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SERVICES FOR CHILDREN AND YOUNG PEOPLE – Health Services for Children and Young People in Child Youth and Family (CYF) Care and Protection and Youth Justice Residences TIER LEVEL TWO SERVICE SPECIFICATION

STATUS: MANDATORY  For the nationwide minimum description of services to be provided. Review History Date

First Published on NSFL July 2012

Updated: August 2015

Amended: Reporting added word ‘directly” September 2015

Consideration for next Service Specification Within five years Review

Note: Contact the Service Specification Programme Manager, National Health Board Business Unit, Ministry of Health to discuss the process and guidance available in developing new or updating and revising existing service specifications. Nationwide Service Framework Library website: http://www.nsfl.health.govt.nz/ SERVICES FOR CHILDREN AND YOUNG PEOPLE – HEALTH SERVICES FOR CHILDREN AND YOUNG PEOPLE IN CHILD YOUTH AND FAMILY (CYF) CARE AND PROTECTION AND YOUTH JUSTICE RESIDENCES TIER TWO SERVICE SPECIFICATION COCH0026 This tier two service specification for Children and Young People in Child Youth and Family (CYF) Care and Protection and Youth Justice Residences (the Services) must be read in conjunction with the overarching tier one Services for Children and Young People Service Specification. Refer to the tier one Services for Children and Young People Services service specification for generic requirements that are applicable to all service delivery. The Services are linked to other District Health Board (DHB) funded service specifications such as:  Services for Children and Young People  Mental Health and Addiction Services - for children, adolescents and youth  Oral Health Services  Specialist Medical and Surgical Services. Access to the above services for Service Users is determined clinically, based on principles of levels of need and ability to benefit. This list is not exhaustive.

Background Services in CYF Residences1 Child, Youth & Family (CYF) is a service line within the Ministry of Social Development (MSD) with statutory duties and powers to provide care and protection for children and young people. As part of these responsibilities, CYF provides residential care for children and young people who either:  have behaviour such that they are placing themselves or others at risk and a secure environment is required to keep them (or others) safe (Care and Protection Residence), or  have a history of offending serious enough to warrant secure placement, or have been charged with a criminal offence(s) or face charges, or have been sentenced to a term of imprisonment which they are serving in a Youth Justice residence because they have been deemed too vulnerable to serve the sentence in prison (Youth Justice Residence). Children and young people may not always be placed in a CYF Residence close to where they live. Following admission, they are provided with a range of programmes to meet their individual needs. Planning is undertaken for their transition back to the community or other facility when the placement is complete. Children and young people (the “Service User / Service Users”) who enter a Residence often have high levels of unmet health needs particularly in the areas of mental health and developmental disability, and often have not had active contact with primary health services and subsequent referral for specialist care.

1 Section 364, Children, Young Persons and Their Families Act, 1989 Health Services for Children and Young People in CYF Care and Protection and Youth Justice 2 Residences tier two service specification September 2015 Nationwide Service Framework 1. Service Definition This service specification applies to the following Residences (each a “Residence” and together the “Residences”): Table 1: Applicable Residences

Residence DHB Care & Protection or Youth Justice Whakatakapokai Counties Manukau C&P Korowai Manaaki Counties Manukau YJ Te Ao Rere a te Tonga MidCentral YJ Epuni Hutt Valley C&P Te Puna Wai o Tuhinapo Canterbury YJ Te Oranga Canterbury C&P Puketai Southern C&P Te Maioha o Parekarangi Lakes YJ The health services provider funded by a DHB to deliver the services specified in this service specification (“the Provider”) will deliver and coordinate the delivery of a comprehensive range of health services to meet Service Users’ needs. Health services (“the Services”) will:  comprise of personal, mental, and population health based approaches to support the attainment and maintenance of the Service Users’ optimal health and development  be user-friendly, culturally-appropriate and driven by the needs of the Service User  be delivered by the Provider in the best interests of the child or young person2 with the consent of the child or young person and their family and whānau are involved, whenever practicable.

2. Exclusions Children and young people not currently resident in a CYF Care & Protection or Youth Justice Residence and staff in the Residences are excluded from these Services.

