability – a person with a disability should not suffer from a health issue any more than non-disabled people
- Having a disability does not mean te tamaiti or rangatahi is unhealthy but may need additional supports to manage their disability and reach their potential. Work with their Needs Assessment Service Coordinator(NASC), District Health Board(DHB) and Ministry of Education(MoE) providers to ensure these are in place. Te tamaiti or rangatahi may have additional or more complex health needs as a result of their disability.
- We need to understand how the particular disability for te tamaiti or rangatahi impacts on health, now and into the future. We need to understand any potential or existing secondary health conditions that are present, such as pain or being susceptible to infections.
- There may have been barriers to accessing services – consult with your Regional Disability Advisor if you need assistance or have any further questions.
Other considerations that impact on health and wellbeing of tamariki and rangatahi in care
- If te tamaiti or rangatahi is placed in care the preference is for placement with members of the wider family/whānau, hapu, iwi and family group.
- Te tamaiti or rangatahi must also be supported to establish, maintain or strengthen their sense of belonging through cultural identity and connections to family/whānau, hapu, iwi or family group. This is even more important if the caregivers are non-kin and support, strengthening and assisting te tamaiti or rangatahi to return home or transition in to the community is important.
- Te tamaiti or rangatahi connections to family/whānau, hapu and iwi through whakapapa and whanaungatanga helps build resilience and mana tamaiti and impacts on tamaiti health and wellbeing.
- In connecting te tamaiti to their family/whānau, hapu, iwi and cultural connections you are supporting te tamaiti to know where they come from, to know the name of their marae, their maunga, their awa, their roto, their moana, their papakāinga and their mana whenua.
- Respecting the mana of te tamaiti or rangatahi involves valuing their knowledge and recognising their input and voice in decision making.
Care partners (396 providers) and their caregivers
Assessing health needs
When te tamaiti are placed with care partners and their caregivers the allocated social worker for te tamaiti, in the same way that they work with an Oranga Tamariki caregiver, will work closely with the care partner and their caregiver to:
- assess the health needs of te tamaiti
- agree on and document in te tamaiti All About Me plan – the health support required (including who will undertake the agreed actions).
Subdomain: Response to trauma
Vulnerable tamariki and family/whānau have often experienced events or circumstances that feel like they threaten their survival, cause significant feelings of fear and distress and overwhelm their ability to cope.
- Tamariki may be impacted by multiple forms of trauma over time including:
- historical trauma and racism through colonisation in Aotearoa
- systemic trauma through interactions with systems of care
- intergenerational trauma across families and generations
- direct trauma to individuals.
- Cultural alienation and discrimination can intensify the trauma experienced by tamariki. Culture is closely interwoven with healing from trauma.
- Child welfare systems and practices can mitigate or exacerbate impacts of trauma.
- Trauma can impact on tamariki growth and development, behaviour, relationships, resilience in responding to risk, and all other forms of wellbeing.
- Consider the safety and protective factors present. What evidence is there of tamaiti or family/whānau resilience – family/whānau wellbeing impacts on individual wellbeing through whakapapa and whanaungatanga – constant reconnection with ancestors and significant people and places validate cultural wellbeing processes and practices.
- Use a chronology of exposure to traumatic events to explore the bigger picture of what’s happening for te tamaiti or rangatahi and their family/whānau and the potential impact of cumulative harm.
- Ask “what happened to you?” rather than “what’s wrong with you?” and look beyond ‘what’s on top’ with the behaviours of te tamaiti or rangatahi, to understand underlying triggers or influences.
- ‘Tune in’ and acknowledge the feelings of te tamaiti or rangatahi and their family/whānau, and their responses to what has happened to them.
- Consider a wide range of signs that may indicate trauma — challenging behaviours, learning problems, mental health concerns. Recognise trauma impacts, trauma and resilience occur within a cultural context, and it is paramount that Te Tiriti o Waitangi relationships are clearly understood by those working across the cultural border.
- Understand that tangata whenua (indigenous) and tauiwi bicultural status is a necessity for engaging effectively in this space.
