The require the chief executive to ensure that support is provided to address the health needs of all tamariki and rangatahi in their care, including taking reasonable steps to ensure that they are enrolled with a primary health organisation (PHO), have annual health and dental checks, and that their health and wellbeing needs are assessed and addressed. This includes physical, mental and emotional needs, and health needs relating to substance abuse.
Tamariki and rangatahi in care have poorer health outcomes than tamariki and rangatahi who are not in care. Data from the Integrated Data Infrastructure (IDI) shows that, for the year ending June 2021, tamariki and rangatahi in care had higher levels of additional health needs identified during Before School Checks1, and higher potentially-avoidable hospitalisations2, Emergency Department admissions, mental health treatment, substance usage treatment, and chronic conditions than tamariki and rangatahi in the general population.
It is through annual checks that any further health and dental needs can be identified and treated. We know that unmet health need can be both costly and detrimental to wellbeing over the life course. Dental caries or tooth decay, for example, is the most common non-communicable childhood disease in New Zealand, but it is largely preventable. Poor oral health can go on to affect physical health, mental health, educational success and employment outcomes.3
Our review into the experiences of accessing primary health services and dental care for and in care found that the health-related have not been implemented well by Oranga Tamariki.
Oranga Tamariki has analysed IDI data, which shows that approximately 70 percent of tamariki and rangatahi in care had been seen at least once by a General Practitioner (GP) in the twelve months to 30 June 2021. However, the NCS Regulations require reasonable steps to be taken for every tamariki and rangatahi to be enrolled with a PHO and attend an annual health and dental check. Our review found that further work is needed to implement these regulations and to ensure they are being met.
There is a lack of clarity regarding what the NCS Regulations require, what an annual health check is, and when parental/ consent is required. We heard in our monitoring visits that policies and guidance are not clear for Oranga Tamariki social workers, which means that caregivers are sometimes made responsible for arranging health care, and that sometimes they do not have important health-related information on the tamariki and rangatahi they look after. We did not hear from kaimahi or caregivers about training, although Oranga Tamariki has since told us that training and information are available for both social workers and caregivers. While Oranga Tamariki has pointed to its practice guidance as evidence of clear expectations being set, we also heard from Oranga Tamariki national office that practice guidance is not embedded across the organisation. Our monitoring visits suggest that clear expectations have not been set from Oranga Tamariki national office to ensure tamariki and rangatahi have access to primary health services and dental care.
Despite data-matching exercises with Te Whatu Ora and the IDI, Oranga Tamariki cannot see accurate enrolment data in its own systems, because its records are incomplete. This can impact on the ability to share important information with caregivers, whānau and other social workers that may be working with the tamariki or rangatahi. There continues to be a lack of urgency to ensure that data collection by social workers is improved.
We also heard that Oranga Tamariki does not always collect health-related compliance data from care partners4, which it would need to have oversight of the care being provided to tamariki and rangatahi in partnered care. Because of this lack of information, Oranga Tamariki is not able to share information with health providers to improve access to primary health care. This is despite the willingness we heard from health professionals to ensure that tamariki and rangatahi in care have access to the health services they need.
Beyond that review, our monitoring over the last three years has shown a continuous improvement by Oranga Tamariki in completing assessments and individual plans that include the health needs of tamariki and rangatahi in care. However, the ongoing absence of reliable data is a major barrier to understanding how well tamariki and rangatahi in care are having their health needs met.
Tamariki and rangatahi tell us that their experience is good when they access health services, but we continue to hear that securing access is difficult. This is particularly the case for mental health services. Oranga Tamariki no longer provides us with data on psychological distress and suicide risk screening among tamariki and rangatahi in care, citing issues around data accuracy in its case file analysis. Given the high levels of trauma associated with being in care, psychological distress and suicide risk assessment is critical to understanding the needs of those in care and seeking the required services.
While we recognise that all tamariki and rangatahi may face difficulties accessing mental health services,5 we continue to hear that some tamariki and rangatahi in care are denied mental health services because their needs are viewed by mental health practitioners as behavioural. Inter-agency collaboration is needed to ensure health needs are met. We continue to hear that inter-agency collaboration is patchy and inconsistent, but we have also started to hear positive accounts of agencies working together to support the health needs of tamariki and rangatahi in care.
There has been improvement in completing needs assessments across all health domains in the 2022/23 reporting period.6 Data was not available from Oranga Tamariki for the 2020/21 year so we cannot measure change over three years.
