Gateway to better education and health care

Background >Budget 2011 included additional government funding for services to address the needs of children in care. >The package includes: >health and education (Gateway) assessments for up to 4,200 children and young people every year >mental health services for 175 children and young people with high/complex behavioural needs and 1,600 with mild to moderate emotional or behavioural problems >funding for early childhood education for all children in state care, aged 18 months to three years.

Overview >Gateway Assessments are an interagency project between Child, Youth and Family, Health and Education. >Their aim is to: >identify the health and education needs of ‘high need’ children and young people >ensure there is interagency agreement on how best to address their needs >facilitate access to appropriate services for health, education and wellbeing >enable families and caregivers to better understand and manage any behavioural issues

Who are they for? >Gateway Assessments are available to any child or young person who: >is entering care (about 2,200 per year) >is already in care, and the social worker believes they would benefit from an assessment (about 500 per year) >is preparing for, or has had, their Care and Protection family group conference and an assessment would help clarify and identify ways to address their health or education needs (about 1,500 per year).

Health needs of children in care Identified health condition88% Emotional or Behavioural problem 65% Mental Health disorder41% Dental41% Hearing37% Child Development13% Vision11% Mental Health41% Dental41% Hearing37% Paediatrician15% Child Development13% Immunisation11% Special Education11% Vision11% ReferralsFindings

Outcomes from the pilots ConditionAge of childOutcome Enlarged kidney3 monthsReferred for x-ray and specialist assessment. Major illness identified. Undergoing treatment Jaundice with arching back 4 monthsReferred to specialist paediatric service. Major concern about permanent brain injury Tongue tie – feeding problems 4 monthsSurgery the following day. Excellent progress and now thriving Cleft palate18 monthsReferred to plastic surgery for repair, speech progressing Club foot2 yearsOrthopaedic surgery corrected deformity. Able to walk 12 months later Squint3 yearsEye surgery to correct muscle problems, coordination improved and building towers Disruptive behaviour5 yearsFamily counselling and learning to manage behaviour positively – child now participating well at school Needle stick injury11 yearsInvestigated for HIV infection, Hepatitis Anxiety12 yearsReferred for counselling to resolve self blame issues Acute psychosis14 yearsReferred for psychiatric assessment, now under specialist mental health care Epilepsy15 yearsCommenced treatment. Able to progress well at school once treatment established

How it works Child identified as likely to benefit from a Gateway Assessment Gateway Assessment Coordinator Collects existing health information Family health history Determines appropriate assessment Health Assessor Review history Comprehensive health assessment Write health report and recommendations Social Worker Prepare information for use at FGC Completes child or young person’s Plan Monitor agreed recommendations Education Social Worker Teacher/Principal (School or Early Childhood Centre) Complete education profile Identify issues affecting education Social Worker Engages with family and gains consents Refers for health assessment & education Profile Gateway Assessment Coordinator Collates information from CYF, family, Health and Education Drafts Interagency Child Development Agreement with social worker and teacher Facilitates Interagency Case Conference (if required) Follow-up on implementation of recommendations at 3 months Health ACC Social Worker Health (NZHIS) Well Child Family Urgent health appointment if required Health Referral (with consultation and consent of the young person or the child’s family)

About the education profile >Profile is completed by the teacher or ECE provider. >Gives a snapshot of the child or young person’s educational status based on: >attendance at school or early childhood service >learning and achievement >factors impacting on their learning. >The profile includes the Strengths and Difficulties Questionnaire (SDQ) - a screening tool for behavioural difficulties. >Teacher attaches any relevant specialist education reports (e.g. RTLB). >Information from the profile is incorporated into the final report and recommendations.

About the health assessment >The health assessment is a comprehensive look at the health and wellbeing needs of a child or young person. >As well as a physical examination, it draws on a review of background health information and information from the social worker and the education profile. >The priority areas in the health assessments are: >current physical health status >current mental health and behavioural issues >developmental and learning problems >eyes and vision >hearing >dental >sexual health.

More about the health assessment >The assessing health practitioner may provide urgent treatments or immunisation services at the time of assessment. >They may also request additional services or interventions to complete the assessment, including: >sensory screening >investigations such as blood tests or x-rays >specialist referrals such as mental health, surgical opinion, drug and alcohol services, dental, optometrist etc. >If appropriate, a specialist referral will be initiated as part of completing the health assessment. >The health assessor prepares a report outlining their findings and recommendations. This is used to inform the Interagency Child Development Agreement.

