Well Child/Tamariki Ora Practitioner Handbook 2013
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Well Child / Tamariki Ora Programme Practitioner Handbook Supporting families and whānau to promote their child’s health and development Revised 2014 Citation: Ministry of Health. 2013. Well Child / Tamariki Ora Programme Practitioner Handbook: Supporting families and whānau to promote their child’s health and development – Revised 2014. Wellington: Ministry of Health. Published in October 2013, updated October 2015 by the Ministry of Health PO Box 5013, Wellington 6145, New Zealand ISBN: 978-0-478-42800-1 (online) ISBN: 978-0-478-428010-8 (ebook) HP 5858 This document is available at www.health.govt.nz This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to: share, ie, copy and redistribute the material in any medium or format; adapt, ie, remix, transform and build upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made. Contents Acknowledgements ix How to use the Well Child / Tamariki Ora Programme Practitioner Handbook xiii Section 1: Introduction 1 Well Child/Tamariki Ora objectives 2 Māori health 2 Screening and surveillance objectives 3 Principles underpinning the assessment process 4 Section 2: WCTO service providers 6 Practitioner competencies 6 Cultural competence 7 Informed consent 13 Effective communication 13 Privacy obligations and Well Child/Tamariki Ora services 13 Providers of Well Child/Tamariki Ora care 13 Quality requirements 17 Continuum of care 17 Complementary roles of general practice and lead maternity carers 17 Enrolment with a primary health services provider 18 Transfer of care from lead maternity carer to Well Child/Tamariki Ora services 18 Needs assessment and care plan 19 Section 3: Overview of the core visits 21 Postnatal core visits 21 Birth–24 hours 21 24–48 hours 22 Up to 1 week 23 Transition core visits 23 2–6 weeks (LMC) 23 6–week assessment (GP team) 24 4–6 weeks (WCTO Provider) 24 Infant and child core visits 25 8–10 weeks 25 iii Well Child / Tamariki Ora Practitioner Handbook 3–4 months 25 5–7 months 26 9–12 months 27 15–18 months 27 2–3 years 28 4 years: The B4 School Check 29 Section 4: WCTO Schedule components 30 Health and development assessments 31 Neonatal assessment 31 Postnatal assessment 33 Hip screening 35 Newborn metabolic screening 37 Newborn baby vision and eye 39 6-week eye examination and vision surveillance 41 Universal newborn hearing screening 42 Hearing surveillance 45 Undescended testes 46 Transition core visits: 2–6 weeks (LMC)/6-week assessment (general practice)/4–6 weeks (WCTO Provider) 47 Oral health 49 Growth measurement and monitoring 54 Development 65 Care and support for families and whānau 83 Whānau Ora 84 Strengthening Families 84 Parenting skills and support 85 Supporting families to access income and housing assistance 90 Strengthening family relationships 92 Building social connectedness and social capital 94 Perinatal mental health 96 Infant and preschool mental health and attachment 106 Family violence assessment: child and partner abuse 115 Smokefree environment and smoking cessation support 129 Alcohol and other drugs 132 Health education 136 Breastfeeding 136 Nutrition 141 iv Well Child / Tamariki Ora Practitioner Handbook Suffocation prevention through safe sleep practices (an aspect of SUDI prevention) 145 Shaken baby syndrome prevention 147 Child safety/injury prevention 150 Recognition of childhood illnesses 155 Immunisation 156 Early childhood education 161 Section 5: B4 School Check 163 Overview of the B4 School Check 163 Informed consent 165 The B4 School Check Information System 166 Child Health Questionnaire 167 Hearing screening 168 Overview of hearing screening 168 Pathway 1: Initial screening audiometry (sweep test) or rescreen 171 Pathway 2: Screening audiometry (hearing concerns) 174 Screening technique: tympanometry 178 Vision screening 181 Overview of vision screening 181 Screening technique: Parr letter-matching vision charts or Sheridan Gardner charts 184 Behaviour assessment: The Strengths and Difficulties Questionnaire 189 Overview of behaviour assessment 189 Section 6: Supporting vulnerable parents with specific needs 201 Overview of this section 201 General guidance for supporting vulnerable families 205 Specific guidance for supporting vulnerable families 208 Teen parents 208 Parents with intellectual disabilities 210 Parents experiencing significant financial difficulties or poverty 211 Parents involved in criminal activities or with gang associations 213 Parents with moderate to severe or untreated mental illness and/or addiction 215 Parents involved with Child, Youth and Family 218 Highly mobile families 220 Migrant and refugee families 221 Families affected by parental conflict, separation, divorce, remarriage