There has also been improvement in incorporating actions across most health domains into plans in the 2022/23 year.7 As outlined elsewhere in this report, this does not necessarily mean that plans have been actioned and that relevant services and supports are in place.
50% - 2020/2021
53% - 2021/2022
56% - 2022/2023
Oranga Tamariki acknowledges that this data is not accurate and is likely to under-represent enrolments.8 Oranga Tamariki has worked with Te Whatu Ora on a data matching exercise, which found that as of 30 June 2023, 93 percent of and in the care of Oranga Tamariki were enrolled with a PHO. The Ministry of Health, with the support of Oranga Tamariki, also completed work using de-identified data on PHO enrolments in the IDI which again found high levels of enrolment (93 percent for males and 95 percent for females as of 30 June 2021).
This data paints a more positive picture. However, we note that this data likely over reports current PHO enrolment rates because it won’t necessarily be updated when tamariki and rangatahi move until they re-enrol with a new PHO. This means, for example, that if tamariki and rangatahi are registered with a PHO in Wellington but then move to the Hawke’s Bay and are not registered with a PHO there, they would still show as being enrolled with a PHO.
78% - 2020/2021
82% - 2021/2022
87% - 2022/2023
Across the last three years, the Oranga Tamariki Health Needs lead indicator shows an increase. While this shows an improvement in identifying health needs and taking them into account in plans, it does not show whether these needs are being met.9
As with previous years, there is no available data from Oranga Tamariki regarding the on annual health and dental checks.
12% - 2020/2021
14% - 2021/2022
14% - 2022/2023
not provided - 2020/202110
26% - 2021/202211
28% - 2022/2023
Oranga Tamariki acknowledges that the disability indicator in its case management system ‘significantly undercounts the prevalence of disability’ at 14 percent. Oranga Tamariki analysis of a sample of 702 children in care estimated that 28 percent have a diagnosed disability.
N/A - 2020/2021
85% - 2021/2022
92% - 2022/2023
The Oranga Tamariki Disability lead indicator shows that, for disabled tamariki and rangatahi in the care of Oranga Tamariki, 92 percent of disability-related needs have been identified and appropriate services and supports put in place during the 2022/2023 reporting period.
This is a positive result. However, it must be read in the context of how Oranga Tamariki identifies disabled tamariki and rangatahi in its system. Oranga Tamariki is only reporting on the identification of needs for tamariki and rangatahi where there is evidence on file of a diagnosed disability (28 percent of tamariki and rangatahi in care12). There are tamariki and rangatahi in care with undiagnosed disabilities – for example, we heard about challenges in diagnosing conditions such as foetal alcohol spectrum disorder (FASD).
In previous reports, we have commented that Oranga Tamariki has a narrow definition of disability that does not accurately represent the true number of disabled tamariki. This work is yet to be done.
Oranga Tamariki uses several verified screens to assess the wellbeing of tamariki and rangatahi over 12 years of age. The Substance and Choices Scale and the Kessler and Suicide (SKS) screen, assess substance use, suicide and other areas of risk.
Oranga Tamariki policy also includes consultations with Towards Wellbeing13, who support social workers to assess and understand psychological distress and suicidal ideation among tamariki and rangatahi in care. These are key tools to support tamariki and rangatahi who may have experienced trauma, are engaging in risk-taking behaviour, and may be at risk of suicidal ideation. Understanding how often these tools are used is also helpful in providing a view of performance in assessing mental health needs as well as adherence to Oranga Tamariki policies.
For previous reports, Oranga Tamariki has provided data on how often these screens and assessments were being used, taken from a sample of files. In 2020/2021, Oranga Tamariki also provided us with the number of tamariki and rangatahi who may have needed these screens and assessments. In reviewing the data, we noted the use of these tools seemed low compared with the concerns raised about the psychological health of tamariki and rangatahi.
This year, we again asked for data on use of these screens and assessments. We also asked whether Oranga Tamariki has plans to report on whether such assessments are taking place when needed.
We received no data because Oranga Tamariki no longer includes the use of these screens in its case file analysis. Oranga Tamariki told us “While we no longer ask specific questions around Kessler and Suicide screens, reviewers are considering the mental health and emotional wellbeing needs through a number of questions looking at assessment, planning, and implementation”.
