Gateway Assessments for all children and young people with high needs
From 1 July, 2011, Child, Youth and Family will be rolling out the new Gateway Assessment process with the Ministries
of Health and Education.
Social workers will ensure all children and young people with high needs have a comprehensive Gateway Assessment. It
is expected that around 4,200 children will meet the criteria for referral each year. This will include all children who
enter non-emergency care, children and young people already in care who have significant health and behavioural needs
and children identified as having high needs at a Family Group Conference.
Over the last two years, Child, Youth and Family and the Ministries of Health and Education have been piloting health
assessments and education profiles across four district health boards – Auckland, Counties Manukau, Lakes and Mid Central.
Nelson Marlborough DHB joined the pilots in April 2011.
Central to the Gateway Assessment process is the Gateway Assessment Coordinator who is employed by the DHB and gathers
together the available background information from the social worker, family, health and education contacts.
Teachers from the child or young person’s school provide a profile of their education engagement and achievement.
One of richest sources of background health data has proven to be the transaction records that the New Zealand Health
Information Service (NZHIS) is able to provide. These reports include birth records, prescribed medications, laboratory
test requests, hospital admissions, mental health contact, PHO enrolment, immunisation records and outpatient events.
ACC also provides a complete record of all reported injuries for the child. The WellChild provider also contributes to
the picture, where they have been involved in the care of the child.
This information provides the leads for the Assessment Coordinator to contact various health practitioners and piece
together the fragmented health record for the child or young person.
The very complex needs of these children means that the health assessment is usually undertaken by a paediatrician with
the assistance of a nurse specialist. Several pilot sites engaged General Practitioners to undertake the assessment, however,
the time requirement (two to three hours), interpretation of screening tools and the mental health and developmental assessments
have proven challenging for primary care. Adolescent assessments are undertaken by youth health practitioners
The output from the assessment is a comprehensive interagency report and recommendations. This report is sent to the
social worker, General Practitioner (where a consistent General Practitioner can be identified), teacher and caregiver.
These children and young people often have health records that are scattered around the country between primary and
secondary care. Health transactions often occur in Accident and Medical Clinics, Afterhours Centres and Emergency Departments.
Child, Youth and Family are exploring opportunities to make the assessment reports and health history available to health
practitioners who subsequently engage with the children. It is envisaged that the Gateway Assessment record could become
the foundation for an ongoing integrated health record.
Everyone involved in ensuring the child’s health and safety will be following their progress. While the social
worker has overall responsibility to monitor and review the child’s development plan with the family while the child
is in care, the primary care provider has a key role in monitoring their growth, development and mental health.
The benefits accruing from the health and education assessment includes:
- Families gaining new insights into their child’s health and behaviour that they had not previously understood
- 88% of children who have been assessed had unidentified or unmet health needs.
- Connecting these children with primary care and specialist health services
- Better information for teachers to help them work with the child in the class room
- More integrated information across agencies which strengthen the relationships, leading to more informed planning
and service development
- Families, teachers, social workers and health professionals working together
- Specialist child health services becoming aware of the needs of the child and advocating on their behalf to access
service (particularly mental health services) to address the child’s needs
The first regions to implement the Gateway Assessment programme will be the health and education pilot sites (see above).
They began providing the revised service on 1 July 2011. This service is designed to ensure that all children with high
needs who come to the attention of Child, Youth and Family have a comprehensive assessment of their health and education
status as early in their development as possible. By identifying and addressing their needs it is expected that Child,
Youth and Family can facilitate a material difference to the child’s educational achievement and social participation.
It is anticipated that this programme will reduce their involvement in the criminal justice system.
Mental health services
Child, Youth and Family was allocated funding in the Budget 2011 to increase the availability of mental health services
for children and young people in care.
This funding will be used to implement a primary care based child mental health service targeted to meet the needs of
children who have emotional and behavioural disorders but do not meet the criteria for specialist mental health services.
It will also be used to expand, over the next four years, the number of Intensive Clinical Support Services available
for young people with mental health and behavioural challenges who are in the care of Child, Youth and Family.
Child, Youth and Family are currently recruiting the team that will develop these services in consultation with the
Money was also allocated in the Budget 2011, over four years, to develop a dedicated youth forensic mental health and “Alcohol
and other Drugs” service across New Zealand. This will provide community youth forensic teams, increase Youth Court
liaison services and provide secure inpatient beds.
As a condition for approving the additional funding for these services, the Government required Child, Youth and Family
to develop a clear set of outcome measures. While these measures are still in development, they will explore the outcomes
in terms of education, health and social welfare. Health measures will include indicators such as immunisation rates,
changes in mental health screening scores, teen pregnancy rates and PHO enrolment.
These outcome measures will enable us all to understand what interventions are successful and how best to address the
needs of New Zealand’s most vulnerable children.