Descriptors: response to trauma
10 — There have been no adverse events or harmful circumstances in the life of te tamaiti/mokopuna or if they have experienced trauma they have the resilience and support to process and manage the effects of the trauma in a healthy way. Whakamanawa has addressed barriers to enhancing wellbeing that have been removed. Te tamaiti has a sense of pride and mana in acknowledging their cultural context and identity that includes their Marae.
5 —Te Tamaiti/mokopuna has experienced trauma and they have some resilience and support to process and manage the effects of the trauma in a healthy way. Actively engaging, acknowledging and nurturing te tamaiti to be proud to be Māori includes supporting them to learn more about their whakapapa, tūpuna, their elders and current Māori role models including their Marae.
1 — There have been single or multiple adverse or harmful circumstances and events in the life of tamaiti/mokopuna which have been life threatening, or so psychologically and/or developmentally devastating that their ability to cope is overwhelmed. They deal with the effects of trauma in ways that are anti-social and/or self-destructive. They feel responsible for the abuse or other trauma. Family/whānau have limited ability to support and stop or address the trauma and are isolated from whanaungatanga connections themselves. There may be early signs of mental ill-health or addictions.
Sub-domain – Emotional wellbeing
Emotional wellbeing is a specific section of the needs assessment requirements of the National Care Standards. In Tuituia it is a sub-domain of the Health domain.
Mental and emotional wellbeing is essential to the overall health and wellbeing of te tamaiti or te rangatahi. Positive mental and emotional health allows te tamaiti or te rangatahi cope with the stresses of life, to grow and develop and learn, and make meaningful contributions to their communities.
Fostering emotional wellbeing from the earliest stages of life helps build a foundation for overall health and wellbeing.
Support for emotional health and active management of mental health diagnoses can mitigate risks associated with unmanaged health disorders. For example, anxiety, mood, depression and impulse control disorders are associated with a higher probability of risk behaviours. Risk behaviours could include tobacco, alcohol and other drug use, risky sexual behaviour, intimate partner and family violence and over the life span many other chronic and acute conditions.
- Understand the family/whānau history that may impact on te tamaiti or rangatahi.
- Is the family/whānau well-connected and well-resourced or struggling and isolated from supports.
- Does te tamaiti or rangatahi have connections to their Marae, whakapapa and whangatanga connections.
- Who are the important people for te tamaiti or rangatahi who can support maintain connections and resources.
- Don’t assume – ask respectfully and clarify what you think you have heard or seen.
Descriptors: emotional wellbeing
Age range: Under 5 year olds.
10 — There have been no adverse or harmful circumstances and events in the life of te tamaiti or rangatahi, or they have experienced trauma/grief/loss but have the support to process and manage the effects of the trauma in a healthy way as they mature. They are showing no concerning signs associated with trauma/grief/loss.
5 — Te tamaiti or rangatahi has experienced some trauma (including grief and loss); they have some ability and support to process and manage the effects of the trauma in a healthy way. Family/whānau and whanaungatanga connections are able to provide some support to te tamaiti or rangatahi.
1- There have been single or multiple adverse or harmful circumstances and events in the life of te tamaiti or rangatahi – including grief and loss (multiple caregivers, loss of significant adults). Te tamaiti or rangatahi is showing a range of signs associated with this trauma (loss of acquired skills in language, toileting, mood changes, sleep and eating disruption, loss of interest in activities, crying clinginess) and is not receiving any support to alleviate these.
Age range: Over 5 year olds
10 — Te tamaiti or rangatahi is mostly cheerful and happy around others and within themselves. If upset, sad, or angry they understand why and that it will pass. They are able to ask for help and support and are confident that it will be given.
5 — There are periods of anxiety and unhappiness that overwhelm te tamaiti or rangatahi. They have some understanding of why, have the support they need and know how to access it when needed.
1 — Most of the time te tamaiti or rangatahi feel so sad nothing can cheer them up. They feel restless or stressed, hopeless, worthless, like everything is an effort, worried or frightened. Te tamaiti or rangatahi has lost interest in activities, friends, family/whānau. May be self–harming, have trouble sleeping or have disordered eating (5 to 12 on the Kessler screen).
Sub domain: Response to grief and/or loss
How te tamaiti or rangatahi grieves when someone they love has died will depend on many things, such as their: age, gender, development, cultural and spiritual practices and support and family/whānau circumstances.