3. Service Objectives 3.1 General The objectives of the Services are to:  identify and address the Service Users’ presenting health conditions and ensure a comprehensive range of health services are provided to meet their needs  work within the constraints of the Residence environment to facilitate a positive caring and therapeutic approach that promotes positive health, wellbeing and development  utilise strength-based approaches3 to build resilience in Service Users  assist Service Users to develop knowledge, skills and confidence to adopt healthier behaviours that contribute to their physical, mental and social wellbeing, and skills that are able to be taken back into the community upon discharge  create sustainable health outcomes for Service Users while they are in the Residence and establish a platform for ongoing engagement with health services after discharge. The Services:

2 Children, Young Persons, and Their Families Act 1989 section 6. 3A treatment approach, that focuses on and helps develop the Service user’s strengths. This approach combines both provision of direct services and treatment, along with helping people define or priorities their needs, navigate the system and link into community resources. Health Services for Children and Young People in CYF Care and Protection and Youth Justice 3 Residences tier two service specification September 2015 Nationwide Service Framework  take into account the particular needs of culturally diverse communities and other ethnic groups  strive to minimise barriers to access to, or communication with, the Services  ensure there is no discrimination in any practice, and that the Services are safe for all Service Users. 3.2 Māori health objectives Refer to the tier One Services for Children and Young People service specification for the overarching objectives for Māori Health. In addition, the Provider will provide Services that are responsive to the unique needs of Māori Service Users who make up a significant proportion of their clients and contribute to a reduction of health inequalities for their Māori Service Users, and understanding and meeting their needs. Māori Service Users are to be supported by the Provider to help achieve their maximum health and wellbeing consistent with the directions set in key strategic documents, such as He Korowai Oranga4–(Ministry of Health, 2014). Providers must recognise the cultural values and beliefs that influence the effectiveness of services for Māori and must consult and include Māori in service design and delivery. Services must build on the current investment and innovation in Māori programmes and services and develop effective models of service delivery that are responsive to Māori and contribute to whānau ora. Providers must offer an integrated service that includes developing and maintaining relationships with other primary and specialist health, education and social services that influence Māori health outcomes. 3.3 Pacific health objectives The Services will work to encourage Pacific Service Users to make healthy choices and facilitate access to health and social services. The Provider is expected to provide health services that will contribute to the improvement of health outcomes and reduction in health inequalities for Pacific people’s children and young people under their care. The Provider will support initiatives that build upon current investment and innovation in Pacific peoples’ programmes and services and develop effective models of service delivery that is responsive and aligned to Ala Mo'ui: Pathways to Pacific health and wellbeing' 2014-2018.5 3.4 Agreement on strategies to achieve the objectives Within three months of signing a Service Agreement and on an annual basis after that, the Provider will consult with the manager of the Residence to develop and agree a Memorandum of Understanding that sets out for the following 12-month period the approach to delivering the Services to achieve the objectives set out in this clause 2, and includes:  the parties’ and the Service Users’ priorities with regard to the Services  the Provider’s staffing plan for the Services (refer clause 5.4)  the Provider’s approach to delivering the Services and working with Residence staff to: meet Service Users’ health service needs deliver the components of the Services described in clause 5 achieve the quality requirements described in clause 8.

4 The New Zealand’s Māori Health Strategy, He Korowai Oranga strategy was updated with input from across the sector during 2013/14 to ensure its relevance for the future http://www.health.govt.nz/our- work/populations/maori-health/he-korowai-oranga 5 Ala Mo'ui: Pathways to Pacific health and wellbeing' 2014-2018. http://www.health.govt.nz/publication/ala- moui-pathways-pacific-health-and-wellbeing-2014-2018 Health Services for Children and Young People in CYF Care and Protection and Youth Justice 4 Residences tier two service specification September 2015 Nationwide Service Framework 4. Access 4.1. Hours of operation The Services are provided during agreed business hours6. The Services are not provided after hours, or on weekends or public holidays. Primary Health Care Services will be provided during agreed business hours. 4.2 Entry The Services will commence when a child or young person enters a CYF Care and Protection or a Youth Justice Residence. Each Service User in a Residence is eligible to receive the Services and to be referred to receive DHB funded health services, where access for Service Users is determined clinically, based on principles of levels of need and ability to benefit. DHB funded services are to be accessed wherever possible. Where private service providers need to be accessed, or co-payments apply for publicly funded services, CYF will consider funding the service as appropriate to their role (refer to Appendix One Table 7). 4.3 Exit criteria and transfer The Services described within this service specification will be discontinued following discharge of the Service User from the Residence, or transfer to another Residence of facility. Refer to 5.1.7 – Discharge Planning.