Interagency Child Development Agreement >This document is prepared by the Gateways Assessment Coordinator, in consultation with the teacher and social worker >It outlines what part each agency will play in meeting the needs of the child or young person. It includes: >the key agencies and people involved with the child or young person >summary of needs identified from the Gateway Assessment >the interventions and services each agency has committed to provide. >Once the document is finalised, each agency is then responsible for implementing the services that they have agreed to.

Roles and responsibilities – Gateway Assessment coordinator >The Gateway Assessment coordinator is responsible for: >collecting existing health information about the child or young person from other agencies >ensuring the mental health and drug and alcohol status of the parents are known >determining, booking and coordinating the most appropriate assessment >providing professionals involved with a copy of the report >drafting the Interagency Child Development Agreement with the social worker, and seeking agreement from the teacher >arranging interagency case conference (if required).

Roles and responsibilities – Assessing health practitioner The health assessor is responsible for: >ensuring the health needs of the child or young person are identified >advising on ways any identified needs can be met >completing appropriate referrals and following up any medical investigations >compiling information into a report for the child, their family, and other professionals involved in the case >ensuring the child or young person has a primary care provider >reviewing and endorsing the Interagency Child Development Agreement and attending an interagency case conference if there are concerns about the agreement that need resolving.

Roles and responsibilities – Teacher The teacher is responsible for: >completing the education profile, including the Strengths and Difficulties Questionnaire, and attaching any relevant specialist education reports (e.g. RTLB) to the profile >reviewing Gateway Assessment report findings and recommendations >contributing to the development of the Interagency Child Development Agreement >attending interagency case conference if there are concerns about the agreement that need resolving >updating child’s individual education plan and sharing information about the child’s progress or successes.

Roles and responsibilities – Social worker The social worker is responsible for: >engaging with family, child and young person >obtaining consents >making referrals for health assessment and education profile >coordinating appointments, and attending where practicable >discussing completed report with family, child or young person and caregiver >assisting with development and endorsement of Interagency Child Development Agreement >participating in interagency case conference (if required) >developing the plan with the family >ongoing monitoring and reviewing of the child or young person’s progress.

Timeframes >In order for the health and education information to be available for the Family Group Conference, the Gateway Assessment process needs to be undertaken within the following timeframes: Social worker > refers for health assessment and > requests education profile Within 5 working days of identifying the need for an assessment Teacher competes Education ProfileWithin 7 working days of request Health Assessment undertakenWithin 6 weeks of receiving referral (4 weeks for under 5 year olds) Report and recommendations distributedWithin 10 working days of the assessment Interagency Child Development Agreement drafted Within 10 working days of the assessment

National implementation >The rollout of the Gateway Assessment began on 1 July 2011 >The 16 Child, Youth and Family sites and five DHBs involved in the pilot undertook refresher training in June 2011 >Remaining Child, Youth and Family sites and DHB’s will implement over the next 18 months >The programme will be fully implemented nationally by December 2012.

Early childhood education >Funding to ensure all children in state care aged 18 months to three years old are able to attend early childhood education (ECE). >This funding covers up to 20 hours of ECE per week, per child. >The funding continues if a child progresses from foster care to a home for life until they are three years old. >The Ministry of Education provides ECE to all children aged three - five years, including those in state care.

Early childhood education – who and where

Mental health services >There is increased funding to provide mental health services for children and young people in our care. This includes: >Primary Child Mental Health Services >Primary care based service (PHOs and GPs) >Referrals initially through the gateway assessment >National coverage by mid >Intensive Clinical Support Services: >Targets children and young people with mental health and behavioural disorders in Child, Youth and Family care >Community based, family focused intensive therapy >One new service per year from late 2011 >Eight services established by mid 2014.

National outcomes framework

More information >You will be able to find more information on the Child, Youth and Family website >This includes: >a more detailed overview of the Gateway Assessment programme >Gateways Assessment process map >an outline of roles and responsibilities, including guides for the various roles - Gateway Assessment Coordinator, health practitioner, teacher, social-worker >forms and templates. >If you have any other questions or concerns, contact the local Child, Youth and Family site manager