2 Overview GATEWAY HEALTH ASSESSMENT SERVICE: Who are we Who do we see Why do thisWhat do we doHow have we done so far..PURPOSEJoint agency approach to identify the health and education needs of children and young people who come to the attention of Child youth and Family CYFEnable children and young people to access services that best meet their needsHealth assessment and education assessment and ISA and 3 month follow upeducation assessment is prior ( allows triangulation of info /reliability of info) so we have report from SW/school/parent/ caregiver
3 Janine Friend ( Nurse Coordinator 1.0 FTE) Who are we ? : MDTJanine Friend ( Nurse Coordinator 1.0 FTE)Drs Donna Woolerton and Sneha Sadani (1.0 FTE)Liz Court and Andrea McOnie Perfect (Psychologists 1.0 FTE )Jill Love (Administrator 1.0)We work in two teams covering 4 clinical days per weekAttempt to see a family all on one day2 clinicians (MDT approach)Paediatric/medical review andPsychological screeningMSD contract for the Waikato DHB: 475 assessments a yearVolumes: 10 clinic appointment a week : 2 hours per child
4 Aims of WAIKIDS Gateway Health Assessments are to: What do we do ?Aims of WAIKIDS Gateway Health Assessments are to:identify “health” needs (broad view: physical, spiritual/cultural, psychological and mental health)identify the interventions/supports that help child/family best meet those needsdevelop an agreement between agencies on who will take responsibility for organising ,funding and facilitating the recommendations
5 Referrals from CYF social workers only Who do we see ?Referrals from CYF social workers onlyAll children and young people entering careChildren and young people already in care when it will help clarify and identify ways to address their needsChildren and young people who are being referred for a care and protection FGC where a gateway assessment would help identify their needsEstimates nationally :coming into care 2,200 per year section 78,101,102,110(2)a,139,140In care 500 per yearFgc 1,500
6 The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.Why do this ?ACE study references The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.Adverse Childhood Experiences (ACE)
7 Gateway pilot projects NZ: 2008 2010 MOH and MOE Gateway population are by definition complex families often with long history of involvement with services (ACE score >4 plus plus).Pilots across four district health boards – Auckland, Counties Manukau, Lakes, and Mid Central, alongside 16 Child, Youth and Family sites. Three or more health needs per child were identified as a result of the assessments. Information from the pilots is consistent with international research, and showed that of the children and young people who came into CYF care:65 % have mental health or behavioural problems40 % of these are likely to need specialist services (historically only around 7% received specialist mental health services)15 % developmental delay37 % have impaired hearingAround 40 % need dental care, help with skin conditions or hearing issues.Hand out ACE q
8 Why psychology input into a medical screen ?? Gateway population complex families often with long history of involvement with services.Gateway Pilots projects have found consistently high percentage of clients with emotional or behavioural difficulties (65%) and mental health disorder (41%).These children require at least secondary level assessments and use of specialised assessment tools (ie ‘more’ than primary health screening tools) and analysis.Pilot projects found referral to mental health /counselling services the most difficult, partly due to clients not meeting entry criteria for existing resources.Psychological input allows for more seamless access by providing the more detailed assessments to inform referrals to mental health, developmental and NGO counselling services.
9 Gateway Assessment process Social worker: referral, CYF file review and consent from guardian (this is usually the birth parents). Initiates request for education review.Gateway Coordinator : sends info requests and arranges appointmentPsych and Paed : ‘Health’ assessment and referralsCoordinator: Interagency Service Agreement (ISA)MDT meetingFollow-up in 3 months (Review)Social worker: completes plan and monitorsEducation profiles (preschool, RTLB, SENCOand SDQ) Information requests ACC NGO DHB’s Well Child Provider NZ Health info serviceGP
10 The Assessment process cont.. 2 hours assessment per childCombined assessment with Psychologist and Paediatrician : Physical, Psychological, Developmental in the wider context of the childIdeally parents; current caregivers and social worker must attend with the child.Care and protection and developmental history, school history and current academic functioning, medical history and health check , mental health and trauma screening interviews and use of psychometric standardised tools , HEADSS tool, review of current placement : issues that may impact on well beingFORMULATION : Presentation and the 4 P’s :Protective, Predisposing, Precipitating, Perpetuating factors
11 How have we done so far? Findings: Multiple placements Safety issues March 2012 to present: 535 referrals 435 assessments completed 57% MALE 75%PLUS MaoriFindings:Multiple placementsSafety issuesConsent privacy issuesDevelopmental delays/poor exec functioning/language developmentHealth problems: skin respiratory and hearingResilience related to IQ , placement, relationship with siblings and stable caregiverAge groups%%%%%increase DNA with set apptsMost common recommendationsRecs are for enrol with GP2000 plus rec
12 All children and young people need: “Safe, stable, nurturing relationships and environment”Parent trainingMST trauma informed careNurse family partnership life skills trainingBuilt environment: decrease access to guns and alcohol/drugsPoverty education housing inequalities
13 And just a little more…..We need to support policies that promote permanency for children in long term careTherapeutic potential for foster/CYF and whanau care is greater for children placed at earlier agesLate placement for children who have already attachment and mental health difficulties has limited therapeutic potential (M Tarren Sweeney and A Vetere (eds.) Mental Health service for Vulnerable Children and Young People : Supporting Children who are, or have been, in foster care Routledge, 2014)Ongoing work : breaking down barriers and silos to accessing support for these children and young prople; research and review e.g. Sibling’s attachment adds to emotional resilience and ; keeping the team safe SUPERVISION
Your consent to our cookies if you continue to use this website.