5. Service Components 5.1 Processes Consent: No Service User will be required to undergo any medical or dental examination or treatment without the Service Users consent, except where another person is authorised to make that decision on behalf of the Service User7. Where the Service User is assessed as not being competent to grant consent8, their guardians must be involved in decisions about health services. Parents, guardians and caregivers will be informed about decisions that significantly affect the Service User9. The Service Users will receive the following assessments and clinical services: 5.1.1 Assessment Assessment will support multi-disciplinary review, discussion with the Service User and their health care planning. Following triage assessment on admission (see 5.1.1.1 below) and medical assessment (see 5.1.1.3 below), a comprehensive Health Care Plan (Medical and Nursing) will be developed and updated during the Service User’s stay in the Residence. The Services will be delivered in accordance with the Service User’s Health Care Plan. 5.1.1.1 Triage assessment on admission Each Service User will receive a triage assessment within 24-4810 hours of entry to the Residence to identify and prioritise their immediate health needs and the appropriate action or treatment required. The assessment will usually be undertaken by a nurse

6 These hours are negotiated between the Provider and the Residence, and the DHB of Service. 7 Regulation 14 (3) – Children, Young Persons and their Families (Residential Care) Regulations, 1996. 8 A Service User who is competent to give consent will be young persons aged 16 years or older and those who are assessed as able to understand the explanations given about procedures/treatment/consequences and assessed as able to make informed decisions. 9 Section 8 – Children, Young Persons and Their Families Act, 1989. 10 This timeframe excludes weekends and public holidays. Health Services for Children and Young People in CYF Care and Protection and Youth Justice 5 Residences tier two service specification September 2015 Nationwide Service Framework and include communicable diseases, infection, immunisation status, fractures, lacerations, infestations, suicide and self-harm risk and medication (to ensure the Service User has access to their regular medication). Where a Gateway Assessment11 has been completed in the community this assessment should be sent to the Residence and be available on admission to the Provider. 5.1.1.2 Nursing assessment Triage assessment on admission is followed up by a comprehensive nurse-led age and development assessment using the HEADSS assessment12 or equivalent tool at the clinically determined time. Ongoing, clinically indicated nursing assessment will be undertaken. 5.1.1.3 Medical assessment The Service User will be examined by a registered medical practitioner within one week of being admitted to the Residence, as indicated in the CYF Regulations13. A registered medical practitioner will undertake ongoing medical assessment, as appropriate. 5.1.2 Primary Health Care Services Primary health care Services will be provided as part of the Services during agreed business hours14. As part of a comprehensive and holistic approach, with the Service User’s consent, family and whānau may be involved in decisions about the Service User’s health care. The Services’ primary health care services will include:  referral for laboratory screening and diagnostic services and pharmacy services, including pharmaceuticals  sexual health screening and treatment  provision of, or referral to, vision and hearing screening  dental services as required  alcohol and drug assessment and treatment  mental health assessment and treatment  immunisation services (where standing orders are in place, the nurse is an authorised non-medical vaccinator and oxygen and emergency drugs are available)  primary mental health services, and services for children and young people with mild to moderate mental health and / or addiction issues which may include behavioural disorders. These services will operate in conjunction with the medical and service coordination processes, and will build in comprehensive, proactive transition planning when the Service User leaves the Residence (Refer to Section 5.1.6 - Discharge Planning). The Service User will be referred to Accident and Medical Services for out-of-hours urgent or acute care, as appropriate. 5.1.3 Service coordination/navigation Refer to Section 6 – Service Linkages

