Gateway to better

educationand health care

Information for stakeholders

Services for Children in Care

> Gateway Assessments (health assessments and education profiles).

> The establishment of primary mental health services for children and young people in care.

> Funding for early childhood education for children in care, aged 18 months to three years.

Budget 2011 provided government funding for services to address the needs of children and young people in care. The package includes:

Gateway Assessments - Overview

Gateway Assessments are an interagency initiative between Child, Youth and Family, Health and Education, for children and young people in care. Their aim is to:

> identify health and education needs early

> ensure interagency agreement on how best to address needs

> facilitate access to appropriate services

> ensure children and young people get the support they need at home and at school.

Who is a Gateway Assessment for?

Children and young people entering CYF care must be referred for a Gateway Assessment.

A social worker may form the belief that a Gateway Assessment would help identify and clarify ways to address health and education needs.

So a referral may also be made when a child or young person is in care already or is being referred for an Family Group Conference (FGC).

Health needs of children in care

Emotional, behavioural, mental health 51%

Incomplete immunisation 20%

Developmental delays 15%

Dental 26%

Hearing 19%

Speech and Language 13%

Skin 14%

Vision 9%

Parental alcohol and other drug 26%

Referrals are made to specialist services to address the identified needs.

Examples of outcomes

Condition Age of child Outcome

Enlarged kidney 3 months Referred for x-ray and specialist assessment. Major illness identified. Undergoing treatment

Jaundice with arching back

4 months Referred to specialist paediatric service. Major concern about permanent brain injury

Tongue tie – feeding problems

4 months Surgery the following day. Excellent progress and now thriving

Cleft palate 18 months Referred to plastic surgery for repair, speech progressing

Club foot 2 years Orthopaedic surgery corrected deformity. Able to walk 12 months later

Squint 3 years Eye surgery to correct muscle problems, coordination improved and building towers

Disruptive behaviour 5 years Incredible Years Programme to help caregivers understand and manage behaviour positively – child now participating well at school

Needle stick injury 11 years Investigated for HIV infection, Hepatitis

Acute psychosis 14 years Referred for psychiatric assessment, now under specialist mental health care

Epilepsy 15 years Commenced treatment. Able to progress well at school once treatment established

Child or young person Identified by CYF to have a Gateway Assessment

Gateway Assessment Coordinator• Collates information from CYF, Health and Education • Collects existing health information• Collects family health history• Determines appropriate assessment

Health Assessor• Reviews history• Undertakes comprehensive health assessment of child or young person• Writes health report and recommendations

Social Worker•ISA recommendations are discussed with child/young person and their family/caregiver •SW assists to get parent/s consent for any follow up referrals •Agreed recommendations are included in the child/young persons Plan and appropriate FGC/whānau hui/court review or case consult.•Support, review, monitor and give feedback to GAC and School/ECE•Record on CYRAS

Education

Health

Social Worker

ACC

Social Worker

Health (NHIS)

Well Child Provider/ Tamariki Ora

Family

GP

Teacher/Principal/ RTLB Cluster Manager ( or School or Early Childhood Education centre)

• Completes education profile

• Identifies issues affecting education

• Engage with SWiS, MASSiSS &YSWiS

Health Referrals•Immunisations •Primary Care engagement

Urgent health appointment if required

Social Worker• Engages with family and gains consents• Refers for health assessment & education profile • Provides information regarding child or young person’s history

Gateway Assessment Coordinator• Drafts Interagency Services Agreement (ISA) recommendations in consultation with Health, CYF and Education• Coordinates Multi-disciplinary Clinical Meeting • Follows-up on referrals and recommendations at 3 months

CAMHS

Primary MH Services

Paediatric Services

Adult AoD and MH Services

ICSS

NGO

Roles and responsibilities –The CYF social worker

The social worker is responsible for:> engaging with the child, young person and their family/whānau to inform them of the process of a

Gateway Assessment and obtain consent> requesting the education profile and making the referral to the Gateway Assessment coordinator > supporting the child or young person and their parents/caregiver to attend the appointment > attending the health assessment with the child/youth and their family/whānau

> assisting with the development of the Interagency Services Agreement (ISA)

> participating in the Multi-disciplinary Clinical Meeting > discussing the completed report with the child or young

person and family/whānau or caregivers > developing the plan with the child/young person and their

family/whānau> on-going monitoring and reviewing of the child or young

person’s progress.