Oranga Tamariki has also told us that the introduction of its practice approach and framework means that it is moving towards a relational, inclusive and restorative way of working with tamariki, rangatahi and , centred around oranga. The practice framework is trauma-informed, helping practitioners to work with tamariki and rangatahi who may be dealing with substance abuse issues, suffering from psychological distress and/ or at risk of taking their lives. Oranga Tamariki is of the view that these considerations meet the requirements of the NCS Regulations, and has told us that it will continue to strengthen practice around supporting tamariki and rangatahi with mental health and emotional wellbeing needs.
Although the NCS Regulations are not specific about the types of screening and assessment required, and to that degree Oranga Tamariki is correct, the NCS Regulations do require Oranga Tamariki to assess the safety, behavioural, emotional and health needs of every tamariki and rangatahi in their care. Oranga Tamariki policy also requires these screens to be completed in various situations, such as upon entry into a secure residence or a change in circumstance. Given the high levels of trauma associated with the in-care population, and therefore the importance of completing these screens and assessments, it remains important for Oranga Tamariki to understand the regularity of their use. In the absence of better data, Oranga Tamariki should report on the use of these assessments and screens and develop an assessment of their need.
In last year’s Experiences of Care in report, we noted that Oranga Tamariki referred us to work underway on disability and mental health. We heard that specialist roles at Oranga Tamariki had been appointed and would be establishing advisory and inter-agency governance groups respectively. These arrangements have been in place for several years now, and we have yet to observe any impact in our monitoring visits.
Oranga Tamariki also referred us to cross-agency work under the Oranga Tamariki Action Plan14 published in July 2022. Since then, the health agencies (Ministry of Health and Te Whatu Ora) and Oranga Tamariki have completed in-depth assessments for primary health, mental health, and the health needs of transitioning out of care. A cross-agency response to the mental health needs assessment has been agreed, with actions to support frontline kaimahi and caregivers, and improve coordination between agencies.
For this year’s Experiences of Care in Aotearoa report, we also asked Ministry of Health what work has been done to prioritise and rangatahi in care during the 2022/2023 reporting period. We heard that completed work includes the updating of key health strategies to prioritise outcomes of tamariki and rangatahi, and their , involved with Oranga Tamariki.
We also heard that several work programmes are underway or planned. These include, as part of Budget 2022, specific funding allocated for tamariki and rangatahi with mental health needs in the care of Oranga Tamariki, with dedicated roles being established to provide additional mental health and addiction support to Oranga Tamariki residences.
We recognise these commitments. Our future reports will show whether any impacts are observed in our ongoing reporting.
As discussed in our review into access to primary health services and dental care for and in care, health professionals told us that they are eager to ensure this cohort has access to health services. However, the lack of information sharing between agencies means that the health system does not routinely hold information about the in-care population. This, combined with a lack of clarity on practice at the frontline (as evidenced by feedback from social workers) and confusion over parental consent, means that primary health care may be delayed for tamariki and rangatahi in care.
When we spoke with tamariki and rangatahi in Oranga Tamariki care, they reported more positive than negative experiences in accessing health services. They also reported more positives than negatives for each of the aspects of kaitiakitanga that we asked them about. Many told us that they could tell their , caregiver, kaimahi at their day-to-day care provider, or their social worker, if they needed to see a doctor or dentist and that they would be supported to do so.
A smaller number of tamariki and rangatahi spoke of having access to regular medications if needed, and/or reported having access to orthodontist specialists and braces.
Some rangatahi spoke of staying physically fit by going to the gym, staying active, lifting weights, and playing sports, with some telling us they are supported by their caregivers to do so.
We also heard that, for tamariki and rangatahi Māori in Oranga Tamariki care, there were more positive than negative experiences around accessing all health services, both primary and secondary.
Although the experience of tamariki and rangatahi was predominantly positive, we heard from many kaimahi that access to health services and supports can be difficult. This is not surprising given the well- reported constraints on the public health system.15 It may well be that the tamariki and rangatahi we spoke to were unaware of the challenges kaimahi and caregivers face to secure health services and supports for them.
Kaimahi from several agencies, including government agencies and non-government organisations (), told us about the delays that tamariki and rangatahi experience when they are referred to services, including mental health services. We heard about long waitlists, and funding and capacity constraints, and that in some cases services are unavailable.
Some of the specific difficulties we heard about include: psychologists and therapists having no availability to support tamariki and rangatahi; delays in Gateway assessments being undertaken; delays in access to the services recommended in Gateway assessments; and long waitlists for mental health services, neurological assessments and behavioural assessments.
