Gateway Assessments

Gateway Assessments - Overview

Gateway Assessments are an interagency project between Child, Youth and Family, Health and Education. For children and young people known to Child, Youth and Family, 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.

Health and Education Assessments – the pilot project

Involved 4 DHB’s and 16 Child, Youth and Family sites between 2008 and 2010.

The pilot project was reviewed and a number of recommendations for improvement were suggested. The recommendations were taken on board and the pilot became Gateway Assessments.

Budget bid of May 2011 provided funding for the pilot to be implemented throughout New Zealand.

There are now 12 DHB’s and 37 Child, Youth and Family sites that have an operational Gateway Assessment clinic. Implementation will be complete by the end of 2012

Services for Children in Care

> Gateway Assessments (health assessments and education profiles)

> 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 state care. The package includes:

Who are they for?

Gateway Assessments are available to any child or young person who:

> is entering Child, Youth and Family care

> is already in Child, Youth and Family care

> is having a care and protection family group conference (FGC)

Gateway Assessments flow chart

Child Identified as likely to benefit from a Gateway Assessment

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

Health Assessor• Reviews history• Undertakes comprehensive health assessment• Writes health report and recommendations

Social Worker• Prepares information for use at care and protection FGC• Completes child or young person’s plan• Monitors agreed recommendations

Education

Health

Social Worker

ACC

Social Worker

Health (NHI)

Well Child Provider

Family

Teacher/Principal/ RTLB

(School or Early Childhood Centre)

• Completes education profile

• Identifies issues affecting education

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 recommendations• Coordinates Multi-disciplinary Clinical Meeting • Follows-up on implementation of recommendations at 3 months

CAMHS

Primary Child MH Services

Paediatric Services

Adult AoD and MH Services

Gateway Assessments - roles and responsibilities

The Child, Youth and Family social worker

The social worker is responsible for:> engaging with child, young person and their family and obtaining consents> requesting the education profile and making the referral to the Gateway

Assessment Coordinator > ensuring the child or young person can attend the appointment and has the

right support with them

> assisting with the development of the Interagency Services Agreement and participating in the multi-disciplinary clinical meeting

> discussing the completed report with the child or young person and family/ caregivers and developing the plan with the family

> ongoing monitoring and reviewing of the child or young person’s progress.

The teacher/RTLB

The teacher is responsible for:

> completing the education profile and attaching any specialist education reports to the profile - this should be completed by someone who knows the child well

> where the child is entering care, liaising with the RTLB cluster manager*

> returning the completed Education Profile within seven days

> ensuring someone from the education sector attends the multi-disciplinary clinical meeting, as required

> reviewing and approving the education services suggested in the Interagency Services Agreement

*As directed by the Ministry of Education, RTLB only work with children entering care between the ages of 5-14

Gateway Assessment Coordinator

> The Gateway Assessment Coordinator is responsible for:

> collecting existing health information about the child or young person from other agencies (e.g. ACC, Plunket)

> collecting the mental health and drug and alcohol history of the parents (if consent from the parent has been obtained)

> ensuring the education profile information is provided to the assessor

> drafting a health report after the health assessment has taken place for dissemination to the child/young person, their family, the caregiver and all of the involved professionals

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

> arranging multi-disciplinary clinical meetings

> a 3 month review of the services provided

Assessing health practitioner

The health assessor is responsible for:> identifying the health needs of the child or young person,

including mental health screening and writing a health report> completing follow-up referrals for the follow, as required > ensuring the child or young person has a primary care provider> reviewing and endorsing the Interagency Services Agreement

once drafted by the Gateway Assessment Coordinator> attending a multi-disciplinary clinical meeting if

there are concerns about the ISA that need clarification or resolving.

Timeframes

Health and education information needs to be available in child focused 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 >Makes the referral for the health assessment

Within 5 working days of identifying the need for an assessment

Teacher >attends RTLB led meeting (within 4 days) and completes the Education Profile

Within 7 working days of request

Health assessor

Completes the health assessment

Within 6 weeks of receiving referral

(4 weeks for under 5 year olds)

Gateway Assessment Coordinator

Distributes health report and recommendations

Within 10 working days of the assessment

Drafts Interagency Services Agreement

Arranges Multi-disciplinary Clinical Meeting

Within 10 working days of the assessment

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

Primary mental health services - interventions

New CYF Funded Mental Health Services

Acute

ICSS

CAMHS

Primary Child 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

What the interventions do

Watch, Wait and Wonder

Incredible Years

• ≈ 8 sessions for caregiver & infant with therapist

• 2 parts to sessions, 1st half infant led, 2nd half focuses on the parent’s observations

• Infant: improvement in attachment; cognitive development, and emotional regulation

• Parent: improvement in parenting confidence, depression, & reduced parenting stress.

• aimed at reducing challenging behaviours and promoting social competence at home and school

• caregivers attend about 14 weekly group sessions

• view & discuss videos showing caregivers interacting in appropriate & inappropriate ways

• reinforced with role playing, rehearsal, phone calls and home work.

™

Triple P (Primary level

and Levels 4 & 5)

Parent-Child Interaction

Therapy

• understanding the negative effects of abuse 

• daily positive interactions (child directed interaction- parents/caregivers learn non directive play skills) and promoting child compliance (parents/caregivers learn to direct the child’s play)

• live coaching either, in the room, one-way mirror, or the “bug in the ear” system.

• combines information with skills training and support

• teaches caregivers to apply parenting skills

• targets behaviours at home and in community

• several different delivery formats available.

What the interventions do

Cognitive Behaviour

Therapy (CBT)

Trauma Focused CBT

(sexual abuse)

• for child and non-abusive caregiver

• teaches techniques to manage the emotional response to trauma

• training on parenting, personal safety and relationship skills.

• goal-orientated systematic procedure to address challenging emotions, behaviour’s and cognitions

• 8-12 sessions which can be face to face or computer based.

Abuse Focused CBT

(physical abuse)

• targets perpetrator and child's behavioural/emotional adjustment

• psychological education, coping skills, discussion, developing social support plans and developing communication skills.

What the interventions do

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.