Te tamaiti or rangatahi are likely to experience grief and loss if/when they come in to care, move schools or loose contact with important relationships with people, pets and places.
- Pre-schoolers find it hard to understand that death/loss is permanent. They are also at a stage of magical thinking, for example, thinking someone will come alive again or thinking somehow they made someone die or that the decisions that have been made are their fault. They understand separation though, and feel insecure and frightened when the familiar things around them change. This age group needs a lot of reassurance that they will be safe and looked after.
- Primary school tamariki are still learning to understand death/loss and can have some confused thoughts about it. They may think death/loss is temporary, or that the person who has died may still feel things, such as coldness, hunger or loneliness etc. They may ask where the person is now, and have blunt questions to ask about what happened to them and to their body. Explaining death/loss to them is very important. If they have come in to care they need to understand why this decision was made.
- By adolescence, death and loss is likely to be accepted as part of life, but it may not have affected a teenager personally yet. Their reactions may fluctuate between earlier age group reactions and reactions that are more adult. Rangatahi will often want to be more with friends than family as they seek support. They may find the intensity of emotion overwhelming or scary and not be able to find the words or ways to talk about them with others. They may want to feel they're coping, and be seen to be, but inside be hurting a great deal, or be putting their emotions on a shelf for a later time.
- Rangatahi might respond to grief and loss by engaging in risk taking behavior – to escape the feelings and reality and as a source of comfort; for example, drinking, drugs, more sexual contact or reckless driving.
- Grief and loss can also affect how te tamaiti or rangatahi responds in every day activities. They might demonstrate challenging or withdrawn behaviors and regression (where skills already mastered are lost) in eating, sleeping, toileting, language and other skills.
- What loss has te tamaiti or rangatahi experienced. Have they moved home, are away from family/whānau and siblings and important people, changed schools and lost connections with significant places. What is and/or has been their response to that loss?
- Each tamaiti or rangatahi will show their grief in a different way and they may lack the words to say how they feel. What family/whānau support is or has been available to te tamaiti or rangatahi.
- Has their developmental need for physical contact and affection been responded to
- Shock, disbelief, sadness, guilt, anger, fear and physical symptoms such as sleep and appetite disruption are normal emotions in response to grief and loss
- Te tamaiti or rangatahi can blame themselves for what has happened in their family/whānau – who can be there from the family/whānau to explain to and support te tamaiti.
Descriptors: response to grief and/or loss
10 — Te tamaiti or rangatahi has not experienced any grief and loss or have enduring relationships with their family/whānau, hapū and iwi, through their Marae, whakapapa and whanaungatanga that provide purposeful relationships to heal and support tamaiti or rangatahi in times of grief and loss.
5 — Te tamaiti or rangatahi has experienced significant grief and/or loss but is getting some of the support they require to work through the impact of this but remains vulnerable. Intergenerational trauma, grief and loss means the family/whānau have some resources and connections to whakapapa and Marae to support healing but are vulnerable themselves.
1 — Te tamaiti or rangatahi has experienced significant grief and/or loss which is having a significant impact on their current wellbeing. This may include being removed from the care of their family/whānau, entry to care, or a placement ending. Te tamaiti or rangatahi may show behavioural and/or, emotional difficulties such as not wanting to live, being preoccupied with death, are angry, crying or sad much of the time and may be withdrawn. Family/whānau lack the supports and resources to help te tamaiti or rangatahi
Sub domain: Suicide ideation
Most people who attempt suicide don’t want to die – they just want their pain to end or can't see another way out of their situation.
Support from people who care about them, and connection with their own sense of culture, identity and purpose, can help them to find a way through.
Over 5 years. Suicide is extremely rare in tamariki under 5 years of age.
- Focus on identifying risk and then taking action if required. Is there any indication that te tamaiti or rangatahi is thinking about suicide or significant self harm?
- Make use of the tools available.
- If you have concerns or questions consult with Towards Wellbeing.
You need to know te tamaiti or rangatahi strengths, vulnerabilities and protective factors. Areas to explore include:
- their views of themselves and others in the family/whānau and caregiving family
- their role within the family/whānau and caregiving family
- their hopes for the future
- when have things gone well and what was different then
- the family/whānau strengths and resources and how these complement each other to support the wellbeing of their tamaiti or rangatahi including their willingness, confidence and capacity to carry out a plan for te tamaiti or rangatahi and make safe and sustainable change.