We were told that there can be serious consequences when tamariki and rangatahi are not able to access necessary services and supports. We heard these impacts can include a breakdown in placement, struggles to learn at school and escalating behavioural challenges. We heard that, for rangatahi in youth justice placements, difficulties accessing services and supports can mean a pathway from youth justice to prison. A regional health kaimahi told us:
“I was in forensics, 99.9 percent highlighted wonderings around FASD, and we know the pathway from YJ to court is prison.”
Data from Oranga Tamariki shows that improvements have been made this year in the completion of assessments and planning for tamariki and rangatahi in care. However, when we talked with caregivers, many told us that they are not seeing individual plans and are not aware of the health needs of tamariki and rangatahi in their care. What we heard is supported by Oranga Tamariki data showing that 54 percent of caregivers had received a copy of the plan for the tamariki and rangatahi in their care, and the caregiver survey showing that 63 percent had received the plan.
We also heard that vital medical information is not always passed on from Oranga Tamariki to caregivers.
”There were gaps in the medical stuff [in the All About Me Plan] – not knowing what therapy stuff was going on. Eczema and asthma. Getting straight answers about what was the right medicine, who her doctor was.”
”[Tamariki] had open heart surgery, and I had no information about their physical disabilities, in the end their adopted father in [another country] got records for me, I wasn’t sure if it was even safe for her to do her dancing due to her disability.”
“‘You don’t need to know the nitty gritty but OT need to give you the health information when the child comes to you. The reason some things fall behind is the information is not available to you. We didn’t get the required health information needed in a timely manner.”
“‘We didn’t know about my moko’s epilepsy for ages. The information came late.”
“‘Often find before school checks are a big issue, don’t know about their immunisations or anything, we have these kids, and we are in the dark. One kid got immunised twice.”
Examples of the flow of essential information being prevented were also shared with us. A care partner received criticism from Oranga Tamariki for sharing a Gateway assessment with a caregiver in a long- term, stable placement.
“Tamariki in shared care, there’s a Gateway assessment, how difficult is it to get that information? For some reason OT doesn’t want to share the information. How can you care for a child if you don’t have the information. We really want our foster parent to have the information. We want our foster parent to feel empowered. Even the gateway assessments don’t normally happen because it isn’t prioritised. “
From what we heard, issues with the sharing of necessary information remain. This is vital so that caregivers and social workers can best support tamariki and rangatahi with their health needs. In addition, as noted by Dame Karen Poutasi in her review of the children’s sector, better sharing of health-related information would aid the identification of any significant concerns. Dame Poutasi recommended that medical records held in different parts of the health sector be linked, and that the health sector be added as a partner to the Child Protection Protocol between Police and Oranga Tamariki.
Difficulties accessing mental health services has been a consistent theme throughout the three years of our monitoring.
Mental health services, including child and adolescent mental health services (CAMHS), are widely recognised as being under-resourced16 at a time when demand continues to increase17. However, our monitoring visits have shown that there is a perception that some tamariki and rangatahi in care are denied mental health services because practitioners believe their issues are ‘behavioural’ and/or arising from their placements. This is an ideological position that we are told can severely limit access to services.
We heard from some health kaimahi, including kaimahi from CAMHS, about service delays due to waitlists and capacity. We also heard from CAMHS kaimahi in one region that CAMHS is designed for short-term support, whereas tamariki and rangatahi in care often need longer term support with consistent kaimahi. They also told us that tamariki and rangatahi in care might have behavioural issues due to their environment (for example, suicidal ideation driven by placement) that can’t be resolved with therapy. They said tamariki and rangatahi in care need to be in a stable placement, with a stable adult/caregiver to support them, before they can receive mental health support. In response to this, Oranga Tamariki has pointed out that a lack of access to treatment and mental health support contributes directly to placement instability.
In another region, we heard from CAMHS that Oranga Tamariki closes files too soon, which in turn, impacts CAMHS ability to support tamariki and whānau.
CAMHS kaimahi told us:
”What we are saying is that the suicidal ideation is driven by the placement – that’s the formulation we have. We aren’t going to fix that through therapy.”
“You need a young person to have a secure place and an adult who can help them to engage with mental health services and do that hard work and it is often unsafe to have them engage with us – if they don’t have a stable [or] secure adult [or] caregiver to support them.”
“Hearing you talk makes me think about our system and the choice in partnership with mental health for us in this room – it doesn’t work for tamariki/rangatahi who have been in care. You meet one person for an assessment for an hour and a half – and then they meet the next one and the next. “
Despite these views on the impacts of placements on mental health, we heard of instances where it is clearly vital that tamariki and rangatahi in care receive the mental health support that they desperately need.
