1. Gateway to better education and health care Information for stakeholders

2. 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:

3. 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.

4. 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).

5. Health needs of children in care Emotional, behavioural, mental health51% Incomplete immunisation20% Developmental delays15% Dental26% Hearing19% Speech and Language13% Skin14% Vision9% Parental alcohol and other drug26% Referrals are made to specialist services to address the identified needs.

6. Examples of outcomes 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 yearsIncredible Years Programme to help caregivers understand and manage behaviour positively – child now participating well at school Needle stick injury11 yearsInvestigated for HIV infection, Hepatitis Acute psychosis14 yearsReferred for psychiatric assessment, now under specialist mental health care Epilepsy15 yearsCommenced treatment. Able to progress well at school once treatment established

7. 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

8. 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.

9. 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.

10. 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.

11. 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

12. 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.

13. 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.

14. 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 MeetingWithin 10 working days of the assessment

15. 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

16. Primary Mental Health Services 0-17 year olds Intensive Mental Health Services 10-17 year olds GroupNames 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

17. Early Childhood Education – why is it important? High quality early childhood education = positive long term effects AND immediate returns for children

18. 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.

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