11 A Gateway Assessment is the assessment currently being piloted by several DHBs in conjunction with MOH and CYF, which may be rolled out nationally 12 The assessment tool Home, Education/employment, peer group Activities, Drugs, Sexuality, and Suicide/depression (HEADSS) is a psychosocial interview tool for adolescents. 13 Regulation 14 (2), Children, Young Persons, and Their Families (Residential Care) Regulations, 1996. 14 Services delivered by the Provider will not necessarily be full time, 5 days a week. Agreed working hours will be negotiated between the Provider and the Residence and the DHB of Service. Health Services for Children and Young People in CYF Care and Protection and Youth Justice 6 Residences tier two service specification September 2015 Nationwide Service Framework Service coordination will generally be provided by nursing or allied health clinicians who have service coordination experience. Service coordination will be supported by the appropriate multi-agency, multidisciplinary team, including CYF, Provider and DHB staff, and other agencies/sectors as appropriate (eg, ACC). Following assessment, timely access for the Service User to the primary and specialist health care services is important because of the limited time Service Users are in the Residence and the need for their discharge planning. The Service Coordinator/Navigator has responsibility for ensuring referrals recognise the high health needs of the Service Users, that they are appropriately prioritised as facilitated between the Provider and the DHB, and that this process occurs efficiently and effectively. Refer also to clause 6 – Service Linkages. 5.1.4 Health education/promotion The Provider will support the health and wellbeing of Service Users by providing health education services, advice on nutrition and physical activity and delivery or referral to relevant services such as smoking cessation. The Provider will work collaboratively with other agencies to develop and deliver appropriately prioritised health promotion initiatives within the Residence. 5.1.5 Intersectoral collaboration The Provider will work as part of a strong effective multi-disciplinary / multi-agency team to support both the Service User and effective discharge planning. This includes participation in multi-agency planning meetings and liaison with CYF staff, special education providers, and other relevant agencies as and when appropriate. 5.1.6 Discharge planning Prior to discharge the Provider will use its best endeavours to ensure appropriate health referrals are in place, and if discharged to the community that the Service User is linked back to a primary health care provider. As appropriate, the primary health care provider or the CYF Social Worker will be asked to follow up and encourage and assist the Service User to engage with any health service provider to which he/she has been referred. If the Service User does not have a primary health care provider, the CYF Social Worker will be asked to encourage the Service User to link back with a primary health care provider. The Provider will work collaboratively with staff in the residence to document discharge plans in the Service User’s Transition Plan, and these plans will also be recorded in the medical record in the Residence’s patient management system. The discharge plans will be sent to the Service User’s CYF social worker, the nominated Primary Care Provider, Prison Medical Officer and/or clinical staff in the subsequent residential placement. Staff will make themselves available to talk about the Service User with relevant staff in the new placement, and will be involved in a case conference, or facilitate this, when appropriate. 5.2 Settings Clinical services and coordination services (where possible) will be based within the Residence. Considerations in determining these settings should include (but are not limited to) accessibility, cultural appropriateness, workplace and physical safety of the practitioner and Service User, and the effective and efficient use of resources. Health services will be provided on site where this is able to be negotiated. When this is not possible, consultations / appointments will be made at offsite facilities. The Provider will request timely access for the appointment because of the limited time Service Users are in the Residence. Health Services for Children and Young People in CYF Care and Protection and Youth Justice 7 Residences tier two service specification September 2015 Nationwide Service Framework Service Users will attend offsite appointments with CYF escorts who are responsible for the Service User. 5.3 Support Services Interpreting services (including sign language), if required, will be provided by CYF. 5.4 Key Inputs Service provision will be guided by multi-disciplinary teams. Team members should be people with skills and experience in clinical assessment, diagnosis, treatment, investigation, referral and follow- up services, and who belong in one of the following categories:  registered health professionals regulated by the Health Practitioners Competence Assurance Act 2003  practitioners who are regulated by a health or social service professional body  practitioners who interact with Service Users and who are not subjected to regulatory requirements under legislation or by any other means. The staff providing the Services must:  be appropriately screened as required by the Vulnerable Children Act 2014  be appropriately trained and skilled in child and adolescent health and development  have training in cultural safety  provide care within their authorised scope of practice and competence  use recognised tools and processes (eg, HEADSS assessment)  have a profile acceptable to CYF that enables them to work on site in the Residence. Providers and CYF should discuss this before any appointments are made. Staff providing the Services will be provided with professional support and supervision, and operat e in a team environment. Where necessary, standing order arrangements will be in place and regu larly reviewed. 5.5 Equipment The Provider is responsible for:  providing clinical equipment that enable the provision of the Services and complies with current clinical standards and codes of practice, for use by the health staff  consumables used in the Residence. There are a range of circumstances where CYF is expected to contribute to or fund the cost of equipment for Service Users as outlined in Appendix One Table seven. The medical room will contain relevant agreed office and clinical equipment which are maintained, serviced and calibrated to the required standards by the Provider and paid for by CYF. A reasonable set of relevant clinical equipment will be negotiated with each health provider. 5.6 Facilities CYF will provide safe, confidential and clinically appropriate health facilities for the provision of Services within the Residence. This will include office and medical rooms equipped with appropriate furniture including a computer with broadband internet connection, a printer, a scanner, and a fax.