“He went through a stage of having girlfriends; when they break up with him, he gets suicidal and very depressed... He had to wait six weeks to be seen by anyone for the suicidal behaviour due to long waitlists. “
In our report last year, we noted that social workers felt left to support tamariki and rangatahi experiencing mental distress without the necessary expertise or assistance from other professionals.
We heard this too from caregivers, who do not feel equipped to care for tamariki and rangatahi affected by trauma.
When we spoke with tamariki and rangatahi about their mental and emotional wellbeing, some reported feeling that they didn’t have anyone to speak to. Others told us that they did have access to a counsellor/psychologist, but they didn’t want to speak to them or didn’t feel comfortable speaking to them.
“[Psychologist] is frustrating. He tries to focus on everything at once. It’s like if I have multiple cuts all over my hand, rather than just one bigger cut, your body expends more resources trying to heal them all and it takes more time to heal.”
Conversely, other tamariki and rangatahi spoke about seeing psychologists (including psychologists from CAMHS) and counsellors regularly to support their mental health and anxiety, talk through problems, and discuss how things are going. Some told us that their Oranga Tamariki social worker supported them to access this support. Others told us they have been supported in the past, but not currently as they no longer need it.
“Social worker will organise [counselling] when I want to do it, but I haven’t wanted to go to counselling.”
“On the mental health side I’ve had a reasonable amount of counsellors. That’s one thing they’ve been reasonably good at [Oranga Tamariki] like setting the mental health stuff up.”
“I just have someone to talk to too [at therapy] and talk about my feelings and stuff like that.”
During our 2022/2023 monitoring visits, we started to hear more positive accounts of government agencies and other providers working together at a local level to support the health and wellbeing of tamariki and rangatahi in the care of Oranga Tamariki.
We heard positive accounts from health service kaimahi about their experience of inter-agency collaboration and their relationship with Oranga Tamariki. We heard that improved collaboration stops tamariki and rangatahi being caught in between government “siloes”, results in faster access to services and supports, and ensures greater consistency for tamariki and rangatahi. We were told that having a positive relationship with Oranga Tamariki makes “a real difference for these children” as it enables tamariki and rangatahi to receive services and supports in a timely manner. A health kaimahi told us:
“We do have a MOU meeting with health, police and Oranga Tamariki – developing trainings – space to discuss really important information – [hospital liaison] is the OT rep – she has been helpful bringing everyone together.”
We also heard from Oranga Tamariki kaimahi who spoke positively about the collaborative relationships they have with other agencies and organisations, that have a positive impact on tamariki and rangatahi.
“We do have a really good working relationship [with ICAF] – we have the team leader come and sit here monthly on a Friday morning – really good engagement – ’is this a good referral?’”
“We have a really good relationship with the Youth Forensics Team. We’ve had a relationship with them for 12-15 years. Every Friday they come in for weekly meetings. They have a psychiatrist, nurse therapist, sometimes a psychologist on the team and AOD [alcohol and drug] counsellor and our kids can get assessed much more quickly. That’s a really good meeting, we know each other so well. They are really obliging. They are good to pick up an assessment before we have to do a 333 [Section 333 Medical, psychiatric, and psychological] report through court.”
“When I go to high and complex needs meetings – all the players are there – I enjoy it because everyone who needs to be there is there. Outcomes for tamariki are improved when everyone is involved.”
We also heard positive accounts of some regional advisor and/or liaison roles, which help to ensure that information is shared between agencies and that kaimahi from different agencies are connected. Health kaimahi told us:
“We now have good relationship as we have an OT liaison, so we get a response that day, able to have that communication when the information we need isn’t there.” ‘’I was trying to get in touch with OT staff from another region and couldn’t get a response from them. I copied her [OT regional disability role] into the email… such a small example, but her prompting social workers on our behalf to follow up on things they said they were going to follow up on is a huge help. I understand though that OT are under resourced.”
However, we also heard from kaimahi from NGOs and health and education agencies about the difficulties they experience working with Oranga Tamariki, particularly in terms of collaboration, communication and information-sharing. Some health service kaimahi told us that they experience poor communication from Oranga Tamariki “until a crisis occurs”, and that they often do not know who to contact to arrange services for tamariki and rangatahi in Oranga Tamariki care. This is a theme that we have explored in more detail in our report into access to primary health services and dental care for tamariki and rangatahi in state care.