and new partners 222 Glossary of abbreviations 224 v Well Child / Tamariki Ora Practitioner Handbook Appendices 226 Appendix 1: Parents’ Evaluation of Developmental Status: Parent response form 226 Appendix 2: Parents’ Evaluation of Developmental Status: Score form 227 Appendix 3: Parents’ Evaluation of Developmental Status: Interpretation form 228 Appendix 4: High-risk indicators associated with child abuse 229 Appendix 5: Signs and symptoms associated with child abuse and neglect 231 Appendix 6: Assessing for child neglect 232 Appendix 7: Referral agency template 233 Appendix 8: Signs and symptoms associated with partner abuse 234 Appendix 9: Risk assessment 235 Appendix 10: Alcohol and other drugs--AUDIT questionnaire 241 Appendix 11: Alcohol and other drugs--CAGE questionnaire 243 Appendix 12: Four major food groups: Examples of foods and the nutrients they provide for infants and toddlers 244 Appendix 13: Food groups, specific foods in each group, advice and serving size examples 245 Appendix 14: Key modifiable risk factors for SUDI* 246 Appendix 15: B4 School Check information for parents and guardians pamphlet and consent form 249 Appendix 16: B4 School Check informed consent standard 252 Appendix 17: Child Health Questionnaire for the B4 School Check 254 List of tables Table 1: Key injury issues to discuss 152 Table 2: Key injury prevention messages and related resources 153 Table 3: National Immunisation Schedule 158 Table 4: Risk factors for hearing-related developmental and learning difficulties 174 Table 5: Sequence of screening frequencies and pass levels 176 List of figures Figure 1: Te Whare Tapa Whā 8 Figure 2: Overview of the Universal Newborn Hearing Screening and Early Intervention pathway 44 Figure 3: Assembled stadiometer 60 Figure 4: Height measurement – Frankfort Plane 61 Figure 5: Taking a reading from a stadiometer 61 Figure 6: Height, weight and BMI referral chart 64 Figure 7: Parents’ Evaluation of Developmental Status clinical referral pathway 79 Figure 8: Parent–infant relationship – referral pathway for depression or postnatal depression that lasts longer than four months 104 Figure 9: Referral pathway for suspected depression 104 vi Well Child / Tamariki Ora Practitioner Handbook Figure 10: Template for identifying referral resources in your community or district health board 114 Figure 11: Child abuse – assessment and response flowchart 122 Figure 12: Partner abuse – assessment and response flowchart 125 Figure 13: Pathway 1 Initial screening (sweep) or rescreen clinical pathway 177 Figure 14: Pathway 2: Screening audiometry (hearing concerns) – clinical pathway 178 Figure 15: Vision screening clinical pathway and referral at 4 years old 187 Figure 16: Vision screening clinical pathway and referral at 5 to 7 years 188 Figure 17: Strengths and Difficulties Questionnaire–Parent (SDQ–P) clinical referral pathway 198 Figure 18: Strengths and Difficulties Questionnaire–Teacher (SDQ–T) clinical referral pathway 199 vii Well Child / Tamariki Ora Practitioner Handbook viii Well Child / Tamariki Ora Practitioner Handbook Acknowledgements This revision of the Well Child/Tamariki Ora Programme Practitioner Handbook would not have been possible without the input of a great many people. These include the people who completed surveys and participated in focus groups at the outset of this project, providing feedback that helped determine the direction of the revised Handbook; those who contributed content to the Handbook; and those who reviewed various drafts of the Handbook and provided feedback. While it is not possible to name all those who contributed, the Ministry of Health would like to acknowledge the following people who contributed to the writing of the Handbook. Name Title/organisation Dr Arran Culver Deputy Director Mental Health, Ministry of Health Dr Rachel Fletcher Paediatric Registrar, Ministry of Health Dr Denise Guy Child Psychiatrist/Infant Mental Health Specialist Barbara McArdle Project Manager, Connectus Kylie McCosh Senior Advisor, Ministry of Health Dr Anna Mistry Paediatric Registrar, Ministry of Health Dr Nitin Rajput Paediatric Registrar, Ministry of Health Kirsten Sharman Principal Advisor at the Office of the Children’s Commissioner Gail Tihore Vision Hearing Technician, Wellington Regional Public Health Dr Pat Tuohy Chief Advisor – Child & Youth Health, Clinical Leadership, Protection & Regulation, Ministry of Health Donna Watson Technical Writer, Connectus Dr Russell Wills Children’s Commissioner; Paediatrician, Hawke’s Bay DHB The Ministry also gratefully acknowledges the following people and organisations for their considered feedback and advice: Name Title/organisation Lisbeth Alley Immunisation Education Facilitator, Immunisation Advisory