CYF will ensure the computer hardware and software (i.e. the electronic patient management system) are maintained and supported (Staff training in the patient management system is the responsibility of the Provider).

6. Service Linkages The Services will work to develop effective working relationships with services / agencies that reflect the size and scope of the relationship they have with each organisation and the degree of cooperation required between them. These linkages will facilitate open communication, continuity Health Services for Children and Young People in CYF Care and Protection and Youth Justice 8 Residences tier two service specification September 2015 Nationwide Service Framework of care, smooth referral, follow - up and discharge processes to ensure that the following principles are acknowledged:  a continuum of care from primary health care services through to secondary / tertiary and back to primary health care services, including those services funded via other funding streams  safety for at-risk children through linkages with Police, CYF, and DHB Memorandum of Understanding for Care and Protection of Abused Children in Hospital  intersectoral linkages with social, education and voluntary services involved in the care and support of the child or young person and their family and whānau  clinical consultation and referral services that support clinical pathways  linkages with other funders and providers, including community and social services, support seamless service delivery and continuity care is maintained. Appropriate linkages will be made with some or all of the following agencies in Tables two and three. The costs of liaison and linkage with these services are included within this Service price. The costs of the services delivered by other providers are included in their agreements, and not this Agreement.

Table 2: Service Linkages with Health Services/Agencies

Service Need Provider(s) After Hours Services / Accident & Medical Services Any after hours medical centre Oral health Mobile Dental Services or School Dental Clinic Any DHB contracted community dental practice [Service Agreement for the provision of Oral Health Services for Adolescents and Special Dental Services for Children and Adolescents] Services for dental trauma are funded by ACC Private dentist Pharmaceuticals Any DHB contracted community pharmacy Laboratory tests and other diagnostic services Any DHB contracted community laboratory/diagnostic provider Moderate to severe mental health problems DHB funded specialist mental health provider Sexual health DHB funded Sexual Health Services Drug & Alcohol issues DHB Alcohol and other Drug (AOD) Services Other specialist secondary and tertiary services (e.g. DHB Hospital specialist services medical / surgical services) Maternity Services Lead Maternity Carer, DHB Community Midwives or Secondary Maternity services Immunisation Authorised non-medical vaccinator Well Child / Tamariki Ora Services Providers who are publicly funded by the MOH Māori Health Service, Whānau Ora Service Services funded by the DHB, MOH or other Māori support and advocacy services Government Agency Pacific Health Service Services funded by the DHB Population health services Services funded by the DHB or MOH e.g. smoking cessation, nutrition & physical activity Disability Services Needs Assessment Service Coordination (NASC) or other relevant disability service funded by MOH

Health Services for Children and Young People in CYF Care and Protection and Youth Justice 9 Residences tier two service specification September 2015 Nationwide Service Framework Table 3: Service Linkages with Non-Health Agencies

Agency Nature of the Linkage Accountabilities Child, Youth & Family Liaise and work with CYF Work as part of an effective (CYF) Residence and Community multidisciplinary/multi-agency team with social work staff respect to Service Users and provide information, education, advice and support to Residence and community staff including support for discharge planning Schools, and Special Refer or liaise re individual Work with other relevant professionals Education providers, Service Users as appropriate whenever there are concerns relating to a including organisations particular Service User responsible for assessing learning disabilities Interagency Co-ordination Attend or instigate interagency Work as part of a multidisciplinary/multi (Strengthening Families; co-ordination meetings as agency team with respect to Service Users Home Interactions appropriate and provide information, education, advice Programme for Parents and support including support for discharge and Youngsters Families) planning