We heard from an social service that poor communication of Oranga Tamariki policies and practices creates barriers for the provider to meet the health needs of tamariki and rangatahi in their care.
“There’s always room for improvement. However, in terms of medications and guardianship, Oranga Tamariki have that however the important thing that I can see is that within the rūnanga, our services we’ve got doctors, medical centres, if we can change that mindset or guardianship and social workers with medications and utilise our own services, it would be a vast win for all in terms of the service. As you know, when the rangatahi needs to go for an appointment it’s not the kaimahi’s job to take them because we’re not the legal guardian, the social workers have to take them and then again that’s a step backwards because it prolongs the process. Whereas if we had the use of our own services, it would cut out the middleman. However, with Oranga Tamariki holding the strings we can’t do that. However, another trick, we are fortunate to have an iwi appointed manager sitting upstairs [in the Oranga Tamariki office] next month who A. are from the iwi and B. hopefully will push changes” [Iwi social services provider]
We were told that these difficulties impact on agencies’ ability to meet the health needs of tamariki and rangatahi in the custody of Oranga Tamariki. Overall, the experience of agencies working together is mixed. However, we are starting to see an improvement in some regions and where we are hearing about good collaboration, kaimahi describe how it benefits tamariki and rangatahi.
We had heard in our earlier monitoring that kaimahi from several agencies, including Oranga Tamariki and Police, were concerned about a lack of funding and support available for tamariki and rangatahi with high and complex needs, including neurodevelopment disorders such as FASD. This year, we heard similar themes from caregivers and whānau, as well as kaimahi from Oranga Tamariki. They spoke about difficulties in getting assessments, and in accessing supports following diagnosis. FASD was again raised as an issue in terms of diagnosis, availability of funding and supports, and the way that it is or is not recognised as a disability within the health system18.
When we spoke to disabled tamariki and rangatahi and/or their caregivers, there were more positive than negative experiences around accessing health services in general. We also heard from tamariki and rangatahi in a specialist disability placement that being able to experience fresh air from open windows at night was a welcome change from being in hospitals. We were told by tamariki and rangatahi that they feel safe and cared for.
“I have lovely people like [name], lovely teachers, good friends …”
“We do Zumba on Thursdays. Sometimes I go in front … We have a circle of high-fives and we go around and give everyone a high five.”
However, we also heard concerns about the system response to parents who are struggling to cope with caring for disabled tamariki and rangatahi with very high needs. We heard that very high and complex needs associated with disability are sometimes treated as care and protection issues. Some whānau with tamariki and rangatahi living in specialist disability placement told us about their struggle in making the initial decision to have their tamariki and rangatahi in care. Some Oranga Tamariki kaimahi told us that they do not think this system response is appropriate.
“A lot of disability work high level is not always care and protection. We almost have to put a punitive label on these whānau in order to get the needs in the support of a placement.”
“There is a different approach between OT and the health sector. The health sector is about removing children from parents and putting them in a residential programme – not about looking at the resources that can support them to remain in their own home … we have a tension at a philosophical level around where we should be intervening.”
“We had a situation – a young person was in respite care with mental health service, were only allowed three days – mum wanted a bit more time – mum couldn’t go and meet with them at the service – they wouldn’t meet mum at home – so they referred to us, we said we would see mum with them – they told us they needed us to take custody of the child. We said that didn’t seem right. We went and seen mum in the end – we negotiated an extra night or two at the respite home – but it shouldn’t have been that complex. We had nothing to do with them – they were under the CAMHS service – it got escalated right through help – one of those perverse situations where you end up with a distorted outcome, when there was a relatively straight forward solution. I know that isn’t part of the policy – you normally get family coming to the service.”
“I am involved with one rangatahi where it would be most ideal if we could contract the service, a rostered service to go into the home, but service providers are not willing to do that. We are ten years behind in our thinking. Spectrum care – those types of providers have been providing these services.”
The importance of government agencies working together to achieve positive outcomes for tamariki and rangatahi in care has been reinforced from what we heard in our monitoring visits. Oranga Tamariki is not responsible for delivering health services, yet we continue to hear that it is left to deal with the consequences of unmet health needs among the tamariki and rangatahi it cares for. Greater clarity over how services are accessed and funded is required, so that Oranga Tamariki social workers and caregivers can more easily navigate the system to get tamariki and rangatahi the services they require.