- if family/whānau noticed any changes in te tamaiti or rangatahi behaviours
- if their school noticed any changes.
Descriptors: suicide ideation
10 — No suicide ideation or suicide attempts currently or in the past
5 — Suicidal ideation has been assessed as MODERATE (using the Suicide screen). History of self-harm such as cutting. Te tamaiti or rangatahi is receiving and/or accepting support to manage their needs.
1 — Te tamaiti or rangatahi is expressing thoughts and feelings that life is not worth living, and/or is talking about and/or has attempted suicide. Suicidal ideation has been assessed as HIGH (using the Suicide screen).
Subdomain: Self harm
Also known as deliberate self-injury or self-mutilation, self-harm is one way some tamaiti or rangatahi use to cope with really difficult feelings (such as sadness, anger, worry) that can feel overwhelming. Self-harm is always a sign of something being seriously wrong. Self-harming may make te tamaiti or rangatahi feel like they have control over their feelings, or that they are “taken away” from their worries and stress. It may result in temporary improvements in mood due to changes in brain chemistry as a result.
Behaviours may include:
- cutting, picking or scratching their skin (including some “self-tattoos”)
- burning themselves
- hitting parts of their body, punching walls, bruising themselves
- taking an overdose of tablets or poisons
- pulling hair
- picking skin
- sometimes excessive use of alcohol or drugs and the development of eating disorders can be self-harming behaviours.
In all the self-harming behaviours, especially alcohol or drug use and eating disorders, it can be unclear what the underlying difficulties are that result in the self-harming behaviour.
Each tamaiti or rangatahi may exhibit behaviours for varied reasons. It can also be a challenge to understand the difference between self-harm and suicidal ideation. It is important not to make assumptions and to take the time to talk it through. Ask for other professional advice if need be.
- 5 years and older. It is extremely rare for tamariki under 5 to self-harm. Self-injury is not uncommon in tamariki with a disability and this would be captured under behaviour and disability domains.
Be aware of:
- unexplained burns, cuts, scars, or other clusters of similar markings on the skin can be signs of self-injurious behaviour
- arms, hands and forearms opposite the dominant hand are common areas for injury. However, evidence of self-injurious acts can and do appear on any body part
- inappropriate dress for the season (consistently wearing long sleeves or trousers in summer)
- constant use of wrist bands or other coverings
- unwillingness to participate in events or activities that require less clothing (such as swimming or other sports)
- frequently wearing bandages
- unusual or inexplicable paraphernalia, such as razor blades or other implements, inappropriate medication
- heightened signs of depression or anxiety.
Subdomain: Physical development and wellbeing
Assessment focuses on all aspects of the physical health, development and wellbeing of te tamaiti or rangatahi and should consider the extent to which individual health needs are being addressed. Collaboration with other agencies and service providers is a key component in ensuring all aspects of development and wellbeing are considered.
- To enjoy a healthy, active and fulfilling life, te tamaiti or rangatahi needs to develop skills to respond positively to challenges, be enterprising, manage risk and develop self-confidence and physical capabilities. This area of learning lays the foundations for long-term wellbeing and contributes to the mental, social, emotional, economic and physical development of te tamaiti or rangatahi.
- Te tamaiti or rangatahi need to learn about their changing bodies and the importance of nutrition and rest for a healthy, balanced lifestyle. Sport and other physical activities assist te tamaiti or rangatahi to learn increased body control, coordination and dexterity.
- Te tamaiti or rangatahi also learn about their responsibilities both as individuals and members of their family/whānau, hapu, iwi through groups and teams they are involved in. They learn to cooperate and to compete fairly, understanding their own and others' roles.
- As they become more confident, te tamaiti or rangatahi develop a growing self-awareness and a commitment to self-improvement so they can make informed decisions that can lead to happy and healthy lives. They raise their aspirations, set goals and work to achieve them, seeing how this will influence their opportunities in education, leisure and in the world of work.
- Tamariki who experience gender identity issues can experience significant stress and distress as they approach puberty and their physical appearance changes. Tamariki may need support and possibly medical intervention to manage and understand what is happening to their body.