8. Quality Requirements 8.1 General The Provider must comply with the Provider Quality Standards described in the Operational Policy Framework 15or Crown Funding Agreements, contracts or service level agreements, as applicable. The Services will be delivered in full compliance with relevant legislation including: • New Zealand Public Health and Disability Act 2000 • Health and Disability Services (Safety) Act 2001 • Health Practitioners Competence Assurance Act 2003 • Vulnerable Children Act 2014. 8.2 Acceptability The Services must meet the following: 8.2.1 Confidentiality of Personal Health Information Under Part 6 of the Children, Young Persons, and Their Families (Residential Care) Regulations 1996 (the Regulations), CYF has a duty to maintain certain records including certain health information in relation to Service Users. Subject to any legal reason for withholding the information the Provider must provide to CYF information required under Part 6 of the Regulations to be on the Service User’s record. Staff providing the Services will work in accordance with the Health Act 1956 and the Healt h Information Privacy Code 1994 and the Regulations. All Service Users’ personal health information will be kept securely and confidentially in the CYF Residence. Access levels will be managed by the Provider according to nationally consistent protocols (agreed with Providers, clinicians and CYF) that meet legislative and regulatory requirements. Such protocols will be clearly described, practised and auditable. In consultation with the Provider and Privacy Commissioner, and in accordance with the Health Act 1956 and Health Information Privacy Code, CYF is responsible for developing and maintaining policies and procedures that ensure health information contained in the patient management system and not required for the records required to be kept under Part

15 The Operational Policy Framework is updated annually by the Ministry of Health and is published on http://nsfl.health.govt.nz/accountability/operational-policy-framework-0 Health Services for Children and Young People in CYF Care and Protection and Youth Justice 10 Residences tier two service specification September 2015 Nationwide Service Framework 6 of the Regulations, is kept confidential to the Provider, and is not available to any CYF staff unless there is a legal or safety obligation for this to occur. 8.2.2 Effective Communication and Informed Consent Wherever possible and practicable, when clinical information about a Service User is to be t ransferred to a third party, the Service User should be involved in the consent process. (See also regulation 58 of the Regulations.) 8.2.3 Maintenance of Clinical and Medication Records All the Provider’s health practitioners will maintain appropriate clinical records using the ele ctronic patient management system (MedTech) provided by the Ministry of Social Develop ment and make these records available to other health practitioners caring for the Service User at the Residence. Appropriate summary records will be available for Residence staff. Subject to the legal obligations information will be shared to enable health services appropriate to the Service User’s needs to be delivered. This will include the maintenance of a timely report to Residence staff on active health issues that impact on the daily management of the Service Users. 8.2.4 Compliance with Legislation and Standards Services provided will be delivered in compliance with appropriate health and disability sect or standards including the Health and Disability Sector (Safety) Standards Act, the Health a nd Disability Commissioner’s Code of Patient Rights, and the Health Information Privacy Co de. 8.2.5 Audit The Provider may be included in audits conducted in conjunction with the Residence audit processes. The Provider will also be subject to audits conducted by the DHB. 8.3 Communication and Reporting Lines Staff providing the Services will report to their own management. Similarly Residence staff are CYF employees and will report to the Residence Manager. Any disputes are to be resolved through local negotiations in the first instance, acting in good faith and DHBs and CYF National Office are to be advised of any probl ems in writing within 10 working days if the dispute is unable to be resolved t hrough these reporting lines.

9. Purchase Units and Reporting Requirements Purchase Units are defined in the joint DHB and Ministry’s Nationwide Service Framework Purchase Unit Data Dictionary. The following Purchase Unit applies to this Service. Table 4: Purchase Units

PU Code PU PU Definition PU PU Measure Definition Description Measure

COCH0026 Service for First health assessment for Service Service purchased in a children and children and young people block arrangement or young people entering Child Youth & Family uniquely agreed at a local entering CYF (CYF) and youth justice level. Care & residences. Includes the Protection or coordination of a range of health Youth Justice services to meet the service residences users’ needs. The service is provided by Doctors, nurses or allied health clinicians.