Teachers and the Education Profile

> Teachers information is important: they know how children and young people learn and socialise at school

> Exchanging information with teachers is part of the social work role and improves the knowledge all professionals have about children and young people

> Social workers request the education profile and draft the Gateway Assessment referral

> Interagency collaboration means teachers, CYF and health all contribute to the Interagency Services Agreement

(ISA).

> Interagency Service Agreements (ISA’s) are a commitment> to provide services to address the educational needs > for children and young people.

Gateway Assessment coordinator

> The Gateway Assessment Coordinator is employed by the DHB and is responsible for:

> collecting existing health information about the child or young person from other agencies

> collecting the mental health, drug and alcohol history and status of the parents (where there is consent)

> ensuring the education profile information is considered in the assessment

> drafting the Interagency Services Agreement, with the social worker and teacher

> arranging Multi-disciplinary Clinical Meetings.

The health assessment

> The type of assessment depends on the age, development status, and health needs of the child or young person.

> Health assessments look at:> current physical health > current mental/emotional health > behaviour, development and learning > skin, dental, eyes, vision, hearing, and > sexual health.

The assessing health practitioner may also:

>offer immunisation if there is specific consent

>request additional services or interventions to complete the assessment.

>provide treatment for current conditions

Multi-disciplinary clinical meeting

Organised by the Gateway Assessment Coordinator Determines what services each agency will contribute to meeting the needs of the child or young person Confirms the Interagency Services Agreement which is a:

• summary of needs identified • the recommended interventions and

services to meet the needs• who will make the referral and when• who will pay for the interventions• how it will be monitored

Once finalised, each agency is responsible for implementing the services that they have

agreed to provide.

Gateway Report and Interagency Services Agreement (ISA)

> The health assessor prepares a Gateway report about the child/young person’s current health and wellbeing.

> It draws on information and findings from information that has been collated, the health assessment, education profile and information from the social worker.

> The ISA outlines the recommended services to address the needs that have been identified.

> Once the document is agreed by each agency that agency is responsible for providing and funding the services to the child, young person and their family/whanau to meet their needs.

Timeframes

Health and education information needs to be available within time frames, so their needs can be addressed in a timely manner.

The Gateway Assessment process therefore needs to be undertaken within the following timeframes:

Social worker> requests the education profile and drafts the referral for the health assessment

Within 10 working days of entering care or identifying the need for an assessment

Teacher >Attends RTLB led meeting (within 4 days) and completes the education profile

Within 7 working days of receiving the request

Health assessor

Completes the health assessment

Within 6 weeks of receiving referral

(4 weeks for children under 5 years old)

Gateway Assessment Coordinator

Distributes Gateway report and recommendations

Within 10 working days of the assessment

Drafts the Interagency Services Agreement

Arranges Multi-disciplinary Clinical Meeting Within 10 working days of the assessment

New CYF Funded Mental Health Services

Acute

ICSS

CAMHS

Primary Mental Health Service

Universal services

We have new funding for mental health services to meet the needs of children and young people identified through Gateway Assessment.

New primary services> Mild to Moderate

mental health = emotional and behavioural needs

> 1,600 children per year

> Average $1,550 per child

> Evidence-based family focused services

> Starting very soon

Extension of Intensive Clinical Support Services> Complex mental health

and behaviour

> 175 young people per year

> Average cost of $14,300

> Evidence-based, family focused services

Primary Mental Health Services

0-17 year olds

Intensive Mental Health Services

10-17 year olds

Group Names of evidence based interventions

– Infants (aged 0-4) – Watch, Wait and Wonder™

Primary services – CYF will fund evidence based interventions

- Children & young people(aged 3 or older)

– Parent Child Interaction Therapy– Trauma and Abuse focused

Cognitive Behavioural Therapy– Primary care or level 4 and 5

Triple P – Incredible Years

- Young People – Functional Family Therapy– Multi-systemic Therapy

These rely on good social worker engagement & case management

Early Childhood Education – why is it important?

High quality early childhood education

=

positive long term effects AND immediate returns for children

Early Childhood Education funding

> Child, Youth and Family funding is available to enable children in the custody of the Child, Youth and Family aged 18 months - three years, to access early childhood education

> Funding covers up to 20 hours per week, or $600 per month.

> The funding continues if a child progresses to a ‘home for life’ until they are three, provided it is set up before the court order is legally secured.

> Beyond three years, all children benefit from the MoE’s 20 hours free ECE.

More information

> You will find more information about these initiatives on the Child, Youth and Family website www.cyf.govt.nz

> You can also contact your local Child, Youth and Family site if you have specific enquiries about how this might affect you.