- Adverse events and trauma can have a significant impact on physical development.
- Physical effects related to trauma. The problem goes beyond unhealthy habits. Experts believe that there is actually a direct biological effect that occurs when your body undergoes extreme stress. When you experience something anxiety-provoking, your stress response activates. Your body produces more adrenaline, your heart races, and your body primes itself to react. Someone who has experienced trauma may have stronger surges of adrenaline and experience them more often than someone who has not had the same history. This causes wear and tear on the body. Stress responses have also been demonstrated in people who have experienced discrimination throughout their lives and this ages their system faster.
- Chronic stress can increase inflammation in the body, and inflammation has been associated with a broad range of illness, including cardiovascular disease and autoimmune diseases. Early trauma disrupts the inflammatory system. This can lead to long-term changes in this system and chronic health problems triggered by constant inflammation. Typically, the more trauma a person has experienced, the worse your health is.
- Are there any health diagnoses that might impact on the physical development and/or wellbeing of te tamaiti or rangatahi.
- Physical disabilities — does te tamaiti or rangatahi experience any form of disability? How does it affect their daily life? Do they require any physical aids or supports and do they have these? Do the parents/caregivers receive the support and help they need to provide quality care?
- How do their parents/caregivers describe physical wellbeing and development of te tamaiti or rangatahi?
- Does te tamaiti or te rangatahi have access to dental and health checks and services?
- Is te tamaiti or te rangatahi exposed to adverse events that could impact on their physical health and wellbeing?
National Care Standards Requirements for Tamariki in Care
- Ensure where possible te tamaiti has access to a health practitioner who has knowledge and experience of the cultural values and practices of te tamaiti.
- For tamariki Māori the health practitioner referred to above has knowledge and experience of Māori models of health.
Things to consider include:
- Enrolment in universal/primary care service — what service/s are they enrolled with (well-child, youth health, General Practitioner, Dental Service)? Are these services used when required?
- Health conditions (chronic or acute) — consider how these affect their everyday life, what additional support or knowledge do they or those around them need to have? Are medical appointments kept and medical advice followed?
- Immunisations and developmental checks — are these up to date? If there have not been immunisations why is this? Does the parent/caregiver have all the information they need to make an informed decision? Do developmental checks indicate anything that may extra support or investigation?
- Dental, hearing and sight — are these aspects of health being proactively monitored or are issues only being considered when they arise?
- Number and frequency of hospital admissions and accidents — are there any patterns that raise concern? Does the parent/caregiver follow up on any after care as needed? Is there anything that could be done to help avoid admissions from chronic or reoccurring illness?
- The housing and living environment te tamaiti or rangatahi is in – for example is it cold and damp or warm and dry. Is it meeting the need for te tamaiti or rangatahi to have a healthy loving home.
- Adequate and nutritious diet, exercise and rest — are these things being provided in a developmentally appropriate way? Are parents/caregivers providing an environment that encourages and supports healthy lifestyles as much as they are able? Do parents/ caregivers, and older rangatahi have a sound understanding of the importance of these aspects to their health?
10 — Te tamaiti or rangatahi is physically well developed for their age and meeting all expected developmental milestones. Lives in an environment that supports healthy physical development.
5 — Expected developmental milestones are not being met, assistance is in place and appropriate progress is being made.
1 — There are significant delays in physical development which are not being attended to. Te tamaiti or rangatahi are not receiving the nourishment, rest, opportunity to practice the physical activities that they require for healthy development and/or lives in an environment that has a detrimental effect on their physical development.
10 — Has no health needs or all health needs (including needs relating to a physical disability) are being met. Has a regular health care provider and attends when unwell.
5 — Physical health needs have been identified and treatment has begun. Has high physical health needs (possibly a physical disability) that require special attention and oversight. There is a hearing or vision impairment which is being managed and requires special care and oversight.
1 — Physical illnesses, injuries or infections are not attended to. There is no dental care. Immunisations are not up to date. Is being physically harmed or is at high risk of physical harm. Is not getting adequate nutrition — too little, too much. Hearing or vision is impaired and no assistance is being provided OR there are concerns that hearing or vision may be impaired. Physical disabilities are not being supported and managed.