Health Services for Children and Young People in CYF Care and Protection and Youth Justice 11 Residences tier two service specification September 2015 Nationwide Service Framework 9.1 National Data Collections and Additional Reporting Requirements (Minimum Data Set)

Table 5: Data Collections National Each Service User must have an accurate NHI* number. Health Index (NHI) level NHI level data will be reported in the quarterly and annual reports in a non- identifiable way to show the range of residents in the facility based on: data  Age  Gender  Ethnicity to Level 2  Domicile by DHB on admission  Average length of resident stay. DHBs will not have access to Service User’s identifiable NHI data.

*Note: Service utilisation information at National Health Index (NHI) level (or its subsequent equivalent) is required to assist with health service utilisation reviews for the purpose of service monitoring, planning and development. The information is used for statistical and analytical purposes in a form in which the Service Users are not identified. As this Service forms part of a national initiative comprising similar services in other districts the DHB may provide summarised reporting information to all DHBs, the Ministry of Health and CYF to assist with future service planning and funding. 9.2 Quarterly Reporting

The Provider will provide Quarterly reporting as described in table six directly to the DHB, at the following time points: Reporting Period Report Due 1 July – 30 September 20 October 1 October – 31 December 20 January 1 January – 31 March 20 April 1 April – 30 June 20 July DHBs are requested to forward a copy of the Provider’s quarterly report to CYF.

Health Services for Children and Young People in CYF Care and Protection and Youth Justice 12 Residences tier two service specification September 2015 Nationwide Service Framework Table 6: Quarterly Report Requirements Quarterly Report Quarterly Summary Number of admissions Number of discharges Admissions by age, gender and ethnicity (Level 2) Admissions with a Nurse Assessment within 48 hours of admission (Number and %) [Reasons for exception to 100% completion and the mitigation strategy to be reported in the Narrative Report] Admissions with a Medical Assessment within one week of being admitted (Number and %) [Reasons for exceptions to 100% completion and the mitigation strategy to be reported in the Narrative Report] Number of Nurse Consultations16 Number of Medical Consultations Consultations by other members of the health care team Referrals by Service Type - Publicly funded specialist services – specified by type e.g. Allied Health, Medical, Surgical, Paediatric, Mental Health, Sexual Health, Alcohol and Other Drugs, Other - Dental - Vision Hearing Testing - Disability Services - Privately-funded health services (identify what services were funded) - Other. Narrative Report Summary for the quarter: - Exception Reporting and mitigation strategy for nursing or medical assessments outside the required admission timeframes - Human resources [number, FTE, and designation of Provider staff for the Services] - Successes, initiatives, opportunities, issues, risks, barriers, emergent trends, lessons learnt in delivering the service.

16 Person working within a nursing scope of practice Health Services for Children and Young People in CYF Care and Protection and Youth Justice 13 Residences tier two service specification September 2015 Nationwide Service Framework Appendix One: Funding Allocation of Funding DHB funded services will be available to Service Users on an appropriately prioritised basis, and it would only be for exceptional reasons that additional funding would be provided from this funding pool e.g. specialist mental health services that can not be met within the current provider arm capacity. Funding Responsibility Table seven itemises funding responsibility for various aspects of care. CYF is responsible for private consultations and co-payment charges. Table 7: Funding Responsibility