Open Home Foundation recorded a PHO enrolment rate of 100 percent for and in its care during 2022/2023. Open Home Foundation data also states that 79 percent of tamariki and rangatahi in its care had an annual health check in 2022/2023, and 75 percent had a dental health check (or were not eligible due to their age). However, as outlined in our report into access to primary health services and dental care, we understand from Open Home Foundation kaimahi that any visit to a PHO may be recorded as an annual health check, irrespective of what that visit was for.
Open Home Foundation data also records that 100 percent of tamariki and rangatahi in its care had access to a culturally knowledgeable and experienced health practitioner during the reporting period1. This is discussed in our report into access to primary health services and dental care.
In terms of equity, Open Home Foundation data shows that tamariki and rangatahi Māori have higher rates of annual health checks than non- Māori. While the numbers are too small to draw firm conclusions, it does point to an absence of any indication that tamariki and rangatahi Māori are receiving fewer checks than non-Māori.
N/A - 2020/2021
99% - 2021/2022
100% - 2022/2023
N/A - 2020/2021
65% - 2021/2022
79% - 2022/2023
N/A - 2020/2021
59% - 2021/2022
75% - 2022/2023
In most cases, there has been an improvement in how well health needs have been included in individual plans.
N/A - 2020/2021
69% - 2021/2022
84% - 2022/2023
N/A - 2020/2021
88% - 2021/2022
89% - 2022/2023
N/A - 2020/2021
87% - 2021/2022
93% - 2022/2023
Open Home Foundation states that 40 percent of tamariki and rangatahi in its care during the 2022/2023 reporting period were identified as having a disability. There have been improvements in how well disability-related needs have been identified and addressed in individual assessments and plans.
N/A - 2020/2021
87% - 2021/2022
97% - 2022/2023
N/A - 2020/2021
72% - 2021/2022
88% - 2022/2023
We heard from and in the care of Open Home Foundation that they know who their doctor is, or they know how to access their doctor, and that they would be supported to see a doctor if they needed to.
“I have a doctor, no issues. Since being here I actually have a regular doctor. I go to the local clinic in [town]. I’m happy with my doctor. In previous homes I never had regular doctor and I might not have got to see them anyway. I’m seeing him [doctor]tomorrow due to my mental health. My […] can read me like a book. He suggested anti-depressants we’re going to talk to the doctor tomorrow. I’ve always felt weird about that, because it says maybe there is something that’s weird about me, but then it might help.”
We also heard from Open Home Foundation caregivers that they had more positive than negative experiences in terms of supporting the health and wellbeing of tamariki and rangatahi in their care.
“Arranged doctor and dentist. He has also been to the optician. He has glasses now. I got him in the dentist because he’s 16 and he needs it. It’s really difficult to get young people into doctors and dentists down here.”
“They [OHF] are pretty quick. They like to stay on top of things. Social worker will come along to paediatrician appointment sometimes and I will let her know latest information, share reports from school, things like that. He has been to the orthodontist and will need braces in the future. Open Home Foundation know about that. They will pay for this bill.”
As with kaimahi from Oranga Tamariki, we also heard from Open Home Foundation kaimahi about delays in access to health services, including mental health services. In some instances, tamariki and rangatahi are unable to access services as books are full, and therefore closed to new patients. We also heard that some tamariki and rangatahi are unable to access some services, such as mental health services and supports for intellectually disabled tamariki and rangatahi, due to the high thresholds for eligibility.
“No funding for counsellors and lack of counsellor…. With CAMHS – a kid can’t get seen, can’t get an appointment. Funding is so hard and so unfair.”
“With health I feel they need to be bad enough or in crisis to be able to be seen – Paediatricians seem to get more access to services. Children who are not cutting won’t be seen. If the behaviours aren’t there then they don’t reach the criteria.”
“I have this child – having nightmares – would wake up so escalated – wakes up at a level nine – I can’t bring him down – he needs counselling, and he needs medication – gun to your head you can’t learn to function at a nine – you can’t come down. Six months to start the process to assessment – he can’t access services because he is not in stable placement.”
Once again, the system supporting tamariki and rangatahi in care must be strengthened to better serve the health needs of this group.
1 This includes B4SC referrals for vision, hearing and/or development; and B4SC dental scores in the referral range.
2 Potentially avoidable hospitalisations include respiratory conditions, gastroenteritis, skin infections, and vaccine preventable illnesses. They also include unintentional injuries and hospitalisations due to assault or self-harm.