Service Example CYF Explanations funding

Primary health care services delivered by the GP/nurse Part charges No contracted health provider (including services by consultations the contracted GP) do not incur a charge. After hours visits CYF is responsible for full charges associated with (when the visiting a primary care provider who is not the After hours medical GP/nurse is not Yes Provider contracted by the DHB to provide services consultation normally present in the Residence – i.e. is treated as a casual at the residence) patient. DHB outpatient There is no charge for public hospital outpatient No services visits or services as an inpatient. Consultations with Specialists, Unless specified and agreed in the contract between the DHB and provider, CYF is responsible including mental Private clinic Yes for specialist consultations in the private sector. health services consultation ACC will fully subsidise a consultation with a specialist if the health issue is covered by ACC. ACC covers the costs for approved sexual abuse ACC part charges Part counselling. Counselling Publicly-funded primary or specialist mental health Private counselling Yes services are covered by DHBs. CYF is responsible for the cost of private counselling. CYF is responsible for prescription co-payments Prescription part and any part charges. Part charges CYF is responsible for medicines that are not listed on the Pharmaceutical Schedule. OTC medications for Medications use by residents– e.g. paracetomol, CYF is responsible for over the counter medications Yes acne and sun block provided to or used by Service Users. cream, vitamin and mineral supplements CYF is responsible for the costs of compliance Blister packaging Yes packaging. Consumables Wound care, No Consumables used by the Provider are the examination and responsibility of the Provider. chronic illness ACC will cover the costs of equipment for wound consumables dressings (up to a certain level). The Provider can claim on this from ACC (refer to the ACC Guidelines). Health Services for Children and Young People in CYF Care and Protection and Youth Justice 14 Residences tier two service specification September 2015 Nationwide Service Framework Service Example CYF Explanations funding

First aid equipment CYF is responsible for the cost of general first aid Yes eg, slings, dressings, equipment used by staff. saline Public health funding (refer to the Service Coverage Schedule) or ACC meets the cost of some devices. Equipment to help CYF is liable for part-charges. CYF is responsible people manage Orthotics, asthma Part for co-payments and any part charges. Medical spacer, crutches conditions If crutches are supplied by the DHB they are at no cost. CYF is responsible for any additional costs outside of this. Physiotherapy, ACC part charges Part CYF is responsible for any part charges. Chiropractic, Osteopathy, CYF is responsible for services that are not Non ACC Yes Acupuncture , publicly-funded. Podiatry See Publicly-funded services provided by a DHB Dietitian explan- dietitian do not incur a charge ation CYF is responsible for private services.

For interpreting in Face to face or telephone interpreting services. Interpreting languages other than Yes English.

Laboratory Part charges Part CYF is responsible for part charges (if any). CYF is responsible for part charges for private ACC part charges Part diagnostic imaging if the injury is covered by ACC. Diagnostic Imaging Diagnostic Imaging services undertaken in a Non ACC Yes publicly-funded DHB service are at no cost. CYF is responsible for services in the private sector. Dental Up to 18 years of age there is no charge to access a DHB funded service – either the Community Oral Health Services for Children and some Adolescents dental service or a dentist for a range of services under the Service Agreement for the Provision of See Oral Health Services for Adolescents and Special Routine dental explan- Dental Services for Children and Adolescents ation (commonly known as the ‘Combined Dental Agreement’ or CDA Publicly-funded hospital dental services normally do not incur a charge, but some services may have small co-payment depending on eligibility criteria (eg, removal of wisdom teeth). ACC meets the cost of dental consultations ACC part charges Part associated with injuries, but there may be a part charge. Orthodontic care See Requires prior approval by CYF. Some services explan- are available under the Combined Dental ation Agreement or Hospital dental services. Hospital Dental Services are provided free to children and adolescents aged 0 up to their 18th birthday: - that are covered in the scope of the CDA, and - orthodontic treatment for the correction of severe congenital craniofacial abnormalities and Health Services for Children and Young People in CYF Care and Protection and Youth Justice 15 Residences tier two service specification September 2015 Nationwide Service Framework Service Example CYF Explanations funding malocclusions. Refer to the Service Coverage Schedule or Ministry See guidelines for subsidies for children’s glasses and Optometry Charges over explan- vision tests. http://www.health.govt.nz/your- (glasses) health’s limit ation health/conditions-and-treatments/disabilities/vision- loss/subsidy-childrens-glasses-and-vision-tests DHBs provide publicly funded VHT and audiology Vision Hearing services. CYF is responsible for private services. Testing (VHT) See Refer to the Service Coverage Schedule and Part charges explan- Ministry’s Guidelines on Hearing Aid Funding Audiology ation Scheme. (hearing) http://www.health.govt.nz/publication/guide-getting- hearing-aids-hearing-aid-funding-scheme

Health Services for Children and Young People in CYF Care and Protection and Youth Justice 16 Residences tier two service specification September 2015 Nationwide Service Framework