3 https://www.health.govt.nz/system/files/documents/publications/good-oral-health-strategic-vision-2006.pdf
4 By this, we mean data from care partners on whether they have met the for and in their care.
5 For example, “demand for Infant, Child and Adolescent Mental Health Services (ICAMHS) is high and services are stretched, which is consistent across all health services. [There] are also significant vacancies and challenges in recruitment, leading to workforce constraints. ICAMHS is funded to serve three percent of the population, but they currently provide services to four percent of the population.” page 35. https://www.orangatamarikiactionplan.govt.nz/ assets/Action-Plan/Uploads/Understanding-need/Mental-health-and-wellbeing/OT-MW-Needs-Assessment_final-for- publication_Redacted.pdf
6 Data from Oranga Tamariki refers to health needs assessments including: behavioural, emotional, physical health, mental health, substance abuse and disability.
7 Data was not available in 2020/2021 on physical health, mental health and substance abuse. Where data is available for 2021/2022 and 2022/2023, the sample size is too small to assess statistically significant change.
8 Data from Oranga Tamariki includes an acknowledgement that the figures provided are “indicative that a specific doctor or medical centre has been advised and recorded. The values entered in this data source are ‘free text’ so are not consistent records that provide an indication of unknown, unregistered, to be confirmed or other non-enrolment that have been grouped as not being enrolled. Records marked as confidential are also not included in the supplied figure.”
9 Overall 97 percent had some form of current needs assessment in 2022/23 (up from 89 percent in 2021/2022).
10 Oranga Tamariki did not provide a figure based on case file analysis for this period.
11 Oranga Tamariki did not provide this figure for our 2021/2022 Experiences of Care in report, but we estimated it to be 25 percent from the data provided to us. Oranga Tamariki now states that this is 26 percent.
12 The 2013 Disability Survey identified a disability rate of 11 percent among children aged 0-14 years in Aotearoa New Zealand. Researchers and have since suggested that the true rate is likely to be much higher. https://www. childyouthwellbeing.govt.nz/sites/default/files/2023-04/Final-202122-CYWS-Annual-Report.pdf
13 Towards Wellbeing is a clinical advisory service contracted by Oranga Tamariki. It supports social workers to identify suicide risk and develop plans for rangatahi to reduce risk. It also assists with accessing mental health services.
14 The Oranga Tamariki Action Plan sets out how Oranga Tamariki, New Zealand Police and the Ministries of Education, Health, Justice and Social Development will work together to improve the wellbeing of the core populations of interest to Oranga Tamariki. The ‘core populations of interest’ are those tamariki and rangatahi at risk of entering state care, those who are currently in state care, and those who have transitioned out of state care up to the age of 25.
15 For example, clinical performance data from Te Whatu Ora shows that preventable hospital admissions, for illnesses that could have been treated earlier, had increased during the year to 30 June 2023, and particularly so for young children. https://www.tewhatuora.govt.nz/publications/clinical-performance-report-1-april-30-june-2023
16 For example, there are only three specialist units providing inpatient mental health services for children and adolescents in Aotearoa New Zealand (in Auckland, Wellington and Christchurch), resulting in some young people being admitted to adult inpatient mental health services https://www.mhwc.govt.nz/news-and-resources/youth-services-focus-report/
17 As reported in the 2021/22 Annual Report on the Child and Youth Wellbeing Strategy, around one in four young people aged 15-24 years experienced high or very high levels of psychological distress in the four weeks prior to being surveyed (24%). This is a statistically significant increase from one in ten in 2019/20 (from 11% to 24%). This continues a concerning trend of sharply increasing rates of youth psychological distress and associated measures over the last decade in Aotearoa New Zealand and overseas. https://www.childyouthwellbeing.govt.nz/sites/default/files/2023-04/ Final-202122-CYWS-Annual-Report.pdf
18 The cross-agency plan for mental health and wellbeing, as part of OTAP, refers to work being undertaken in 2023 to expand caregivers’ access to specialist skills development in supporting neurodevelopmental disabilities including FASD, and work in 2024 to design role-specific learning pathways in care and protection residences to support neurodevelopmental disabilities including FASD.
1 NCS Regulation 13 includes the requirement that reasonable endeavours are made to ensure that tamariki and rangatahi have “access to a health practitioner who has knowledge and experiences of the cultural values and practices” of those tamariki and rangatahi. For tamariki and rangatahi Māori, this means “a health practitioner who has knowledge and experience of Māori models of health”.